Saturday, July 09, 2005

Out of Money

OK, I'm not in the business of making people skinny. But occasionally someone will comment on my personal physique, which is trim, and inquire as to my methods. I take this as a compliment, and rightly so. But deeper down is a feeling that doesn't quite sit right, as though this is a slightly personal and intrusive question to ask of your doctor. I'm free, able, and supposed to observe what's wrong with you: the red ear, the bulging eye, and the dropped reflex. The table is not supposed to be reversed.

Nevertheless, when asked this question, the great line from Sommerset Maugham runs through my mind, something along the lines of, 'an iron will and the grace of God.' Well, not quite, but I do take care to stay lean. I tell the bold questioner that I eat well, enough and not to much, and I excercise.

Not a magic answer. Dissapointed with my lack of a magic pill for them, this particular woman then told me that she cannot excerise, because she is in too much pain (her obesity has caused her knees to become prematurely arthritic). And then there are the other problems that I've failed to see which account for her weight (I'd suppose it to be well over 200): she actually never eats.

Never? My raised eyebrow was of it's own accord - involuntary movements of various types have gotten me in trouble in the past (I have children) and now.

That's right. Never. She doesn't even blush.


I then explain to her the facts of energy utilization within the human organism. When an animal, like a human, obtains energy from food (as humans do not obtain energy from the sun), that energy is either used or it is stored. It is stored away for future use in the form of fat. Presently, the (large) amount of fat that is present in the head, neck, arms, abdomen, and legs - here, here, and here, and here - has been stored because it was not used. I explain that the way to use the stored up energy is to decrease intake and increase expenditure.

Thus I recommend excercise. Like walking if possible. No? OK, then like swimming.

Oh, I can't do that.

And why not?

It costs too much.

A gym with a pool probably costs less than a dollar a day. If you gave up your smoking habit, then you could perhaps afford it.

For some reason I think I might have lost a patient. But what was really on my mind was the fact that if she would give up her food habit, then she could save more. Then, unbidden, came several futher suggestions for her to save money, starting with her manicure, makeup, and high fashion. Her cell phone. At home she could rid herself of TV and cable. Those are just some suggestions that I didn't make.

Perhaps I should get fat so I could avoid this entire conversation.


Blogger marybishop said...

Dear Doc..worry not...

You get her to give up one obsession, she'll pick up one ever loses an addiction, just changes one addiction for another...

scary thought but true ==shmg

9:04 PM  
Blogger acumamakiki said...

I haven't posted a comment here yet, but I love to read your blog. The weight loss thing......I get many inquiries as to whether acupuncture can help with weight loss and it's the same thing. Yes, it will help you IF YOU HELP YOURSELF. Watch what you eat, exercise, stop taking in more than your putting out!
I generally won't treat people that want to lose weight because what they really want, is someone ELSE to be accountable when it doesn't work. When I was still a student and in clinical rotations, I had a patient that came for weight loss and after 2 months of nothing working, she insisted that I bring my supervisor in so that she could 'talk' to her about how my treatments weren't working. She was convinced if I would leave the needles in longer and not use part of the visit for intake, she'd see results. Never mind that she was eating too many carbohydrates but because she wasn't eating bread or baked goods, it wasn't carbs in her mind. The bag of rice cakes that she'd eat for snack each day weren't carbs. Nor was the spelt cereal. Once she got to talk to the supervisor and didn't get the answer she wanted, I never saw her again.

5:56 AM  
Blogger Doc NOS said...

MB: wouldn't it be terrific if more people were addicted to excercise? You'd start a run in the afternoon and you'd have dozens of people to run with and chat.

Acumamakiki: great name. The more I practice medicine, the more I realize our limitations. Like yeah, you had a huge heart attack and now that muscle is dead as a doornail. It must be the same for you: you can relieve pain with your accupuncture, but for some reason you are unable to make a person lose weight - a person who eats pounds of lard, trans-fats, and refined carbs while not doing any physical activity.

The sad thing is that this woman went to the next person down the block, who probably offered her 100% certain results. And she pain up. Anything to avoid reality.

11:10 AM  
Blogger acumamakiki said...

I'm always in awe of those 100% result promisers. What happens when you don't get the results? Very often the practitioner will have an excuse why it doesn't work although in the back of their minds, I have to wonder.Do they questioned the validity of their claims to begin with?

4:02 PM  
Blogger marybishop said...

I'd be happy if people just realized that they don't have to eat the quantity they eat (even the non-eating woman)and should taste food and enjoy it rather than shovel it in like a race.

11:55 AM  
Blogger Ern said...

That's the problem with Americans is that everyone wants a quick fix, or a magic pill. NO.SUCH.THING!

I actually heard these words in a commercial a few days ago: "Are you fat because you can't take stimulant diet pills for medical reasons?" No. You are fat for other reasons. You don't need to take speed (diet pills, same difference) to lose weight. You have to change your lifestyle. It can be done, but not easily.

4:16 PM  
Blogger Doc NOS said...

AC: I agree, but I'm not in awe of these people who offer 100% results. I simply think they're either idiots out to make an easy buck, or they do something like hair removal: it's easy to get 100% results when the task is simple. I got 10/10 fingernails timmed: I get 100%!

The shovel method should only be used by teenagers. Otherwise: not safe!

And I forgot how much this stuff plays into itself, thanks Ern, for reminding me. These idiot consumers out there are repeat victims. You didn't get thin on euthoria - which carries 100% results - then you need euphuria! So come out and get some.

7:14 PM  
Blogger acumamakiki said...

Only in awe as in audacity to promise such crap! I think it takes a lot of hutzpa to offer 100% on anything ~ the stakes are very high in those instances. Even with hair removal, the results aren't 100%. Even the pill.....the people that offer that sort of guarantee are just looking to make a quick buck and these types will always exist.

12:44 PM  
Blogger Doc NOS said...

Yeah, right on. Later,

6:19 PM  
Blogger marybishop said...

acumamakiki - so so so true! But as Doc says, people keep buying into this crap...anything other than being reasonable...they'll spend zillions of dollars on diet plans, but not a moment to consider -- in the words of my saintly departed mother: what doesn't go through the lips won't go on the hips...

8:25 PM  
Blogger laurenbove said...

Great post! Very funny and alarmingly ubiquitous.

However...if you take two topomax and call me in a month...

2:50 PM  
Blogger laurenbove said...

I'm addicted to excericise but I think it's a bad thing b/c if I don't go one day I fall into a beatmyselfup depression. I'm great at taking a good thing to a bad level. DOC, acumama is there a pin or pill for that? tee hee...

2:51 PM  
Blogger laurenbove said...

oh mother always told me: There's no such thing as fat starving people. It's sort of like MB's point.

2:53 PM  
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