The Obesity Epidemic Up Close

Australians are fat! I know it's a gross generalization, but the sad statistic is that Australia has an obesity rate second only to the fattest country on earth - the good ol' US of A. I know there's a fat-acceptance movement out there to make obesity less of a social stigma. However, even if it becomes socially acceptable to be fat, it will still be a huge problem for these people medically. From these two months of seeing patients, I've come across more fat patients with obesity-related problems than I care to remember. Both yesterday and today, I've been in surgery with two morbidly obese patients whose problems wouldn't have been there if they were within normal weight.

Yesterday I assisted in a circumcision. No, it wasn't like the routine mutilation of healthy baby boys for non-religious reasons that's still widely practiced in the US. This was a man in his late thirties with diabetes, too heavy for the operating table whose capacity was 140 kg. He had so much suprapubic fat that his penis was completely surrounded and swallowed up by it. Because of that, he couldn't keep it clean and kept getting infections. Circumcision would be part of the solution, but as long as he has that much fat around his penis, there will be plenty of skin folds for bacteria to grow and cause more infections. My job was to push down on the fat around his penis so the surgeon could perform the circumcision. If he weren't so fat, this would have never become a problem in the first place. I don't know, but if I were him, there might be a point when I might think, "Gee, I think maybe I should lose some weight," like when my penis turned into a vagina, or maybe when I could no longer pee standing up?

Today I watched a hip replacement surgery on a woman. Again, another morbidly obese patient. The anesthetist couldn't find a vein in her hands or arms to put in a cannula; they ended up putting in a central line through the jugular vein in her neck. Her obesity put her at very high risk for general anesthesia; a spinal block would be much safer for her. But it took two anesthetists to dig through her lower back to put in the block. Surgery was delayed by over an hour because of all the difficult prep work. To have adequate access to her hip joint, the surgeon had to make an incision twice as long as a normal one. Even with her hip wide open, the surgeon had to dig in there like he was working with his hands down a well. The surgery was successful, but she was at a higher risk for postoperative complications and her new joint wouldn't perform as well for as long.

Those two were just the latest of a constant stream of overweight and obese patients I've seen over the last couple of months. I know they are extreme examples. I don't want to blame the victims, but only if obese people are totally helpless victims. Yes, there are things, like genetics, that are beyond control of the person when it comes to obesity, but they've got to take some personal responsibilities - there are so many things people can change and manage to control their weight. Of course it's not easy; if it was, there wouldn't be overweight people. It's not about going on a diet to lose 5 kilos to fit into that dress for a wedding, it's about changing the lifestyle to gradually get down to a normal body mass index and keep it that way; it's about not losing a leg, not going blind, not dying on the operating table unnecessarily!

All right, I'll get off my high horse now.