Sunday, 11 September 2011

Obesity and the Dream Chaser


Yesterday afternoon, I visited one of the hospitals I used to work at. As I approached its imposing main entrance, I stood and watched 7 paramedics trying to load an enormous man on a stretcher on to an ambulance. They couldn’t do it - the driver had to get out of the cab lend a hand; with the combined muscle of an even 8, they just managed it. Now that is a big man.

Obesity is a problem - I remember when I was a house officer, we were told that if we wanted to scan someone too big for our CT scanner, we would have to send them to  London Zoo - imagine the humiliation for the patient: ‘I’m sorry, Sir, but you are too fat to have a CT scan, so we are going to have to send you to the zoo, where they are used to dealing with larger specimens.’ I never quite worked out whether the London zoo scanner had a table that such patients could lie on, or whether they had to use the slings that they put their sedated animals in.

I later heard that the zoo was no longer prepared to do scans for the NHS, because it was taking up too much of their scanning time. I suspect that this is aprocyphal, but it paints a picture. In any case, some bright spark decided that it would be a good idea to up rate the loading capacity of the tables we use in the CT scanners, so the problem of having patients that are too big to scan is not one we face all that often.

But we have had to adapt the way we do things - wheelchairs are wider, theatre operating tables are stronger, and we have access to re-enforced hospital beds when we need them.

Being overweight has become the norm. My Mum showed me a photo of her class at primary school, and the only chubby kid in the class was the son of the chap who ran the chip shop. I want to believe his name was Rollie, but I don’t think it was. I suspect the ratio of chubby to not chubby has changed dramatically over the last twenty years.

A recent family debate centred around whether overweight people should pay extra for health care, because obesity is a self-inflicted condition, borne out of eating too much, or rather, by not being able to control oneself enough to stop eating eating and associated with higher health costs.

I argued against this view point with the idea that obesity should be considered a problem of poverty and poor education - it is the new malnourishment- everyone has enough to eat, but cheaper and easy-to-prepare food tends to be less healthy.

But I wondered if I was being over simplistic about this: obesity is a problem affecting the whole of society, not just the poorest parts of it. The Independent ran an article recently stating an estimate that by 2030, half the population will be overweight.

Will we end up like the people in Wall-E, too fat to walk, and living our lives in floating chairs, consuming entertainment and ingestibles?



This modern epidemic is more than just an imbalance between calorie intake and energy expenditure - the balance of our entire lives has shifted. For example, we used to forge our leaders on the sports pitch - ‘play up, play up and play the game!’ and all that ( http://goo.gl/cTT93 )  and while this was not an entirely good thing, serving as it did to stifle social mobility, it did at least mean that lots of people grew up doing lots of exercise, and that in itself is not a bad thing.

School seems to be overly focused on exam results, and these kids really do work hard.  The price for failure, defined these days by a B grade or below, is so great, that other important factors get neglected - sport, responsibility, independence, critical analytical skills and so on. Education seems to bow to the Exam God, and we enter adulthood without the exercise habit.

But there’s more to it than that: I have no doubt that I did a lot of growing up on the sports field - the joy of winning, the pain of losing, the camaraderie, and the ecstasy of performing way beyond what you ever thought possible. There is something incredibly powerful about playing a part in the hopes and expectations of other people that mirrors closely a lot of what is important both in life and in the work place. Sport can teach us about personal responsibility, team work and the value of hard graft.

When I was twelve, we had a new rugby coach from New Zealand - he was young, charismatic, and a junior All-Black. To us he was a seasoned international, and our hero. He taught us the Maori Haka, and showed us that you didn’t have to be naturally brilliant at something for it to be worth trying hard at it. We worked our little prep school socks off for him, and had one of our most successful seasons ever. In the final, crunch match of the year, we played our nearby rivals, and despite camping out on their try line, and giving it everything, we lost 4-3 - not the highest scoring rugby match in history, but keenly contested all the same. At the full time whistle, most of us just burst out crying - the frustration at working so hard, coming so close, and yet still losing was too much for us at the time. But on the bus home, our coach congratulated us for being men enough to care, and for showing it. He told us that that was not a sign of weakness, but rather of strength.

That was one of the most important lessons I ever learned: it is ok to try and fail. Success is not the only outcome that justifies the effort. In fact, we often learn more from our failures than we do from our successes. It is the opposite of this attitude that causes people to stop chasing their dreams, and to settle for something less.

I have seen a lot of ‘settling’ by young doctors, who confused and scared by the challenge of chasing their dreams (eg becoming a surgeon or a neonatologist) settle for an easier, more predictable option.

So what is my point - that we are becoming fat and risk averse? Possibly. But really, what I wanted to say was that the problems we face in society are usually much more complicated than they appear, and we should be wary of simple solutions that do not tackle the actual cause. Obesity is not simple a problem of people eating too much, and not doing any exercise - these are simply the manifestations of much deeper changes in the way we live, and solutions need to tackle all the different facets involved, from education, to work, to leisure time, so that living healthy, fulfilling lives stops being something we have to learn to do, to becoming simply the way we live.

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