Obesity as disease touches a nerve

About once a month, we get asked to do an upper gastrointestinal exam on a patient who exceeds our table's 400-pound weight limit. It seems to me that anyone who weighs 400-plus pounds must not be having stomach trouble. Yet these patients seem perplexed, as if the underlying problem weren't draped over their belt. I have trouble as a physician dealing with diseases that appear self-inflicted.

When I was in medical school, around the time of the industrial revolution, the concept of alcoholism as a disease was relatively new. Rather than being chastised for lack of character and moral fiber, alcoholics now fell into the sick category. Treatment programs were developed, and insurance companies-reluctantly, of course-began covering this disease.

Today the U.S. is facing an epidemic of biscuit poisoning. Everywhere I go, I see obese people. My practice is filled with these patients. Clearly, obesity causes a host of medical problems, but is it a disease?

Once a week or so, we get a batch of requests for studies on patients applying for disability. About 90% of these requests involve lumbosacral spine or knee films on very heavy patients. If I walked around with a 150-pound bag of rocks on my back all the time, it wouldn't take a radiologist to figure out what was causing my symptoms. But here I am describing osteophytes and subchondral sclerosis like I'm Dr. Resnick, solving some complex musculoskeletal dilemma.

Every time I read these studies, I go through a little mental joust. A part of me (Republican, I suspect) resents the idea of my tax dollars going to people I feel ate themselves into disability. Is it any surprise that a 40-year-old 300-pound woman's knees and back hurt? Does society really want to reward this kind of behavior by giving her a paid vacation forever? Is this any different from the 40-year-old emphysema sufferer with a 50-pack-year history of smoking? Didn't these people choose their self-destructive behavior? I don't mind supporting someone who is a victim of chance, but I have this hang-up with self-destructive choices.

Then I think about what we are doing to our kids. American children are getting huge. Every day, I see obese parents herding a couple of terribly overweight children through the line at our cafeteria. These kids never had a chance. Diabetes, worn-out knees, hypertension, back pain, and coronary disease are ordained for them before the first grade. Is this a disease? Do they really have a choice?

Exercise, or lack of it, is another issue involving choice. Suburban dwellers don't exactly choose not to walk or bicycle when sidewalks are nonexistent in their communities. Do we blame them or the engineers and developers?

Recently, I watched the movie Super Size Me. Like the cigarette companies and alcohol producers, the food industry is giving Americans what they want. It is obvious that our eating habits are unhealthy, but we still spend billions for massive jolts of fried carbs and high-fructose corn syrup. The flick reinforced my belief that we are truly hurting our kids.

The third part of my joust is my small Episcopalian remnant. When I start to resent that someone is taking advantage of the system, I remember, "There, but for the grace of God, go I." If circumstances had been different, I might be that obese patient with the sore knees. I end up dictating the films as objectively as possible and being thankful for the life I have. And my kids may never go to McDonald's again.

Dr. Tipler is a private-practice radiologist in Staunton, VA. He can be reached by fax at 540/332-4491 or by e-mail at btipler@medicaltees.com.