By Dr. W. Gifford Jones
It's oft said that "an apple a day keeps the doctor away". But what happens if faulty lifestyle has increased the midsection so much that you're apple-shaped? Or if excess weight on the hips makes you pear-shaped? Are both forms of weight gain equally detrimental? Or is one body shape more likely than the other to cause medical problems? And what has a train wreck to do with this nation's health?
O_ Dr. Horatio Oria, is an obesity surgeon at Spring Branch Memorial Hospital in Houston, Texas. He recently told delegates attending the meeting of The American Society for Bariatric Surgery that the distribution of body fat makes a difference in obesity and its hazards. That for those who pack pounds around the midsection and become shaped like an apple, the risk of diabetes, heart disease, hypertension, stroke and sudden death are greater than for those who are pear-shaped with waists smaller than their hips.
Dr. Oria reported more bad news for the apple-shaped. He suspects that these patients are also at higher risk for gallbladder and liver disease. Some bariatric surgeons are so convinced of this relationship that they advocate removing the gallbladder when an abdominal operation is done to combat obesity. But this is still a contentious issue among surgeons involved in this kind of surgery.
But there is good news for those whose expanded girth makes it difficult for them to see their feet. Fat cells in the midsection are large and metabolically more active, making it easier to lose weight around the waist. Conversely, the smaller fat cells in the lower body are less active metabolically. It therefore takes a major effort to shed pounds from the hips.
Dr. Oria's discovery is an interesting clinical fact. But, whether you're apple or pear-shaped, to be obese is to be ill. I tell patients it's like dancing with a grizzly bear. You may think he's cute and cuddly. He may even play with you for a while. But sooner or later he can give you a lethal whack.
Some things in medicine are obvious but many medical consumers still fail to grasp the point. A story goes that a man applied for a job at the railroad station. He was asked," Suppose you saw a train coming from the east at 100 miles an hour. Then you looked west and saw another train approaching at the same speed. The trains were on the same track and just a quarter of a mile apart. What would you do?" The man scratched his head for a moment and replied," I'd run and get my brother." "Why, in the name of heaven,Ô 0*0*0* would you get your brother at such a critical time?" he was asked. The man replied simply, "Because my brother has never seen a train wreck."
Today millions of people are headed for a massive train wreck. My formula, EP = A + D ( extra pounds = atherosclerosis + diabetes), will never win the Nobel Prize. But it's one of the most important prognostications of medical train wrecks.
A death certificate may label heart disease, hypertension, stroke, or kidney failure as the cause of death. But too often it's really the overabundance of fat cells that's killed the patient.
Today we should no longer think in terms of single diseases, like mumps, measles or coronary disease. Rather, a more generalized approach to medical problems is mandatory. It's too hard to know now which is the cart and which is the horse. Or where one health problem merges into the next one.
For instance, 40 years ago 90 per cent of diabetes was due to genetics and 10 per cent resulted from obesity. Today 90 per cent of diabetes is caused by obesity. This has created an unparalleled epidemic. Every 60 seconds a new diabetic is diagnosed in North America! Diabetes, in turn, sows the seeds of atherosclerosis, gangrene, degeneration of nerves, blindness and hypertension. High blood pressure then sets the stage for strokes, heart and kidney failure.
Extra pounds are also related to arthritis, sore backs, hemorrhoids, varicose veins and pregnancy complications. Cancer of the large bowel, gallbladder and female organs is also seen more often in the obese.
One great problem is that patients expect doctors to perform miracles once this vicious cycle begins. Unfortunately they forget a major difference between medicine and religion. Theologians tell us we can be scoundrels all our lives, cheat, steal and be headed straight for Hell. But it's still possible to change our ways at the last minute and repent. A forgiving God will have mercy and we may yet enter the Kingdom of Heaven.
Medicine, unfortunately, has no relenting God. In medicine, what we sow in early life is what we reap later on. There is no second chance. It's impossible for doctors to reverse a lifetime of bad habits, many of which are exhibited by apple and pear-shaped obesity. The moral is, don't forget the train wreck!
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com
My book, �90 + How I Got There� can be obtained by sending $19.95 to:
Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1
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