Weighty Issues: Judgment, Obesity and Life & Death

One of the constant refrains on My 600 lb Life is Dr. Nowzaradan’s warning to patients that they don’t realize how close to death they truly are.  Unfortunately, I’ve seen a few other programs dealing with super morbidly obese patients who didn’t have the chance to make it to surgery or the surgery came too late. I know probably better than most how difficult it is to struggle with obesity all your life and the dangers that come with it.  For those who’ve never had weight problems, it probably seems like the obese are just lazy or gluttonous and while they don’t believe we are deserving of sympathy or help, they do believe we are deserving of their disgust and derision.

I can understand how some people never think of a box of donuts or a bag of chips as dangerous. Personally, I’ve never thought of a case of beer as being something dangerous to me, but to other people in my family, it might as well be a rattlesnake: if you don’t watch out, it can bite you! For those who’ve never struggled with their weight, they don’t understand how someone can eat a whole loaf of garlic bread at one meal any more than I can understand how someone can drink a whole case of beer in a couple of hours (or less). But just like people can drink themselves to death, people can eat themselves to death.  Obesity, like alcoholism, can kill you in more than a few ways.

The most obvious way obesity kills you is that your weight is just too much stress on your body.  Your heart and lungs are simply crushed by your weight: your body is too big for your heart to keep the blood flowing to all your organs and extremities, and as for your lungs, not only are they struggling to keep up with the oxygen demands for your body, but they are having to fight the weight of your chest each time you take a breath.  And that’s the situation if you have no other health problems related to your weight! There’s a host of health problems that come with obesity, including type 2 diabetes, congestive heart failure, kidney (renal) failure, sleep apnea, high blood pressure (hypertension) and fatty liver disease just to name a few.  Those are the ones that can kill you, but there are a lot more than just make your life utterly miserable, such as lymphedema, skin ulcerations, cellulitis, asthma and gout. FYI: some of these can kill you too if you don’t keep them under control.

Obviously not-being-obese is a big step towards staying healthy. Of course there are plenty of skinny people who have serious health problems but when you weigh double (or triple) what you are supposed to weigh, you have a lot less wiggle room when it comes to your health.  Getting an infection that might be mild to someone with normal weight can be fatal when you weigh 500 lbs.

For most of us, we scoff at the idea that we will ever be anywhere close to 500 lbs.  Even while we may admit that we ‘might be overweight,’ we never think that we’ll be as big as ‘those people.’  I was reminded today of the frog analogy.  Most of us are familiar with it: you drop a frog in boiling water and it jumps right out, but if you put the frog in cold water and slowly turn up the heat, the frog will get cooked alive. (As a frog lover, I totally hate that analogy!) Whether it’s true or not, this is what happens to most of us when it comes to our weight. We start out a few pounds overweight and don’t think much of it; then we end up getting kind of plump and start thinking we should fix this; and then we’re suddenly shopping in the plus size department and start to get really concerned (maybe we even start dieting), and before we know it we are really-without-a-doubt FAT and now we start freaking out.  We don’t give much thought to the fact that food is everywhere. It’s cheap and easy to get and we often eat without even thinking about it.  How many of us have finished off a bag of chips or most if not all of a box of cookies without realizing it? It’s not that we’re gluttons– the cookies were just there and available and we weren’t paying attention!

This is what overeating is like for most people: too much pizza out with friends; scarfing a whole bag/ box of something while binge-watching a favorite show; or too many holiday treats.  But for some of us, overeating has way more in common with alcoholism: it’s become an addiction.  There are more than a few ‘experts’ that protest the idea of a ‘food addiction,’ but for the patient, it’s irrelevant.  They need to find a way to control their eating so they can lose the weight before it kills them! Does this sound over-dramatic? Believe me, it’s not.

People overeat for a variety of reasons.  For some of them, it’s a comfort mechanism: eating something they enjoy makes them feel safe and happy for a little while.  For others, it’s a way of controlling their body or their situation: it takes away feelings of helplessness. I am sure there are other reasons and for many super morbidly obese people, they may not know why they overeat.  The point is that when your weight is approaching a quarter ton, your first goal is to get control of the weight and worry about the whys and wherefores later. It’s basic damage control. Why you are overeating isn’t going to matter much if you’re dead.  Unfortunately, this is where most of us hit the brick wall: we know we need help but we don’t know how to get it.

I had a cousin who died from obesity.  He was in his early forties and weighed over 600 lbs.  Like all those patients on My 600 lb Life, he fought obesity all his life.  I remember him being about 18 years old and having high blood pressure. He was probably about 200 lbs then and his mom was screaming at him for eating potato chips and yelling at her husband for not hiding them from their son. He tried everything to lose weight, including joining the Army.  He was probably his thinnest ever once he got out of boot camp, but the weight came back and his health problems worsened: kidneys, diabetes, heart and liver issues. Although bariatric surgery at his weight was still highly risky, his doctor laid it out for him: either he takes the risks with surgery or he gives up and dies from his weight.  He risked the surgery and died on the table, leaving behind a wife and a son.

In my small high school, I was the second heaviest person in the school (that’s including the football players).  The heaviest person in high school was my friend Jennifer.  We were in the same grade and we took a lot of the same classes. She made a lot of her own clothes because it was hard finding anything that fit (this was the early 80’s). After graduating, Jennifer lost a lot of weight. In fact, I didn’t recognize her when I first saw her because she was ‘normal weight’ and looked so different. I confess I was completely jealous because I still weighed the same, around 200-250.  After college, she gained the weight back like so many of us do and this time she decided to try bariatric surgery.  She didn’t die in surgery like my cousin, but there was a complication with the anesthesia and she spent the last year of her life in a persistent vegetative state before dying of pneumonia.  She would have been 37.

My aunt was someone else who was always unhappy with her weight.  Unlike my cousin or my friend, my aunt (my dad’s sister in law) never approached 500 lbs or even 250.  My aunt’s weight hovered around the 200 lb mark but for her, it might as well have been 500 lbs. She hated being overweight and tried diet after diet. I tried a lot of them with her, mainly because I outweighed her by about 100 lbs.  She wanted to lose weight and lose it fast so she also opted for the gastric bypass. She was in and out of the hospital in no time at all and the weight seemed to melt off her.  She was over the moon! Until she started having issues with keeping food down.  Her weight went from slender to emaciated and she didn’t have the strength to walk or even stand up.  One of the complications with bariatric surgery that gets swept under the rug is anorexia. If eating a little bit of food leads to quick weight loss, eating even less food or no food leads to faster weight loss! For those patients who use food and their weight to control others or their surroundings, this is especially dangerous. For my aunt, I think it was just that she had always wanted to be thin so badly all her life and by the time her weight loss became a problem, the physical problems involved with anorexia had taken over. They were simply too much for her to overcome and sadly a few weeks after attending Jennifer’s funeral, I went to my aunt’s.  She was fifty-one.

The point of this post isn’t “bariatric surgery will kill you.” For a most bariatric patients, the surgery is literally life-saving. The point is I remember my cousin as being compassionate and funny and a warm-hearted young man.  I remember Jennifer as being a gifted artist, great with children and so giving of herself.  My aunt was also artistic, quick-witted, with a wicked sense of humor and a wonderful grandmother.  These are the people I knew and they are missed, but for the stranger on the street they were just fat.  They were neither gluttonous or lazy.  They were in fact some of the most industrious people I knew. Obesity is a serious medical problem but it gets overlooked because of snap judgments: “She wouldn’t weigh so much if she kept her hand out of the cookies!”; “He’d be thinner if he got off his butt and worked more!”

What is tragically ironic to me is that Jennifer, my aunt and my cousin all died while trying to help themselves while so many of the obese are stymied by their situation.  They know they need help, but other than ‘a diet’ they don’t know what to do or how to help themselves.  Unfortunately, many of their family members don’t know how to help them or believe their weight is the result of their own gluttony, laziness or greed (I remember my mom’s sister screaming at her son). Because it’s seen as “something they did to themselves,” it’s not seen for the real danger that it is. The obese are lumped in with drug addicts and alcoholics: “it’s their own fault!”  These are diseases of lifestyle, which nowadays include conditions like diabetes, but no one gets judged for having type 2 diabetes. Blame is a sad excuse for lack of compassion and a sadder excuse for letting someone die.

 

 

 

 

Connected: Being Part of a Pack- er- Tribe?

I recently heard a podcast about ‘Longevity village’ in China.  This is an isolated village (or at least it used to be!) where the residents routinely live 100 years or pretty close to it.  Once researchers found out about it, they naturally had to figure out why these people were living so long and were so healthy. From what I heard, most of it was the obvious: hard physical work that keeps them mobile most of the day; getting up and going to bed with the sun; clean fresh food and water; natural optimism when it comes to stress; and strong social connections.  The strong social connections is what catches a lot of people by surprise.  What does it matter if you have a positive social network?  Being a devoted pet parent, it’s easier for me to understand than for someone who doesn’t spend 90% of their time around four legged individuals.

Some of you know I am a hard core TLC addict, and I’ve been seeing ads for a new show called The Putmans, which has yet to premiere.  It’s about an extended family all living in one home, which is about 25 people.  I grew up in an atypical family and although we didn’t all live in the same household, we regularly interacted.  If any of you have seen the movie My Big Fat Greek Wedding, my family was really similar.  There’s the scene where Tula gets busted because her cousin sees her with her boyfriend who tells her aunt who gets in her face about him.  That was pretty much how I grew up: lots of relatives who all live in the same town so we run into each other all over.  We also had a tradition of getting together on Sunday afternoon/ evenings.  We would eat dinner and spend time talking, playing games or passing around parts of the newspaper.  Usually the television would be off and any devices would be put away.  This was time we spent being together and holidays were simply to ‘all day version’ of Sunday afternoons.  These weekly get-togethers ended when my grandparents passed away (we met at their house) and they are one of the things that I miss most.  Although I still connect with my family, it’s mainly over the phone or through social media.  While the host of the podcast feels this is still a viable connection, for me, it lacks the real connection of being in the same room with them.

SinceI grew up having my family around me, it was normal to stop at a bakery or business where a relative worked.  Seeing them in stores or around town was and still is normal.  Even as a child I was very aware that this was not how it was with most of my classmates and colleagues (my grandparents lived into their 90’s, so this tradition lasted well into my 40’s).  I also came to realize that for friends and colleagues who grew up in other countries that this was very normal for them.  For them, running into a relative while shopping or having coffee with friends was just part of every day life and most of my foreign-born friends soon came to realize that most American families have a different idea of ‘family.’

I’m not criticizing anyone’s idea of ‘family,’ but having grown up with one version and now living a more ‘standardized’ version, I know which version I prefer.  I miss the connections and interactions with family, and while many of them are happy connecting through social media, I’m pretty lame when it comes to apps like Facebook or Instagram. The important aspect is the Connection.  Humans are social creatures and we don’t do well in isolation. This is what makes positive social interaction important to our health.

There is a reason that solitary confinement is a punishment, not only in prisons but also as children.  Remember all those times we misbehaved and got sent to our room?  It’s solitary confinement: if you can’t work well or play well others, then you’re going to be alone.  Across the world, cultures have traditionally used a form of isolation or ostracism to punish those who disrupt the society at large, and it tends to be successful.  Loneliness is a huge problem, even in our cyber-connected society, and it leads to a host of health problems.  As the author of The Longevity Plan pointed out, people who have strong and positive social connections live about seven years longer than those without them.

Having grown up with pets all my life, I have seen the interaction among them.  Dogs are as social as humans are and while we travel in ‘tribes’ and dogs travel in ‘packs,’ it’s all the same thing: this is my social unit.  We eat together, we sleep together, we play together and we work together.  This is how we survive. (Cats are less social, but they also strengthen their societal bonds in the same ways.) If any of you are familiar with Dr. Jane Goodall’s observations of chimps, our closest primate cousins also travel in tribes and follow the same kinds of bonding behaviors: grooming; sleeping; eating; playing; working.  We are more successful, productive and safer in our groups. A chimp, dog, cat or human is far safer in their group than on their own.

I have a very clear memory of when I began living alone, or at least being the only human in my house. It was the day my sister moved away to college: I said good bye and watched her drive away and as I walked back into the house, I realized that I was alone.  More specifically, I realized that changing the lightbulb in the garage had new implications for me: if I fell off the ladder, it could be days before anyone realized something had happened to me. This is one of the reasons ’emergency pendants’ are such big business now: more of us live alone and face the same dangers.

Falling off the ladder aside, positive social connections promote a positive outlook.  When we’re happy, we have others to share our joy and when we’re upset or angry, we have others to commiserate and share our burden. We have others to help with a project, come up with plans or even help with the physical labor. Remember the expression ‘many hands make light work’? Being alone makes everything harder, even the every day tasks most of us don’t really think about.  Living alone, if I don’t do the dishes, they sit in the sink until I do them.  The same with throwing out the trash, making a meal, doing the laundry, and the shopping and the rest of the housework.  If I don’t do it, there is no one else in my house who will.  That means all of the work falls to me, which means I have less time to pursue things I enjoy or to socialize.

Even taking care of my pets falls to the sole human in the pack (2 cats, 1 dog, 1 human).  I notice a lot of the same bonding behavior among us even though we are different species: they will all groom each other, play with each other, sleep next to each other and eat together.  As the lone biped, I am not exempt: they include me as much as they can with playing, licking and sitting on me.  When we go to sleep at night, all four of us end up in the same room and usually on the same bed. I realize that most people think it’s pretty weird to consider animals as part of a family unit, but I really grew up treating them as people (they are a Who not an It.) I have come to the conclusion that it doesn’t matter so much what we interact with so much as the fact that we do interact.  If we feel we are connected and feel the benefits of those connections, then it doesn’t matter if the connection is with a phone, a tablet or a dog or a cat.  We benefit from knowing that we are not alone.  Recently, in fact, I was at home without my dog since I had returned from a trip on a Sunday and could not pick him up until the following day.  When I went to bed that night, I was very aware that there was no dog in my house and I didn’t feel as safe as I do when he is there (he’s all of 12 lbs!) The cats were also aware that one of our pack was missing and were looking for him in the house, which felt oddly empty without his bouncing around. I know my furry little family unit looks a lot different than most and while they may not be human, they are most definitely my tribe.