I turn around, smile and wave to the next patient. He has an open and kind face, with big brown friendly eyes.
‘I can’t see you!’ he shouts.
Ah yes, this patient is blind. ‘Okay sir!’ I yell back. ‘Be with you in just a minute – we’re having a look at your notes.’
He’s a smart man in his 50s, with a lovely attitude and big smile. His large head supports a ginormous pair of glasses, which confuses me. Do people usually wear glasses when they can’t see? Maybe he’s got partial vision.
His neck isn’t very visible, with large folds of fat storage falling down to his chest. His abdomen is quite simply huge – a massive pushed out beach ball with his breasts tipping over the sides at the top. His legs by comparison, are thin and spindly; sporting a pair of compression stockings that I’d been told in my teaching the previous day absolutely don’t work.
His blindness is the result of type 2 diabetes, an illness that plagues everything he does. Type 2 diabetes is a nasty one. I get the feeling sometimes that people think you can just take a pill for it and it’ll go away, but it’s rarely that simple. Type 2 diabetes gets your networks of small blood vessels into trouble. Like the ones at the backs of your eyes, and the blood vessels in your kidneys. It also results in your feet going numb, causing giant ulcers to develop. Sometimes people need a toe, a foot or half a leg removed because of it simply dying away.
As we chat more to this lovely man, we learn that he’s hoping to walk more. Maybe switch to a zimmer frame for stability, hopefully working up to a few steps to he can get around the house. Continue to care for and feed himself.
I look down at his urine pooling in a little bag at his ankle. It’s quite red. Looking in his notes, I see this man has chronic kidney disease. And heart failure. It must be hard work for his heart, pushing blood to all that extra adipose tissue. Gosh. He’s on a lot of medication.
As he chats away to us, he mentions his diarrhoea. It’s normal for him, he says, after he had his gastric bypass. He’s got only a short gut now – one that doesn’t absorb as many of the nutrients, which instead find themselves going straight into his poo.
What’s this man’s outlook? Will he be walking in a year? How long will his heart hold out? His kidneys?
He’s an interesting guy, full of stories and smiles. He deserves everything. He deserves life.
So why is he like this? My heart breaks for him. Despite everything the NHS has done to help him, he appears to be slowly being killed by a Western diet.
After only a short time in medicine, I’m already crushed by how many of these patients we’re letting down. Sometimes you see them on the Friday, and they’re not there by Monday morning. The fat on their chest weighs heavy, sometimes too heavy for them to expand their chest and breathe against. The fat in their cells causes the genome to switch into an inflammatory mode – making cancers and infections more likely.
I feel so lost with how I can help. All I know is I have to do something. People seem unaware of what obesity might do to them one day. I was, until I saw inside hospitals. Most of us seem preoccupied with how fat makes them look, rather than what it’s doing on the inside. I just want to be clear at this point, that every single human is 10/10 for attractiveness. We’re all sexy. We don’t need to worry about that shit.
What we can do is eat plants, eat plants to live. If it’s not a plant or a fugus, if it’s not obviously something edible, we shouldn’t bother buying it. I mean honestly, what the fuck is a kit-kat? Or milky way? Or a microwave meal? What sort of wacky corporate bullshit has convinced us to open a plastic packet and eat the congealed factory-produced contents within?
I don’t have the answers. But I’m ready to listen. If you struggle with weight, I want to hear your story.
There’s a lot of talk in the press at the moment about ‘medicalising obesity’. Talking about it as a medical condition, one that we prescribe for and follow as a GP. Part of me is tempted to think this could help. I don’t know what people who struggle with weight gain might think about this, though. I’m worried that it’s not that simple. Food is so intertwined into our culture and social expectations. And then there’s the immense cloud of mental health issues that drive us all to have unhealthy relationships with food, and then there’s poverty and the addictive nature of certain foods. We need robust ways of helping people. I’m sure people do not choose to become obese, but they can choose to eat obesogenic foods. Are these the same thing?
I’m not sure. But over the next decades of my life I want to help people like this gorgeous patient with the big friendly brown eyes I met in hospital. Nobody should have to live with the awful health affects of obesity. Nobody should die of obesity.
The patient I’ve spoken about here is fictional, based on the many patients I have met so far in hospital.