The Life and Death of Lovable Sam – A Cautionary Tale
Section titled “The Life and Death of Lovable Sam – A Cautionary Tale”When Sam first came to see me, he weighed so much he broke the step at the end of the exam table. He was a sweet man and it was embarrassing for him.
It is not news that obesity is a scourge. I see medical problems linked to overweight in my office every day, and I see the heart-breaking struggles people go through trying to get back to a lower weight. Today I want to tell you about how bad it can get. But I also want to suggest how we can prevent the sad results. It starts with children and with the parents and grandparents who raise them. But first, let me tell you about Sam.
Treating Obesity the Hard Way
Section titled “Treating Obesity the Hard Way”Sam and I worked together on his weight problem for several years. We'd tried appetite suppressant drugs and he had completed two gastric bypass operations. The first procedure restricted his eating capacity so much that he couldn't eat at all, and he'd undergone several painful procedures to dilate the opening between his esophagus and his stomach. Once he had gotten past that, he found himself unable to comply with the nutritional recommendations given by his surgeon and promptly regained most of his weight.
It's a well-kept secret that after gastric bypass surgery the individual must relearn how to eat. Sam had been instructed to slowly reintroduce food, starting with a week of liquids, followed by a month of foods that have been run through a blender, then two months of soft foods. After gradually introducing firmer foods into his meals, he still needed to avoid spicy or crunchy foods such as nuts, popcorn, tougher vegetables (broccoli) or meat with gristle. No soda, carbonated beverages, or bread. Even after this three to four month initial phase, Sam was asked to limit himself to several tiny meals, only half a cup of food at a time.
Weight Loss Surgery – Not a Magic Bullet
Section titled “Weight Loss Surgery – Not a Magic Bullet”Gastric bypass is not a magic bullet. Depending on the medical center and the procedure, roughly half of patients need repeat surgery of some type. While weight loss a year after surgery can be impressive, most people slowly regain the weight over the following 10 years, and average weight after that period of time runs from 30 to 40 pounds below pre-surgical weight.[1]
Sam was one of those unfortunate individuals who had a particularly difficult time with the surgery, hence the complications and the requirement for another. After the second surgery Sam got up on my examination table with a little less trouble, and there he recounted to me with his usual cheerful, considerate, and almost apologetic manner his current difficulties. At one point during the visit he sighed, let his shoulders slump, and looked me in the eye. “Doc, I just can't stop eating. I know it's killing me. I feel bad for everyone I love and who loves me, but I just can't stop.”
The Dopamine Connection
Section titled “The Dopamine Connection”At the time that Sam said this, studies were just coming out that gave some hint as to why he had to eat. First done on laboratory animals, subsequent studies on humans have confirmed that dopamine, a neurotransmitter critical to our sense of well-being, plays a major role in appetite and weight gain.[2] When dopamine levels are adequate, we feel content. But let those levels fall too far and we will do almost anything to make them rise. For example, the addictive drug methamphetamine gives us a temporary dopamine rush. This temporary fix is followed by so a drastic a fall in dopamine that people will find themselves stealing television sets, robbing others and neglecting their children – anything it takes to get those dopamine levels up.
When Food is a Drug
Section titled “When Food is a Drug”Similarly, the more weight a person gains the more their baseline levels of dopamine fall. Eating will provide a temporary rise in dopamine and the person will feel all right for a while. But let those levels fall, and even though a person like Sam knows that food has become a poison for him, he is terribly driven to eat. Only food or an amphetamine will allow him to escape the dreadful feeling caused by inadequate dopamine.
This is why amphetamine in all its forms has long been used to help people lose weight. Amphetamine kicks dopamine to higher levels and the appetite goes away. Can the person give up that amphetamine and still maintain a normal weight? That's not so easy, hence the stringent legal controls on prescription amphetamines.
What Sam weighed at his maximum is not important. All that matters is, eventually it was enough to kill him.
I miss Sam. Everyone who was in our office at that time misses him. He was a loving and lovable, kind and intelligent human being.
A One-Way Trip
Section titled “A One-Way Trip”The lesson here is that most often, weight gain is a one way trip. People can back up 10 or 20 pounds if they work hard, but once that dopamine metabolism gets out of whack, it tends to stay out of whack. To be sure, dopamine isn't the whole issue; there are other physiologic and psychological factors that cannot be covered in this newsletter.
A Gift of to the Next Generation
Section titled “A Gift of to the Next Generation”I will do everything I can to help adults with weight issues in their struggle to get leaner and more healthy. But what I would truly like to see is parents stopping childhood obesity before it starts. The reason that parents shouldn't let children get fat is the same reason that parents shouldn't let children use addictive drugs. Excess weight and addictive drugs place a ball and chain on that child which will not go away when the child reaches the age of adulthood.
Here are six things you can do to protect your child from obesity.
- Model the behavior you want to pass on. One of my patients got serious about her own weight and changed how she shopped, cooked, and ate. For the long haul. Without any lecturing or cheerleading, both her husband and her son slimmed down as well.
- If a food is not healthy for your child, it shouldn't be in the house. If you wish to stock snacks, buy fruit, hummus, or other healthy foods.
- Make sure your child attends all classes at school including (especially) PE. Larger people need to be even more active. If your child is large, be sure he or she engages in athletic activities in addition to PE. When you yourself walk or bicycle to nearby places, this speaks louder than any words you can use.
- Blame doesn't work. Don't turn lifestyle management into a power struggle that the child can only win by gaining weight.
- Don't use food as a reward for anyone in the house.
- While it is not true in every case, children with weight problems more often come from parents with unresolved emotional and interpersonal issues. If you think this applies to you, take action.
Friends are Important, Parents are Irreplaceable
Section titled “Friends are Important, Parents are Irreplaceable”Your children will have many friends through their lifetime, but only one set of parents. You have responsibilities a friend will never have. I am most grateful for my own parents, who never worried that I might or might not like them, and sure enough, sometimes I didn't. But at this point in my life, my brothers and I are very grateful that they pushed us to do things we otherwise would not have done.
Many parents can and do see themselves as having a responsibility towards their children. If that's you, then you eat healthfully. You have found some source of physically enjoyable activity. Your child is lucky you are their parent.