Recently, a 47-year-old woman walked into my clinic for medical evaluation and consultation. Her chief complaint was fatigue when she exerted herself by climbing a flight of stairs or walking quickly. She had multiple medical problems including high blood pressure, diabetes and arthritis. She was 6 feet tall, and weighed just over 300 pounds. So her body mass index (BMI) was 40.7 — well over the obesity definition of 30 and above.
When I suggested her weight was likely at the root of her problems, she frowned. "I am not overweight. This is not fat. I have been an athlete before. See these muscles?" she said, pointing to her not-so-bulging biceps.
"Your BMI is consistent with obesity," I replied. She was upset.
The most common answer I get when I ask people why they are overweight is this: "Beats me. I eat very little, just one meal a day." On deeper questioning, it's clear many of them have no idea how much they really eat.
Others try to convince me they are not obese. "No doc, this is not fat, it is just fluid," is a common excuse. "My parents are big people, so what do you expect?'' and "It could be my hormones," are favorites, too.
In truth, hormonal imbalance and fluid retention account for very few cases of obesity. When I explain the trouble most likely is what they're eating, many people look surprised.
Most patients become uncomfortable when I try to talk to them about their weight. Some think it is demeaning to be branded "obese," believing the word infers judgment and bias. Some even claim they are proud of their unhealthy weight. A recent TV show paraded several very obese young women, seemingly happy with their size.
However, medical statistics tell a totally different story. There is a litany of complications associated with overweight and obesity, including hypertension, diabetes, heart disease, cancer, sleep apnea and arthritis, just to name a few. Even with small increases in BMI, cardiovascular risk goes up. This is why the American Medical Association's House of Delegates voted to recognize obesity as a disease.
U.S. spending on obesity-related condition already tops $190 billion annually. If current trends continue, spending could rise by as much as $66 billion a year, much of which becomes taxpayers' responsibility.
As a nation, we need to ask some hard questions: Why do we overeat? What can be done about it? The answers depend on whom you ask.
"Oh, I am depressed and stressed out after losing my job," one 63-year-old confided recently.
"I have such a sweet tooth," said another patient.
Obesity is rare in countries where food is scarce. It's also rare for obesity to result from a cause other than overeating. Fact is, most people who are obese got that way from eating too much.
America, it is time to wake up. We need to take this condition seriously — already, 70 percent of U.S. adults are obese or overweight.
Behavior modification is the first step. This includes calorie restriction, portion control, healthy choices, regular exercises and stress reduction. In this regard, I applaud NBC for hosting the The Biggest Loser, a show that focuses on such common-sense approaches to obesity.
"Eat less, live longer," should become our new mantra. Unfortunately, eating less in this land of abundance is not popular. Clearly, the national mind-set has to change.
The Japanese have a saying, "hara hachi bu,'' which means, "stop eating when your hunger feels sated.'' Not when your stomach is full or until your appetite is satisfied.
So, the first step to lose weight is to reduce the amount of food you tuck away on a daily basis. Cut down on calories — decalorification, if you like. Try low-calorie veggies and fruits for snacking. And exercise regularly. The final option is bariatric surgery, although it is expensive and inconvenient and comes with its own risks.
We need to face the tough facts about obesity, and take action as a society and as individuals. We have a responsibility to secure a healthy future for our younger generation. As the new AMA president, Dr. Arden Dee Hoven, said in her inaugural speech, "The future of health care is in our hands." And that means all of us should maintain a healthy weight.
M.P. Ravindra Nathan, M.D., is a retired Brooksville cardiologist who volunteers at a community clinic in Spring Hill and speaks at area hospitals.