Fat Read online

  Ever eat a full pie for dessert? Or even half a pie? As difficult it is to maintain great physical fitness, it is equally as difficult to maintain massive weight. Eat six thousand calories a day? Ten thousand? Thirty-thousand? I have seen Xander eat an entire X-large pizza and wash it down with a 2-Liter of Pepsi. Kate has told me he spends thirty dollars at McDonald’s for a dinner for one. I have seen Xander picnic in the park with a lunch of sandwiches measured by loaves of bread and packs of meat. It is a serious commitment to stay large. A rigid regiment needs to be followed and strictly adhered. First, ignore the fact that the quantity being eaten is multiples of even the excess portion sizes that the average person consumes -- four extra value meals for lunch, why not? Second, eat only high calorie concentrated grub -- don’t waste valuable chewing on just a single patty burger when a triple stack can be stuffed into the mouth with just a little more effort. Third, eat all the time -- any period not spent eating is calories lost and calories that need to be made up to maintain massive weight. Burger King run at midnight, don’t think about it, just do it. And lastly, stop caring and start justifying -- spiral into self-loathing and play the victim if necessary, to square away laziness and shirking personal responsibility in the mind.

  Kate snapped back from her stare, and started crying. “Stupid genes we gave Xander! Stupid slow family metabolism! He had no chance from where he came from!”

  I patted Kate’s head as she cried, but this was ridiculous. Trying to blame obesity on a uniquely slow metabolism or a bad genetic inheritance is ridiculous. Metabolism and genetics are varied, but the road to morbid obesity is single: intaking multiple-fold calories than burned. Why can’t anyone just admit that obesity is created from conscious decisions to intake a perpetual tsunami of excess calories? Deciding to make snack-size into party-size? Deciding to trade the Happy Meal for a Super Sizer? Deciding to be active for nothing more than just the goal of getting to the next meal? Intaking a week’s worth of fats in one day, then de-conditioning the body to the point of becoming more slug than man, will certainly slow the metabolism, but that slowing has nothing to do genes – it’s just the inevitable consequence of poor habits.

  Obese parents have obese kids because they pass on their poor eating habits, and not because of some abstract fat gene. Kate and Al were lean and athletic, so her claim of some fat gene was even more absurd. Even if reality was suspended, and Kate and Al each had some unexpressed recessive fat gene they each gave to Xander, that genotype is still just a starting point, and it has nothing to do with why he is unable to improve on his phenotype. Not everyone is going to look like Brangelina, but that does not mean a life of never taking showers and always getting bad haircuts. Obesity is not a hopeless genetic mutation. Xander has decided to worsen perfectly adequate genetics with terrible behaviors. Now he has his mom buried in guilt.

  Kate kept blubbering. “He’s tried everything and worked so hard at his weight for so long, but his body just won’t react.”

  As if claiming that nothing more could’ve been personally done for his weight loss was believable. Talking about working hard is not the same as working hard. Reading self help diet books is not the same as being on a diet. Buying an elliptical trainer is not the same as exercising. After cutting through all the self pity and excuses, there is just hard work. The hard work of weight loss is to just figure out a way to burn more calories than you eat. Simple. That extra three hundred pounds is not due to some special medical condition. It is due to the condition of gluttony. An entirely selfish condition. Playing the victim is the most pitiful means to skirt responsibility. A victim is someone that gets shot during a robbery or someone who invested with Madoff; there is no victim when someone finishes an entire black forest cake in one sitting or decides to have an after dinner snack of a triple Whopper. There is only obvious consequence.

  I remember when Xander thought eating a bowl of oatmeal every morning for breakfast would be the magic ticket for weight loss. He caught me at the grocery store one day and revealed his plan, rambling on about fiber and less fat absorption and other generic nonsense he probably read in a a blurb on some random website -- he must’ve forgotten I was a doctor and not some housewife at a book club willing to take hearsay medical knowledge as fact. He ate plain oatmeal every morning for a month, and was puzzled that the scale wasn’t budging. It was a good thing that he was substituting oatmeal for his usual breakfast of a packet of bacon and carton of eggs, but all he did was prune a couple leaves when the entire tree needed to come down. Never mind his triple value meal lunches, and King-sized candy bar snacking, and full extra large pizzas for dinners with entire French Silk pies for dessert, and midnight runs to Taco Bell for bedtime snacks. He quickly went back to his usual breakfast bombs. Fads like that are never sustainable.

  Massive weight gain is a consequence that can easily be foreseen and expected from excessive eating behaviors; it is not a cryptic puzzle unable to be logically prevented. The obese put too much effort into the search for a magic decoder that will unlock the mystery of weight loss, when simple logic is to eat less. Living that simple logic may be difficult, but just because it is difficult does not mean it cannot be done or that it should not be done. “Why” is not the appropriate question. Someone that gets HIV from sharing heroin needles during whacked out weekend benders cannot wonder why. Taking down a whole deep fried chicken for lunch and then complaining about a five pound weight gain at the end of the week needs a shutting up. Kate, shut up about Xander.

  I reached into my pocket and pressed my speed dial. I called my pager. Katie was still tearfully musing about Xander. The anticipation was making my stomach churn, as if I had eaten a bag of White Castle washed down with a gallon of chocolate milk, or what Xander would call a little bite. How long does it take to go from wireless station to radio signal? My pager finally went off.

  “Damn, it’s the hospital. I am so sorry Kate, but I have to go. Hey, don’t worry so much, he’ll get on the right track after surgery, I just know it.”

  I gave Kate a hug.

  When a woman is crying, I will say almost anything to slow the tears. I told my ex-wife at a wake that her mother was a super nice lady, even though her mother’s soul was black tar. Xander is not going to get on the right track after surgery. I get the feeling everyone thinks surgery is going to be an instant cure-all, and that Xander is going to be the next People magazine cover story of victorious weight loss. Surgery is just a band-aid until Xander can learn to control his weight alone. That control is never happening. No amount of time bought under a knife is ever going to quell his need to gorge. He is a food dumpster.

  I broke the hug, my arm brushing her right breast at release, and then I rushed out the door into the fresh, fresh air.

  ADJUSTMENTS

  Taco Bell Fridays. I really looked forward to my Friday nights, which nowadays consisted of picking up a chili-cheese burrito and three hard shell tacos from the Bell, sitting in front of my flat screen and watching whatever until I fell asleep on the couch. It was just a great way to unwind from a week of work, at least for someone my age. It was unwinding after having to deal with entitled parents all day and having to give the same schpeel ad nauseam trying to explain why every sniffle or sore throat doesn’t require antibiotics and then having them leave in a huff that they didn’t get what they wanted. To have to deal with parents that think they know more about medicine than someone who went through med school and residency and years of practice and hundreds of hours of CME because those parents read some stuff on the internet or heard something from some other non-physician family member. After spending my week dealing with those parents, I always choose downtime activities that require no contact with any people.

  This Friday, the drive-up was crazy, so I decided to park it and walk into the restaurant to get my order. I caught myself at the world “restaurant”. Taco Bell being called a restaurant? Like a bowler being called an athlete. It is not a restaurant when the menu only consists of the same
seven ingredients mixed and matched in slightly different combinations.

  “Hey, Dr. Grant!”

  The voice jolted me. It was Xander. He was seated by himself near the back window. He looked a little bit slimmer. I walked over towards him.

  “Hey, Xander, how are you doing?”

  “Great, really great. Are you making a run to the border like me?”

  “Yeah, just picking up some dinner. I love this place.”

  “Me too. It’s a shame I can’t eat as much of it anymore.”

  I looked down at his tray and it had just three hard tacos on it.

  “Oh yeah, your mom mentioned you might get surgery. How’s it been going?”

  Patting his belly, “Not too bad. I’ve lost twenty pounds in the last three weeks, so that’s pretty good.”

  “That’s great, Xander. You look good.”

  “Thanks, doc. I went with the gastric banding. I’m getting so full, so fast now. But, I have to keep going into the doctor’s office to get it retightened.”

  “Well, that’s just the process.”

  “But when I first had to get my band retightened, I felt full after only a few bites for a while, then I starting feeling hungry even with more and more food, so then had to get it retightened again.”

  “You should tell your doctor about that.”

  “I did, but all he told me was that I have to use some willpower. Hell, if I had willpower, I wouldn’t have needed the band.”

  I laughed. It was a funny point. Misinformed, though. Anyone can eat through their banding if they don’t try to make any changes. The band surgically shrinks the stomach and that smaller stomach gets full faster, but the feeling of that artificial satiety can be overridden, just as the normal feeling of satiety was overridden for so long to eliminate the sensations of normal satiety and unleash the abnormal obesity that required the banding. When that override happens, food backs up and the esophagus becomes the extension of the stomach. Like sewers becoming full and backing up into the pipes of your home. It’s called overpacking the pouch.

  “Xander, unfortunately, the band is not the end-all cure-all for obesity. It’s just a band-aid until you can figure out how to regulate your own food intake. It’ll help you in the short term, but if you don’t work at controlling your diet, even the band won’t fix everything for the long term.”

  “Yeah, I guess you’re right, Dr. Grant.”

  “Hey, three hard tacos is a decent portion. You’re doing okay. Are you exercising?”

  “Not yet, my back hurts too much. Even walking kills.”

  That pain is the body trying to hold onto being sedentary. Of course it’s going to hurt when you're a blob trying to transition from sedentary to active. It’s supposed to hurt. It’s supposed to be hard. Or else everyone would be running marathons instead of gorging on marathon buffet sessions every day. That’s part of the reason so many fall deeper into obesity – because it's hard to stay in shape. It requires daily effort with negligible immediate benefits and with no real end. On a day to day basis, running a few miles and eating healthy doesn’t feel any better than ice cream and a nap, so it becomes easy to slide out of shape. Most daily activities just require the ability to sit on a chair for long periods of time, so the sneaky loss of physical fitness will not be noticed because the body is never cardiovascularly taxed to test its limits. If that daily maintenance is neglected, the work of staying in shape accumulates, and soon it becomes a mountain. The cumulative massive effort it now takes to overcome that mountain in the way of changing from an obese slug into a fit machine, only makes the benefits and end seem further away, so the defeatist mind sets in and the effort never get undertaken and instead the mountain just gets bigger.

  Looks like Xander had his food plumbing reorganized just so he could stay sedentary and still lose weight. His fat ass is half-assing it again. Sure, any movement away from morbid obesity is technically getting healthier, just as eating a Big Mac meal with a diet coke is technically healthier than a Big Mac meal with a chocolate shake, but the ultimate goal is to be healthy and just getting skinnier is not always healthier. Runway models that strut Versace and Prada are certainly skinny, but they likely exist on diets of cigarettes and caffeine. Women on the covers of Cosmo and Redbook always look fit and shaped with lean muscle, though they’re helped with botox, a pre-photo shoot crash diet and photoshop. Men’s Health displays a cut-up freak of a muscled tank on its cover monthly, suggesting him as an example of the possible results of following its articles espousing the best diet and workout tips, but he likely just finished a cycle of performance enhancers and has a costume of a body with bad acne on his unseen back, a catalog of damaged internal organs and shriveled peas for testicles. Too much is Hollywood magic. Hollywood owns the image of attractiveness and it is a skinny one, regardless of fitness. Everyone wants to be attractive at some level, so people try to look slim at all faddish costs. Eating only meat doused in butter and equating Wonder bread to poison? Drinking nothing but maple syrup, cayenne and lemon juice for two weeks? Using a stainless steel tube to suck fat out of an incision like a wet-vac cleaning up drunk vomit? Everyone wants a shortcut to the appearance of health. There is none. But, because of frank laziness, the goal has become only about looking superficially healthy rather than doing the work to actually be healthy.

  “Well, you have to start exercising. Just start real light, like stretching or even walking for five minutes at a time, then if you can do that, then try ten minutes, then fifteen, then you can keep slowly increasing your activity and intensity so you’ll be running a marathon in no time.”

  Xander laughed, “Me running a marathon? That’s crazy.”

  “It’s not crazy. Losing weight is great and all, but you should really be focusing on getting healthy. It is very possible to be fit and still be a little overweight, just like it is possible to be out of shape and really skinny.”

  “Really?”

  “Who do you think is healthier: a skinny guy that sits on his ass all day, or a chubby guy that just ran the Chicago marathon?”

  “I hear what you are saying, but it’s also hard to find time to exercise; I’m so busy with my business sometimes.”

  “How many dinners have you skipped this week because you were too busy?” I looked down at Xander’s tacos.

  “Um, none, I guess.”

  “If you can set aside thirty minutes every day to eat, you can set aside thirty minutes to exercise.”

  “Yeah, I guess you’re right, doc.”

  “It’s just priorities. What do you prioritize more, eating or exercising? If you’re obese, the priorities need to be flipped.”

  “Yeah.” Xander took a bite from his last taco and chewed slowly, letting his teeth and saliva disintegrate the bite into mush before sending it down to his pouch.

  “Diet without exercise is like that taco without the shell.”

  Xander laughed as he popped the last bit of the taco into his mouth. “You’re right, doc. Man, you are right.”

  I am right. It’s good advice. Not many people will use busy schedules or stressful days or being too tired as reasons to completely skip meals consistently. Most will drop what they are doing at almost any cost when they are hungry to grab a quick bite of anything – even if it is just miscellaneous meat in a fried corn-like shell topped with iceberg shreds and cheesy strings.

  That taco without a shell metaphor could be dripping with a little bit of personal hypocrisy, though. Here I am, tossing advice about diet and exercise at a Taco Bell, just before I am about to eat three tacos and a burrito, which I have eaten almost every Friday for a few years now, and just before I then go home and not move from in front of the TV for hours. I am giving all that advice even though pizza is my absolute favorite food, of which I will eat three-fourths of a large deep dish pie every sitting, with cold leftovers for the next morning’s breakfast, at least once a week. And I eat at least one chocolate covered something every day, most days it being chocolate cover
ed chocolate in chocolate sauce. And I can never turn away from a well-crisped basket of fries. Doctor heal thyself? A good thought, only I don’t need healing. This is not hypocrisy because no one is demanding perfection, just moderation. I may have some bad dietary habits, like any average guy (a life never eating fries or chocolate is no life to me), but I don’t let those habits ruin the rest of my life – I force myself to work out hard four times a week, mix in some salads before dinners, pass on the donuts most mornings and will stop at three-fourths of a pizza rather than downing a full one by myself. So I have been able to stay healthy through the years. Admittedly, it has taken more effort as I have gotten older, but it’s what I have to do for my health so I do it. The fact that my less than ideal eating habits can still be part of a sufficiently healthy lifestyle just goes to show how far from moderation someone has to go to get morbidly obese. If someone can maintain relative health even with mediocre eating habits, let them be, but if eating habits become problem eating habits as shown by massive weight gain, then it’s time to shuttle current habits and change. But that potential change is too much of an obstacle for most people – it becomes a horrifying prospect to have to overcome terrible eating habits ingrained by obese parents since childhood who allowed Little Chunky to eat whatever in whatever quantity, to overcome comfort food being set as McDonald’s and Twinkies, to overcome the lifestyle of having daily activity barely rising above inanimate object status, or to overcome the anticipated discomfort of the regular cardiovascular exertions needed to maintain health. But, they have to be overcome. And that is all doctors are trying to get across when harping about diet and exercise: just care about your health the right way.