Not much on the telly tonight, so I ended up watching "My 600 lb. Life" --- the show where folks go to Houston for bariatric surgery… some successful, some not so much.
After watching a couple episodes, I'm left with some mixed feelings.
Is super morbid obesity:
1) a disease along the same lines as alcoholism and drug addiction?
2) a lifestyle issue (poor food choices, lack of exercise, laziness)?
3) a mental health issue (poor self esteem, depression, etc.)?
What have you seen in your practice re: number of super morbidly obese admissions, bariatric surgeries, disease processes related to super morbid obesity, difficulty caring for super morbidly obese patients.
The answer to this questions is the same as every thing else people have tried to boil down to a single, simple cause.
There isn't one: it's a combination of genetics, personal choice, and environment influences. Evidence continues to mount that the gut biome and genetics play a huge role in a person's weight, as does a person's dedication to diet and exercise.
I watch that show regularly. One of my main take-aways is always astonishment at whoever is playing the role of the Enabler. There is always one primary enabler, usually mom, boyfriend or husband. While I don't know how much behind-the-scenes counselling may or may not be taking place, it really doesn't seem as if the subject is addressed enough.
I've seen 2 shows this season where the husband was actively sabotaging the patient's weight loss because (1) husband likes "fat" women and he wouldn't be attracted to a thinner person, and (2) husband was afraid she wouldn't "need" him any more after she lost the weight.
The mothers always seem to have the martyr complex going, as in "If I don't take care of her, who will?" Or the "she's my baby and I want to keep her happy so I buy her any food she wants."
In one episode, it was a poor slob of a son who was bathing, dressing and buying food for his mom. That one really got to me. Someone in that surgeon's practice should really be focusing on the other factor in the situation. And as I said, for all I know they are, just behind the scenes.
One of my main take-aways is always astonishment at whoever is playing the role of the Enabler. There is always one primary enabler, usually mom, boyfriend or husband.
@roser13: I agree with you. The enabling behavior is disturbing, though I guess really is no different than a drug addict or alcoholic where the enabler is too deeply involved in the sick behavior to see their part in the destructive enabling, supplying the addict for years with the means to continue in their addiction.
While I've found "600 Lb. Life" to be distressing and disturbing at times, I've also felt encouraged by the folks that actually do make the changes to start getting healthy. I know how much trouble I have exercising and eating well (especially in the winter with SAD), so I can't fathom doing that as a morbidly obese person.
I do think more gets addressed than we see on the show. I'd assume they must edit for time, though I'd certainly be interested to know how much goes into pre-op counseling, dietary consultations, and psychological evals and support not just for the patient, but for the family (especially food enablers).
I have to admit I've wondered who is paying for all of these surgeries? I have yet to see an episode where ANYONE in the family is employed. The caregivers are not employed and obviously none of the patients are, so I find that aspect especially curious.
"I have to admit I've wondered who is paying for all of these surgeries? I have yet to see an episode where ANYONE in the family is employed. The caregivers are not employed and obviously none of the patients are, so I find that aspect especially curious.
Yes! My other fascination. How are these folks able to afford to move to Houston, while keeping their current home? I have to assume that the show pays for some, if not all of the expensese.
"I have to admit I've wondered who is paying for all of these surgeries? I have yet to see an episode where ANYONE in the family is employed. The caregivers are not employed and obviously none of the patients are, so I find that aspect especially curious.
Yes! My other fascination. How are these folks able to afford to move to Houston, while keeping their current home? I have to assume that the show pays for some, if not all of the expensese.
Oh, I hadn't thought about the show paying. I guess when you are laid up in your house and unemployed leaving it all behind if someone else is paying is pretty easy.
"Yo-yo" dieting is one cause. It disrupts normal metabolism to the point of weight gain when eating minimal calories. It is a common sequela of disordered eating (starve, binge, starve, binge).
We have patients who have died in their 40s due to the stress the extreme weight puts on their bodies- so very sad.
But often it stems from the psychiatric component. If not the eating disorder directly, then usually a combo of psych meds and the diabetes and weight gain many of them cause.
Specializes in Critical/Acute Care, Burns, Wound Care.
Without a doubt, it is a lifestyle issue more than anything else, but yes all three factors play into their disease. Obese people will say that they are at a genetic disadvantage 9 times out of 10 as they polish off their third helping of lasagna and bread sticks. Name the genetic disorder that makes adipose tissue and calories spontaneously appear. Sure, people have different metabolism rates and family history of obesity...well then, prepare to be at a disadvantage and choose foods carefully, exercise daily and you can beat the odds.
As far as what have I seen in taking care of obese patients? I've seen many terrible things: unable to do effective chest compressions because of the layers upon layers of fat over the sternum, they usually take a whole bucket of pills in the morning to control their multiple co-morbidiities, lower extremity ulcers/wounds that eventually lead to gangrene and amputations because their diabetes left them with neuropathy and a huge gut so that they couldn't even see their legs unless a friend takes a picture for them, bedside commodes/beds/chairs/CT scanners/MRI machines/doorways/cots/etc that are too small for the morbidly obese patient, staff injured trying to help the obese patient transfer or simply turn in bed, really everything is worse when you have an obese patient to care for because they are so taxing of your time and resources. They put me in a sour mood and I have to force myself to smile when I take care of them, but I do have compassion for all of my patients. It's nice to be able to be honest with my private thoughts, universal to nurses, on this forum. All of the nurses that I have ever worked with have negative things to say about the amount of work it takes to care for an obese patient, unless the nurse is also obese. In that case, we don't discuss the hypocrisy. If they want to become like the obese patients that are slowly killing themselves, then I can't stop them. At least they are in a career that warns them of the cost.
Sadly, the obese population is costing this world a BUNCH of money in new equipment needs. It is ridiculous and their hospital bills should reflect the extra manpower and equipment needed to care for them. I know one nurse who had her wrist SNAPPED when the obese patient was too much for her to handle as she tried to turn him in bed. He flopped back over basically on top of her. She was on short term disability for months after her surgery. An obese patient could suffocate a nurse, so precautions should always be used, like putting on a nasal cannula with high-flow oxygen before lifting skin folds to assess for yeast, especially beneath the behemoth pannus, in case it comes crashing down and knocks out the nurse, suffocating her as a cloud of yeast spores fill the air.
It's not all bad though, sometimes obese patients are the most funny, and sadly they can even make fun of themselves.
From Urban Dictionary: Pannus- A large roll of abdominal fat which can extend anywhere from the genitals to, in some cases, all the way past the knees.That woman is so fat, she has her pannus tucked into her pants!
Specializes in NICU, PICU, Transport, L&D, Hospice.
Yup, it really is widely accepted to negatively judge the obese in this society. Of course, not everyone is interested in seeing an obese person and then making assumptions about their "lifestyle", but those who are that shallow are not rare and they are typically not shy about sharing their opinion.
I have my BS degree in Exercise Physiology and have done Clinical exercise physiology since I graduated in 2011. I have seen A LOT in these 4 years. Let me tell you.
I think there are multiple factors that contribute to obesity 1. Disease 2. Addiction 3. Lifestyle 4. Mental Health
With these factors a person can suffer from 1 , 2, 3 or all 4. Everyone situation is different and everyone has a story.
1. Certain diseases play a factor in obesity (ex hypothyroidism)
2. You can become "addicted" to sugar. Sugar releases the same hormone (dopamine) from your brain as other narcotics.
3. With the industrial and technological revolution it became so easy for us to become sedentary. (How many of us have ever lost the remote to the television and felt our entire world just came to a complete halt because we actually had to get up and change the channel). I know I have!!!!
4. People suffer from different mental issues and use food as a coping strategy. There are a lot of emotional eaters and if the mental wellbeing is never addressed then weight gain will follow.
So there is never one particular cause to obesity. It is a disease and there has to be behavior changes to take place in order to maintain successful weight loss.
As stated, it is a MULTIFACTORAL issue. All play a part in the disease, but I think there are psychological processes that reinforce overeating that are the biggest factor in the issue.
Specializes in orthopedic/trauma, Informatics, diabetes.
I am overweight. I am one of those people blessed with a very efficient metabolism. For me to lose weight, it is 1000 calories and 45 min of cardio 5 days a week to maybe lose a few pounds. I have thyroid issues also. I opted for weight loss sx after being dx with diabetes 5 years ago (i spent 2 years trying diet and exercise, 2 years in a diabetes research study and then gave up)
Right now I am losing (2 weeks post-op) about 5 pounds a week. I am not morbidly obese (starting weight around 225) and I watch those shows too and wonder about the enablers.
The sad part is the healthier I became, the heavier I got (I don't drink-liquor or soda, smoke, do drugs, I exercise and try to eat right-my body just used every stinkin' calorie I ate). It is such a struggle. Only if you live it can you sort of understand it.
In my opinion, it's all 3 factors the OP mentioned. Honestly though, I feel like genetics is the weakest factor. I do believe certain people inherit certain physical and metabolic traits, but all that means is that once they recognize those tendencies then they need to be somewhat more mindful of their diet and lifestyle. No one can tell me that there's a person out there who could eat a healthy, responsible diet and live a healthy, active lifestyle and still become obese. I mean if you're not giving your body the unhealthy ingredients to make you obese then it's not going to just pull fat out of thin air.
As for obesity being a disease, I just can't take that seriously. It sounds like an excuse for people to not do the work necessary to take care of themselves and for pharm companies to sell more pills. It may be a symptom of another illness, but not a disease within itself.
I really believe that lifestyle and mental health would be to blame far more than anything else. This society just has some completely warped perceptions of health and wellbeing now days. We are a fast food society, and by that I don't just mean fast food restaurants, I mean the "instant gratification" mentality that we all get caught up in from time to time. We even see it in medicine. People don't want to actually do the work of watching their diet and being active, instead they'd rather take a pill or get surgery. Also this society gets carried away trying to justify everyone's lifestyle. There are people actually encouraging others to take pride in their obesity. there's something just fundamentally wrong about that.
Even people that are trying to be healthy often have a warped understanding of health. A diet coke is NOT healthy. If you look at the big picture and not just calories (one of the many things people wrongly get caught up on), it's not even healthier than a regular coke. Lean cuisine frozen dinners are NOT healthy. Many of us just don't even understand how to truly be healthy, much less have the discipline to actually do it. Instead we buy into quick fixes and flashy advertisements and fall further down the rabbit hole of bad health.
Anonymous1257
145 Posts
The answer to this questions is the same as every thing else people have tried to boil down to a single, simple cause.
There isn't one: it's a combination of genetics, personal choice, and environment influences. Evidence continues to mount that the gut biome and genetics play a huge role in a person's weight, as does a person's dedication to diet and exercise.