DIET AND EXERCISE
One doesn't have to tell a skinny farm hand to eat faster. When the boss finishes lunch and they go back to work together while the farm hand is still hungry, tomorrow and ever after the young helper eats faster. You might say our bodies are tuned for the jungle; lots of exercise and limited opportunities for eating.
When I was a student in the 1940s, Duncan's textbook, '”Diseases of Metabolism" stated at the beginning of every chapter: "All obesity is alimentary" and we were taught that obesity is the most prevalent preventable disease. Several generations of physicians went out into the world as medical Don Quixotes looking for obese windmills to joust with. The result: diets galore, Slimfast, amphetamines, phen-phen. You can name many such. The bottom line: Even among the select group that achieves their goal weight, five years later 95% have gained it all back usually with an additional increment. Even though it is true that all flesh ultimately derives from food, a realistic solution is not that simple. As mentioned above, a primary function of our appetite mechanism is to assure that we get enough food to sustain our activity. When food is scarce, automatic lassitude prolongs survival, thus limiting the speed of weight loss on short rations whether due to famine or an intentional weight reduction program.
As I finally became aware of the low success rate of dieting for weight control, I stopped routinely hassling overweight patients. Within a few visits, they would almost always ask something like: “Why haven't you mentioned my weight?" and I would reply, “Didn't you want a doctor who takes care of what's bothering before he takes off on weight?" Then they would tell about the bad-mouthing they had received from other physicians in the past. Occasionally, they would twist my arm to get specific suggestions. These suggestions require much detailed negotiation. Nobody takes off weight and keeps it off without many changes besides diet. These changes won't be the same for everyone. There must be new interests, new daily routines, new motivations. Success comes when the appetite mechanism is brought to be proportional to food requirement by methods which are acceptable to that person for their remaining years. It is easiest when some previous athletic interest can be brought back to life.
Let me tell you of a gratifying example: He was a successful developer and contractor with high blood pressure, the beginnings of heart trouble, smoking and drinking habits and, of course, overweight. I told him he needed a "medical conversion" and it would be a least as tough as switching from Baptist to Catholic. (He was already Catholic). I didn't tell him that he had to sell his business, he decided that was necessary to get off dead center. To fill his time, he became the Bishop's representative to the Vatican which involved extensive travel. Along the way he quit smoking and drinking and started walking regularly. His blood pressure and cholesterol became normal without medication. When he came to see me, he would tease, "Here is your Catholic convert Doc.” (He knew I was not Catholic). I think he illustrates that the necessary changes had to be his initiative and choice. It wouldn't have worked if he tried to make himself over in my image (I have never prescribed mountaineering for a patient, but it does take care of vastly increasing the food requirement).
A somewhat modern (since I was in school) insight into the biological background of obesity comes from the study of the Pima Indians of southwest U.S.A. They have the highest incidence of obesity of any ethnic group worldwide. They descended from the ancient inhabitants of the very arid canyons of the four corners area such as Mesa Verde and Grand Gulch, Utah. Their ancestors were the survivors of drought and famine in endless sequence so they were preferentially selected for the ability to gain weight promptly when food again became plentiful, thus being better able to survive the next famine. We are all a little like that just less extremely so. There are many ways in which, if we understand how we got the way we are, we can better arrange to adjust our behavior to blunt the undesirable consequences, another example of the benefit of scientific literacy.
John A. Frantz, M.D.
Chairman, Health Committee Monroe City Council
to finish but asks the waiter for the menu.
Mortal combat with this menu ensues
until she brightens up, opens her purse,
pops a diet pill and orders pie ala mode.
A significant fraction of inspired childcare is con-artistry. Years ago, a patient of mine who kept foster children told me of a new boy with terrible nightmares. I suggested that she explain to the boy that nothing really bad can happen to you in a dream: If you fall out of an airplane, practice flying—it’s a free ride. If the dragon is eating you, wiggle out through the smoking nostril and wave at the crowd. The kid bought into the program and started having adventures instead of nightmares. I give the foster mother much of the credit for the success because she put it across. I never met the boy.
In medical school I found biochemistry quite fascinating. We learned about how sugars and starches created by plants are processed in the animal’s digestive tract, liver and muscle; but the photosynthetic process for carbohydrate production and creation of other chemicals by plants was a “black box”. Since then I have learned some plant biochemistry that provides unexpected insights about human medicine and some incidental things that are just plain interesting. For instance, corn and a short list of other plants have an “overdrive” mechanism for getting about 15% more photosynthetic mileage out of a given amount of light compared to the rest of plant life. A cornfield in July is so efficient that, on a calm day, it exhausts all the carbon dioxide from the air in the vicinity of its leaves. Thus it grows measurably faster in a slight breeze that brings in new air with its full 0.04% carbon dioxide.