Sandy Brown, MD


May 02, 2008

In the middle of lunch the other day, I was approached by an attorney acquaintance (who was not my patient) looking for some medical advice. "Mind if I run something by you?" Albert asked. Ordinarily I don't, but I had run a legal question by Al a few years earlier, and he had sent me a bill for 125 bucks. Payback time, I mused, until I remembered that we doctors can't charge for our time like other professionals. There should be a code for curbsides, I thought. Why are we always giving free advice?

"You know I'm a diabetic," Albert began. Actually, I did not, but I was not surprised to learn, given his endomorphic body habitus, that he was also on medication for hypertension and hypercholesterolemia. "I know I'm obese," Albert went on, "but I can't seem to lose weight, and I can't get my diabetes under good control. My doctor wants me to consider having bariatric surgery. What do you think of that?"

I told Albert that that kind of surgery was extreme for people who weren't morbidly obese and suggested that he try harder to eat less -- although I knew that was easy for me to say, not having a weight problem. "Look," I said half-facetiously, "the end result of bariatric surgery is that you're full after a few bites, so why don't you just take a few bites and avoid the procedure? If that doesn't work, try wiring your jaw shut." On a more serious note, I said, "You know, Al, I really don't think that obese people allow themselves to experience hunger." I then added some thoughts about food being the most abused substance in this country, and that obese people really don't get into the taste, texture, and sensations when eating food. Furthermore, they don't even like the foods that they overeat, and they don't pay attention to and are not conscious of what they are eating most of the time. I also said that I didn't think thin people ate as much as fat people and that thin people didn't eat when they were bored, angry, or frustrated. Albert listened passively, and then excused himself so that I could finish my lunch.

A few days later I ran into Al at a meeting and he said, "You know, Sandy, something that you said to me made more sense than anything anyone else has ever told me about being overweight." "You mean about wiring your jaws shut? Don't forget to carry a pair of wire cutters," I joked, unsure of what was coming next. "No," Albert said. "I mean what you said about eating so as not to feel hunger. I didn't realize how much I didn't like feeling hungry. I can tolerate pain and other unpleasant sensations, but not hunger pangs. I don't know why exactly, but you made me see that and I thank you for it."

Helping Al see an aspect of his weight problem more clearly made me feel good about myself, and about the thought of asking him for pro-bono advice the next time I needed legal counsel!

Has anyone had experience or had success in getting obese patients to lose weight with other forms of counseling? If so, please add your comments, opinions, or questions on our discussion boards at $$boards$$/forums/.29d6dfb6/0


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