Difficult to Swallow

What I am about to write about is a something that is not easy to talk about. It is something that I see everyday. It is something that is plaguing the health of this country and is costing the American people billions of dollars. It is so prevalent that it almost appears as if it is the norm. There is a movement towards its acceptance in social media and in the general public. It is prevalent throughout all socioeconomic classes, yet it unfortunately affects the poor more than any other class (among many other things that affect the poor the most, which is another discussion in its entirety). I want to present the facts gathered from the CDC to you before I share my thoughts on the issue. I want to talk about something that I am going to call “nutritional obesity.”

More than one-third (34.9% or 78.6 million) of U.S. adults are obese.

The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008.

The medical costs for people who are obese were $1,429 higher than those of normal weight.

There are 12.7 million obese children and adolescents between the ages of 2-19.

In our state of South Carolina, only 9.3% (nationally 14%) of people are receiving their daily value of fruits and vegetables. Only 18.6% of adults meet aerobic and muscle strengthening guidelines. Only 23.8% of South Carolinians exercise daily.

As of 2011 to 2012 in South Carolina, only 36.1% of our youth have access to parks, community centers, and sidewalks in their neighborhood. With that number being even less in lower socioeconomic communities.

Do you know what is despairing about these statistics? They did not surprise me at all, and it probably did not make you jump out of your seat either.

During my second year as a medical student, I typically will walk to the hospital cafeteria every day to eat lunch. As I sit down to eat my meal, I will look around me to see a diverse group of people eating their meal in the food court. I see patients, nurses, custodians, doctors, administrators, students, and visitors all sitting in the same open room. My eyes will then move toward their lunches, and all I see is unhealthy food. From burgers to fries, people are gulping down their meals with a large soda. The other day, I sat down next to a table at which an elderly female patient sat.

She was eating a sandwich that had so much mayonnaise on it that I could not make out what was actually inside the bread. With a side of fries and a tall drink, she also had bought two extra-large cookies. One of which she ate, and the other she tucked away in her purse for later. As she slowly walked away with her oxygen tank on her walker, I immediately began to question.

Why is this woman doing this to herself? Why is she causing her body more harm than good by ingesting so much fat and sugar? Does she even know that with her weight, that she will probably need a knee and hip replacement in the coming years because her body was never built to support that much weight? Does she know that she is at an increased risk for a stroke and heart attack among other diseases? Is she eating so much because she is depressed, stressed, or suffering from increased amounts of anxiety? Does she care about her health? Does she have some family and friends that are helping her regain her healthy and liveliness? Has she struggled with weight and eating her whole life? Did something happen in her life that has caused her to eat this way? Does she receive enough physical exercise? How is her mental health? Does she try to exercise and eat well but to no avail? Does she have access to healthy food resources in her neighborhood? Is she disabled? Has she gained the weight because she has a diagnosed medical condition? Can she perform any physical activity these days? Does she have enough money to even afford healthy food? Does she know how many calories and grams of sugar are in her meal? Does she know the amount of money she is costing this hospital system to treat her preventable diseases associated with her weight? Does the hospital know that our patients are doing unhealthy things in a place where health should be our number one priority? Do we even truly care about our patients? Are we treating the underlying problem with the patient? Do we even have enough staff to educate our patients? Do we just do the best we can during the time we have? What are we not doing right? Is it the hospital’s problem, the patient’s problem, or a problem with our government? Is society the problem? Social media? Why is unhealthy food so much cheaper than nutritious alternatives ? Why are there more fast food options in low-income neighborhoods? Why are we marketing to our culture things not good for us? Do we have any sense of livelihood anymore? What went wrong with this woman? Where have I gone wrong? What can I do to help her? Is it too late?

As you can see, I have about 100 different questions racing through my head as I continue to witness obesity. It is a topic that we all do not want to talk about in fear of offending our friends, families, and even patients. As health care providers, even as common citizens, we should strive towards health. I know that one day I want to live long enough to see my grandchildren grow up. I do not want to spend the last days of my life with a multitude of wires and tubes inside of me while I lay in a hospital bed. I do not want to cause a financial burden on my family due to my inability to secure a future for my health.  I want to be able to walk around outside and not live with the constant pain, fear, and anxiety that can come with obesity.

I have written this note because I do not want you to suffer with things that can be prevented with help. There are a multitude of factors that shape our health into the people we are. I believe the decision to choose life is ultimately ours. As a future physician, I can counsel patients as best as I can, preform procedures to help alleviate pain, administer medications when needed, and guide you back towards health. It pains me to witness patients struggle with obesity, while others choose to leave their health burden for others to handle. It also pains me to know that there are so many patients that feel like there is no way out of their current state. They believe that there is no way to combat their physical state and nothing will change. It pains me that social media has grown to accept obesity and has allowed people to live in a constant state that could result in a healthcare emergency at any moment. It is sad that so many people are misinformed about proper health management. It pains me that large food corporations market towards our desire for comfort – sugar, salt, and fat. I wish you could see what poor diet and lifestyle does to your body from within.

My plea is for you to take a small step towards reaching a small goal, and then build upon that goal. I urge you to think about your health and the influence it has on our youth. I want you to be proud of choosing life. I have witnessed overweight patients exercising and choosing healthy food options at meals. You are a shining example of commitment, determination, and effort. Do not be afraid to bring up serious issues in a positive way with your friends and family about issues such as obesity. There is no reason to criticize a person’s health without knowing their history and story. I believe there is a right way to approaching sensitive subjects, and this topic is one of them.

 

Tee Griscom

Tee Griscom

I was born and raised in Nashville, Tennessee before heading to Furman University for my undergraduate studies. Football brought me to South Carolina, and I participated on the varsity team for a little over a year before deciding to focus more of my time on my studies and community involvement. I graduated Furman in May 2014 with a degree in Religion, and I believe that my background allows for a unique perspective into the lives of patients. I have been wanting to practice medicine since my youth, and I am grateful for the opportunity given to me by the USC School of Medicine Greenville to pursue that dream.

Jeanne Petrizzo

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  • Tee Griscom - 1 year ago

    I am writing in response to some feedback that I have received concerning my blog post about obesity. I want to reiterate that this subject is something that is not easy to address in today’s world. We must take a step back and consider the ramifications and consequences that this idea has on the emotional, social, and physical well being of one another. It is something that we can quickly become angry about – even to the point of completely dismissing another person’s attempt, whether we agree with it or not, to grapple with difficult discussions about health and the facts presented to us.

    I wanted my piece to be a reflection of the inherent, initial thoughts that come to mind when we encounter such a condition. Despite my limited time in medicine thus far, I have learned a great deal about the anatomy, physiology, and disease processes of the human body. My medical school is teaching us through an innovative approach that incorporates nutrition, lifestyle medicine, and socio-economic and emotional factors into our future care for patients. Along with my preparation in the classroom, I have had the opportunity to visit patients in the hospital and treat those in the community within their homes. I have seen the poor affected by disease more easily than the wealthy due in large part to lack of access to healthcare. Seeing patients and having a “new set of eyes” in the healthcare field has made me realize that there are many things that we need to fix and ways in which we can improve. With that perspective, it has been difficult to witness what appears to be a common trend among our patient population: the acceptance of obesity as the “norm.” The idea of “weight-gain” (or weight-loss for that matter) is strongly correlated with self-body image—something that, I believe, everyone can agree upon. I also think we can all agree that it is important for each one of us to have confidence, high self-esteem, and pride in who we are; however, we cannot allow those ideas to blind us to the numerous and significant health problems that come with obesity.

    I have found myself interested in reproductive health, so the following was very concerning to me: when it comes to caring and providing for our female OB patients, studies have shown that maternal obesity is linked with adverse outcomes for mothers and babies. It is linked to greater risk of pre-term birth, large-for-gestation-age babies, fetal defects, congenital anomalies, and perinatal death. Maternal obesity has shown to result in longer duration of hospital stay with greater resources needed for the mother and child. (1) Obese women have clinically shown to have a poor response with regards to in vitro fertilization. It was found that obesity significantly decreased this fertilization treatment in these patients. (2)

    Obesity doesn’t just affect reproductive health. There are a multitude of studies that demonstrate obesity is correlated with poorer health outcomes in a variety of organ systems and diseases. Cardiovascular health, joint health, digestive health, pulmonary health—these and many more are all negatively affected by obesity. From more people with obesity dying from kidney injury, to more people with obesity dying from atherosclerotic plaques, these outcomes could be prevented with healthier habits. So how do we address this problem? Whether it’s something that the government can do (evidence from restaurants in New York that analyzed the impact of trans fat bans on cardiovascular disease mortality rates showed that restriction of its use in fast food establishments caused a 4.5% reduction in CVC morality rates per year – that is about $3.9 million dollars saved per 100,000 persons annually in health care) to having physicians combat major depressive disorders associated with body image concerns, there needs to be a way that we can find ways to engage with such a difficult topic in order to provide everyone with a better life. (3, 4, 5)

    But how do we approach such a sensitive topic? I find that it will be increasingly difficult for physicians to engage in challenging conversations with patients, as healthcare appears to be moving towards a physician-compensation system based upon patient satisfaction. Is a pediatrician going to bring up that a couple’s child is obese and ask for them to help their child make a lifestyle change? If I brought up alcohol use or sexual activity (two things that have the potential for being very personal) with my patients about their risks, is that acceptable? Shouldn’t healthcare providers be able to freely converse with the patients on a ground of mutual trust and respect, so that both parties can achieve a better state of health? How do we do that without the fear of patient resentment towards us? Are healthcare providers going to engage with the community and make real change towards better lifestyles for everyone? Studies have shown that physicians and physician trainees rarely identify or address overweight/obesity in hospitalized children. The authors concluded that this was a crucial missed opportunity for both patient care and physician trainee education. (6) Another study showed that pediatricians could help prevent obesity by measuring BMI at least yearly and providing age-appropriate and development-appropriate anticipatory guidance to families. Interventions on family habits and parenting strategies along with public policy were among the top ways to combat childhood obesity. (7) It pains me to read that literature has shown that adolescents’ social insecurity was the main predictor of dropout in a multicomponent family-group-based obesity treatment program. (8) They concluded that the family’s awareness of eating-related behavior needs adjustment in order to change the behavior. Bottom line: much of the negative outcomes of obesity, even childhood obesity, can be prevented if physicians and patients discuss it early, but physicians are hesitant to broach such a sensitive topic in the current healthcare system.

    Despite overwhelming evidence of all the harms that increased weight can have on a person, obesity is becoming the new norm. More and more people are accepting that being overweight is “just who they are,” and physicians are hesitant to speak up about the disease and death that comes with obesity, not to mention that there’s hope and ways to overcome it. My piece was not meant to judge, or blame, but rather highlight an epidemic that deserves our attention. There are many contributing factors to obesity (wealth, access to health care, genetics, public policy, lifestyle choices, etc.), and it’s important to consider all these when tackling this tough issue. I hope that my patients know that I am struggling and will continue to struggle about how to find ways to actively engage with the discussion of obesity. I find myself having had an easier time talking about death than I have had with issues such as this one. It pains me to see patients hospitalized for diseases that may have been prevented with healthier eating and lifestyle. I know that I will not know everything, but I hope to continue to work with nurses, educators, rehabilitation specialists and dieticians one day to provide an integrative system of care for my patients. I want my future patients to know that I am working diligently everyday for you, and I hope I can provide you with enough information and resources to find ways to live your life to the greatest potential.

    (1) Obes Rev. 2015 Aug;16(8):621-38. doi: 10.1111/obr.12288. Epub 2015 May 28. Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews. Marchi J, Berg M, Dencker A, Olander EK, Begley C.
    (2)Biomed Res Int. 2015;2015:781543. doi: 10.1155/2015/781543. Epub 2015 May 27. The Role of Overweight and Obesity in In Vitro Fertilization Outcomes of Poor Ovarian Responders. Vural F, Vural B, Çakıroğlu Y
    (3) J Health Econ. 2015 Nov 10. pii: S0167-6296(15)00106-X. doi: 10.1016/j.jhealeco.2015.09.005. [Epub ahead of print] Trans fat and cardiovascular disease mortality: Evidence from bans in restaurants in New York. Restrepo BJ, Rieger M.
    (4) Child Obes. 2015 Nov 18. Understanding Academic Clinicians’ Decision Making for the Treatment of Childhood Obesity. Bailey K, Cunningham C, Pemberton J, Rimas H, Morrison KM.
    (5) J Clin Psychiatry. 2015 Oct 27. Fat distribution and major depressive disorder in late adolescence. Coryell WH, Butcher BD, Burns TL, Dindo LN, Schlechte JA, Calarge CA.
    (6) J Pediatr. 2015 Oct;167(4):816-820.e1. doi: 10.1016/j.jpeds.2015.06.040. Epub 2015 Aug 5. Physicians and Physician Trainees Rarely Identify or Address Overweight/Obesity in Hospitalized Children. King MA, Nkoy FL, Maloney CG, Mihalopoulos NL.
    (7) Pediatr Clin North Am. 2015 Oct;62(5):1241-61. doi: 10.1016/j.pcl.2015.05.013. Epub 2015 Jul 16. Addressing Childhood Obesity: Opportunities for Prevention. Brown CL, Halvorson EE, Cohen GM, Lazorick S, Skelton JA.
    (8) Int J Obes (Lond). 2015 Sep 18. doi: 10.1038/ijo.2015.183. Behavioral predictors of attrition in adolescents participating in a multidisciplinary obesity treatment program: EVASYON study. De Miguel-Etayo P, Muro C, Santabárbara J, López-Antón R, Morandé G, Martín-Matillas M, Azcona-San Julián MC, Martí A, Campoy C, Marcos A, Moreno LA, Garagorri JM