Fat (14 page)

     I laughed.  It was a funny point.  Misinformed, though.  Anyone can eat through their banding if they don’t try to make any changes.  The band surgically shrinks the stomach and that smaller stomach gets full faster, but the feeling of that artificial satiety can be overridden, just as the normal feeling of satiety was overridden for so long to eliminate the sensations of normal satiety and unleash the abnormal obesity that required the banding.  When that override happens, food backs up and the esophagus becomes the extension of the stomach.  Like sewers becoming full and backing up into the pipes of your home.  It’s called overpacking the pouch.

     “Xander, unfortunately, the band is not the end-all cure-all for obesity.  It’s just a band-aid until you can figure out how to regulate your own food intake.  It’ll help you in the short term, but if you don’t work at controlling your diet, even the band won’t fix everything for the long term.”

     “Yeah, I guess you’re right, Dr. Grant.”

     “Hey, three hard tacos is a decent portion.  You’re doing okay.  Are you exercising?”

     “Not yet, my back hurts too much.  Even walking kills.”

      That pain is the body trying to hold onto being sedentary.  Of course it’s going to hurt when you're a blob trying to transition from sedentary to active.  It’s supposed to hurt.  It’s supposed to be hard.  Or else everyone would be running marathons instead of gorging on marathon buffet sessions every day.  That’s part of the reason so many fall deeper into obesity – because it's hard to stay in shape.  It requires daily effort with negligible immediate benefits and with no real end.  On a day to day basis, running a few miles and eating healthy doesn’t feel any better than ice cream and a nap, so it becomes easy to slide out of shape.  Most daily activities just require the ability to sit on a chair for long periods of time, so the sneaky loss of physical fitness will not be noticed because the body is never cardiovascularly taxed to test its limits.  If that daily maintenance is neglected, the work of staying in shape accumulates, and soon it becomes a mountain.  The cumulative massive effort it now takes to overcome that mountain in the way of changing from an obese slug into a fit machine, only makes the benefits and end seem further away, so the defeatist mind sets in and the effort never get undertaken and instead the mountain just gets bigger.   

     Looks like Xander had his food plumbing reorganized just so he could stay sedentary and still lose weight.  His fat ass is half-assing it again.  Sure, any movement away from morbid obesity is technically getting healthier, just as eating a Big Mac meal with a diet coke is technically healthier than a Big Mac meal with a chocolate shake, but the ultimate goal is to be healthy and just getting skinnier is not always healthier.  Runway models that strut Versace and Prada are certainly skinny, but they likely exist on diets of cigarettes and caffeine.   Women on the covers of
Cosmo
and
Redbook
always look fit and shaped with lean muscle, though they’re helped with botox, a pre-photo shoot crash diet and photoshop. 
Men’s Health
displays a cut-up freak of a muscled tank on its cover monthly, suggesting him as an example of the possible results of following its articles espousing the best diet and workout tips, but he likely just finished a cycle of performance enhancers and has a costume of a body with bad acne on his unseen back, a catalog of damaged internal organs and shriveled peas for testicles.  Too much is Hollywood magic.  Hollywood owns the image of attractiveness and it is a skinny one, regardless of fitness.  Everyone wants to be attractive at some level, so people try to look slim at all faddish costs.  Eating only meat doused in butter and equating Wonder bread to poison?  Drinking nothing but maple syrup, cayenne and lemon juice for two weeks?  Using a stainless steel tube to suck fat out of an incision like a wet-vac cleaning up drunk vomit?  Everyone wants a shortcut to the appearance of health.  There is none.  But, because of frank laziness, the goal has become only about looking superficially healthy rather than doing the work to actually be healthy.   

     “Well, you have to start exercising.  Just start real light, like stretching or even walking for five minutes at a time, then if you can do that, then try ten minutes, then fifteen, then you can keep slowly increasing your activity and intensity so you’ll be running a marathon in no time.”

     Xander laughed, “Me running a marathon?  That’s crazy.”

     “It’s not crazy.  Losing weight is great and all, but you should really be focusing on getting healthy.  It is very possible to be fit and still be a little overweight, just like it is possible to be out of shape and really skinny.”

     “Really?”

     “Who do you think is healthier: a skinny guy that sits on his ass all day, or a chubby guy that just ran the Chicago marathon?” 

     “I hear what you are saying, but it’s also hard to find time to exercise; I’m so busy with my business sometimes.”

     “How many dinners have you skipped this week because you were too busy?”  I looked down at Xander’s tacos. 

     “Um, none, I guess.”

     “If you can set aside thirty minutes every day to eat, you can set aside thirty minutes to exercise.”

     “Yeah, I guess you’re right, doc.”

     “It’s just priorities.  What do you prioritize more, eating or exercising?  If you’re obese, the priorities need to be flipped.”

     “Yeah.”  Xander took a bite from his last taco and chewed slowly, letting his teeth and saliva disintegrate the bite into mush before sending it down to his pouch. 

    “Diet without exercise is like that taco without the shell.”

     Xander laughed as he popped the last bit of the taco into his mouth.  “You’re right, doc.  Man, you are right.” 

      I am right.  It’s good advice.  Not many people will use busy schedules or stressful days or being too tired as reasons to completely skip meals consistently.  Most will drop what they are doing at almost any cost when they are hungry to grab a quick bite of anything – even if it is just miscellaneous meat in a fried corn-like shell topped with iceberg shreds and cheesy strings. 

     That taco without a shell metaphor could be dripping with a little bit of personal hypocrisy, though.  Here I am, tossing advice about diet and exercise at a Taco Bell, just before I am about to eat three tacos and a burrito, which I have eaten almost every Friday for a few years now, and just before I then go home and not move from in front of the TV for hours.  I am giving all that advice even though pizza is my absolute favorite food, of which I will eat three-fourths of a large deep dish pie every sitting, with cold leftovers for the next morning’s breakfast, at least once a week.  And I eat at least one chocolate covered something every day, most days it being chocolate covered chocolate in chocolate sauce.  And I can never turn away from a well-crisped basket of fries.  Doctor heal thyself?  A good thought, only I don’t need healing.  This is not hypocrisy because no one is demanding perfection, just moderation.  I may have some bad dietary habits, like any average guy (a life never eating fries or chocolate is no life to me), but I don’t let those habits ruin the rest of my life – I force myself to work out hard four times a week, mix in some salads before dinners, pass on the donuts most mornings and will stop at three-fourths of a pizza rather than downing a full one by myself.  So I have been able to stay healthy through the years.  Admittedly, it has taken more effort as I have gotten older, but it’s what I have to do for my health so I do it.  The fact that my less than ideal eating habits can still be part of a sufficiently healthy lifestyle just goes to show how far from moderation someone has to go to get morbidly obese.   If someone can maintain relative health even with mediocre eating habits, let them be, but if eating habits become problem eating habits as shown by massive weight gain, then it’s time to shuttle current habits and change.  But that potential change is too much of an obstacle for most people – it becomes a horrifying prospect to have to overcome terrible eating habits ingrained by obese parents since childhood who allowed Little Chunky to eat whatever in whatever quantity, to overcome comfort food being set as McDonald’s and Twinkies, to overcome the lifestyle of having daily activity barely rising above inanimate object status, or to overcome the anticipated discomfort of the regular cardiovascular exertions needed to maintain health.  But, they have to be overcome.  And that is all doctors are trying to get across when harping about diet and exercise: just care about your health the right way. 

     I had a colleague in residency named Barry that weighed over three hundred pounds.  His white coat looked like a bed sheet.  Yet, his patients never laughed in his face when he told them they were overweight and offered advice on how to lose weight.  That was because he always gave his standard lecture on portion control and exercise with self-depreciation and in a tone that he was giving the advice with only their best interest at heart.  Barry was just trying to get them to care about their health, even though he wasn’t caring too well for himself.  I guess his patients still figured the advice was good, regardless of whether the giver followed it himself.  Good advice is good advice, and most people already know what good advice about their health will sound like – an iPod playing continuous loops of “eat better and exercise more” inside of a blowup doll is likely just as effective as any nerd in a white coat.  Current Xander could take advice from even Barry because Xander needed to lose about seventy-five pounds more to become close to the super-sized Dr. Barry.  That hit of the harsh truth in the form of advice can only acceptably come from a few sources, so reality is rarely given its needed opportunity, and the childish freedom to call someone fat to their face soon becomes lost behind social tact so obesity becomes easier to ignore.  Even though most of my best friends are overweight, I would never toss them any unsolicited advice because being told to lose weight by even your best buddy will quickly turn that buddy into a distant acquaintance.  I have just accepted the fact that our men’s league basketball team is now mostly a squad of post-NBA TNT Charles Barkley’s and the team is getting slower, jumping lower and becoming closer to being winless every year.  There are only a few windows to get across the sentiment to care about personal health the right way, and if those windows are missed, the fight for fat self-awareness can be lost forever.  Doctor visits are a window.  Solicitation for advice is a window.  This Taco Bell encounter was a window.  I rolled into this restauarant just as the window opened.            

     “Alright, Dr. Grant, I will try to get active.” 

     “Don’t try, just do it.  I hate working out just like anyone, but I do it anyway.  Look at me, I’m a decrepit old man and I still work out almost every day.”

     “Come on, you’re not that old.”

     “As old as your mother.”

     “Damn, that is old.”  Both Xander and I started laughing.  Xander added, “Man, I wish you were still my doctor.”

     I slowed my laughter.  That hypothetical chilled me.  It is patients like Xander, people who were making themselves sick by one of the “too-much’s” – eating too much, drinking too much or smoking too much – that made me choose pediatrics as my specialty in the first place.  Pediatrics is about keeping kids healthy enough to live life; adult medicine is about slowing the progression to death.  It’s just hard to empathize with an adult that is the cause of their own morbid health.  The too-much’s are like skydiving.  Is a skydiving death a tragedy?  It may be sad for their loved ones, but it is not a tragedy.  Skydiving’s appeal is the adrenaline rush from tempting death, so when death answers now and then, it is not a shocking event.  If some competent person is eating four thousand fried calories, drinking a couple cases of Keystone and smoking a carton of unfiltered every day, it is no tragedy when they heart attack out of this world.

     “How is your mother doing, Xander?”

     “She’s doing well.  I am actually just grabbing this quick dinner before I pick her up for our Friday movie night.  We’re going to see the latest Harold and Kumar.  She loves those kinds of movies.”

     “That’s hilarious.”

     “You should join us.  Mom would love to see you.”

     “No, I can’t. Thanks anyway, but I already have some plans tonight.”  I looked at my wristwatch for effect.  “Ooh, for which I am extremely late.  I better get going.”

     “Well, it was good seeing you, Dr. Grant.”

     “Good seeing you too, Xander.  Say hi to your mom for me.”

     “Will do.”

     I turned towards the counter, as Xander dug into taco one of three.  My mouth watered thinking about my order of three tacos and a burrito.  Maybe even a Mexican pizza tonight.  Now there’s a fusion item.  Where else can I get an Italian-Mexican entree?  The smell of toasted processed corn shells and over-seasoned meat was comforting aromatherapy.  I love Taco Bell.

DEAD

     “I am so sorry, Kate.”

     With those words, she collapsed into my chest, sobbing delicate mews.  She smelled lightly of springtime.  Her body felt soft and warm like the insides of freshly baked French bread.  She was perfect in formfitting black from head to toe.  If you could ignore the casket in the front, all these bright flowers and background classical music made this room feel like a Sunday afternoon in the park with the Chicago Symphony Orchestra.