On obesity

Watched Monster House the other day - a cute movie, very charming (and one of J's friends worked on its special effects). Not to give too much of the plot away (spoiler), but one of its turning points is the realization that the rage of the "monster" of the title was created by the cruelty of children making fun of someone overweight.

We've evolved so that it's no longer PC to make fun of people who are a different race, or who are handicapped. But it's socially acceptable (as evidenced by the presence of the obese sidekick friend) to mock people who are heavy. Perhaps it's because we think that overweight people can control their weight, that it's their fault.

The irony is, doctors know that it's not - that obesity is a subtle and devastating disease process with genetic predisposition. Some people try all their lives to diet and exercise and medicate themselves into thinness, and eventually turn to surgery which, though successful, can also fail. Even knowing this, we doctors are the same as everyone else - we laugh at our obese patients' expense, making faces as we try to lift them out of OR gurneys. I still remember watching my first gastric bypass, a seven hour ordeal on a 600 pounder with fat folds so big it took four of us to put in a Foley catheter. At the end of the case, wheeling the patient back to the anesthesia post-op area, I cracked open a power bar and started gnawing away at it. My resident looked at me stuffing my face, pointed at my patient, and shook his finger and head warningly.

I know why we do it - why we joke about the "biggies" - because fat people are _difficult_. Difficult to catheterize, difficult to intubate, difficult to place central lines in (sometimes you have to get extra-long needles to penetrate the fat). They've invariably got four or five associated diseases - diabetes, hypertension, coronary artery disease, high cholesterol, degenerative joint disease, or sleep apnea - with med lists just as long. And we resent them for the extra work they require.

But part of me wonders whether it's more than that - that we envy them because we think that they succumb to desires that we deny ourselves. Half of the days we barely get to eat lunch, and there they are, engulfed by a million calories' worth of fat. Could it just be that we're jealous?