Vol 10: Just a little big-boned
One of my favorite subjects in high school was English literature. I easily excelled in all sciences but literature, while I found it fascinating, was initially a struggle. There was just too much complex vocabulary employed coupled with ambiguous, often audaciously hidden, linguistic interpretations. The highly rated works of William Shakespeare, George Orwell, John Steinbeck and the like notably come to mind. But by grade nine there was a shift.
My teacher, Mr. Cox, taught me to look beyond the words and instead focus on the intention of those words to truly understand every character and the meaning behind their actions. Once I understood that, my grades skyrocketed and I graduated with the second highest score in the class. It’s a life lesson that I’ve carried with me and continue to utilize on a daily basis.
In medicine it’s very much the same. It’s really not what people say that helps me the most diagnostically – it’s what they do, body language cues, how they walk, the wear patterns in their shoes – the story is always there if you know where to look and are willing to take the time to explore. You have to search for the clues. In doing so, what the patient tells me simply augments and never supplants the evidence I’ve already found.
When Brutus talks to Cassius in scene three, act four of Julius Cesar, he tells him that ‘there’s a tide in the affairs of men which taken at the flood leads on to fortune’. In plain English, what he was espousing is that the key to success in life is being able to differentiate warning signs from opportunities and then seizing upon the moment. He was telling Cassius that it’s now or never.
I’ve used that lesson on multiple occasions with patients inspiring them to recognize body warning signals and to seize the opportunity to alter course and live a better healthier lifestyle. Studies have shown, however, that people rarely change their habits even when their life is threatened. In the past 40 years the rate of obesity has increased exponentially in almost every country across the globe and no nation has been able to curb this increase. Social media is the litmus test for popularity in today’s world and in that world being fat is unacceptable; obesity abhorrent. But it’s the juxtaposition of being large and yet so invisible that is most striking.
Nearly three-quarters of the Bahamian population is classified as either overweight or obese. Many of the physicians and nurses in the public and private health system – individuals who stand at the reins of safeguarding the health of our country – comfortably fall within this category. The question then becomes how is this affecting the nation as a whole and what can we do about it? Obesity has been linked to multiple health abnormalities like high blood pressure, diabetes, high cholesterol, cancer, back/ hip/ knee and foot arthritic joint pain, stroke, cardiovascular disease, heart attack, snoring, sleep apnea, difficulty sleeping, fertility problems, gout and incontinence to name a few.
One of my most beloved patients suffered with obesity for most of his life. In his early 60s he stood 6’3” tall and weighed over 350 pounds. Body mass index (BMI) is a measure of body fat based on height and weight. A BMI of 25-29.9 signifies being overweight while 30 or higher is regarded as obese. His BMI was 45.2.
His medical history included diabetes, high blood pressure, high cholesterol, peripheral vascular disease and three heart attacks over the span of 10 years. I treated him during this time for a Charcot (collapsed) foot deformity, foot swelling, loss of sensation, recurrent foot wounds and infections. He had a larger-than-life, caring and incredibly funny personality but unfortunately, he died after a fourth fatal heart attack.
Truth be told it did not come as a surprise because simply walking from his car to the front door, with the minimal exertion that it requires, left him sweating profusely and near breathless.
One potential reason why many Bahamians are overweight is that they consistently underestimate their daily caloric content. They assume they’re consuming a 1,000-calorie meal for example but it may in fact be over 3,500+ calories. Couple that with minimal exercise and in short order the weight alarmingly increases. People certainly don’t become 350 pounds overnight so given that the transition is so gradual, it takes a while for individuals to realize that their clothes are a little snugger than usual. Comparing themselves to old pictures months to years later is a rude awakening for many but quite often even that does little to inspire change.
Fixing symptoms without addressing the cause is a futile application of one’s time. As such, and over the upcoming weeks, I will be collaborating with Mr. Jimmy Mackey (owner of MacFit360 and one of the country’s leading fitness experts) in a multi-part series that highlights the obesity epidemic in The Bahamas. I’ll additionally be speaking with local family physicians, nutritionists and psychologists to gauge where we stand as a nation and offer concrete solutions in this regard.
I challenge readers today to heed Brutus’s advice and, in a time, when the entire world faces a crippling pandemic, seize this opportunity to get healthier because prevention is always better than a cure. Any tangible measures taken to address the health of our nation must first include obesity awareness and reform as a fundamental building block within this noble pursuit. Perhaps this steady messaging will increase the national appetite for wellness…Stay tuned.
This is The KDK Report.
