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
Winter, 2001
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.