Lose that weight...

I got upset in my problem based learning (PBL) session the other day. For those who don’t know, PBL involves receiving a sample case from a fictitious patient who presents with certain symptoms and figuring out what disease the patient might have. I love this way of learning. It complements the lectures that sometimes make me want to gouge out my eyes with a dull spork, but I digress…

This week, we assessed the symptoms of a 55-year-old African-American female who presents with symptoms of diabetes mellitus (i.e., frequent urination, yeast infections, excessive thirst, etc.). While she presented to be an “overweight” (5’4, 170 lbs) female, she had a blood pressure of 124/80, which is regular. This puzzled some of my colleagues who expected the patient to automatically have high blood pressure because of her overweight Body Mass Index (BMI). This assumption (among others) triggered a thought I must share with cyberspace.

One can’t assume a patient is automatically unhealthy simply because a he or she is overweight. Being overweight doesn't ruin your health. Ingesting excessive sweets/sodium, not exercising, and smoking ruin your health. Now might there be a problem with her blood pressure? Perhaps, but I feel very uncomfortable assuming her issues result from her weight alone. In fact, a 2005 study showed that those in the overweight range (of the BMI) are at a lower risk of death than those who are considered to have a “normal weight.”

For me, this poor assumption is analogous to discussions on evolution. Many people who haven’t studied biological anthropology may incorrectly assume that men evolved from monkeys, yet they didn’t. Both men and monkeys evolved from a common ancestor (most likely from the early catarrhini family). Juxtaposing that to obesity and diabetes, many incorrectly assume that being "fat" causes diabetes. However, how would that explain the sizable number (no pun intended) of larger people who eat well, run, and are in very good shape (and don’t have diabetes). Living an unhealthy lifestyle (drinking pop/soda, eating fast food, not exercising) can lead to excessive weight gain and can lead to insulin resistance (diabetes).

I worry about this because focusing so much attention on larger people can shunt attention away from “normal” size patients. I spoke to a slim medical student about this, she confessed that many doctors overlook her eating or exercise habits because they assume that because she’s skinny, she’s in good shape. I, however, have always received tons of criticism from my doctors for my “overweight” BMI until I tell them that I lift weights, run 2 or 3 times a week, and was on the swim team in high school. (I also have a 32”/33” waist.)

As we delve into our patient’s social history, we find out that she never exercises, consumes tons of sugary soft drinks and fried foods. Bingo! We have a problem.

Now the work must continue. As I prepare a presentation on the etiology (causes) of Diabetes Mellitus Type II, I plan to erase the words “fat” or “obese” and replace it with “poor nutrition” and “lack of exercise.”