Bariatric Talk

In a Long Island Hospital, two high school pupils were faced with transporting their Dad the hospital for breathing problems. The man weighed 500 pounds. The hospital beds and transport equipments were not made for such extreme bodyweight. The first episode occurred when the newly arrived patient had a bowel accident due to his inability to walk to the restroom and the lack of proper equipments to lift him from this stroller to the toilet seat. Let alone the fact that most hospitals lack motorized strollers that could help transport bariatric patients with least human effort.

The two adolescent girls were faced with an unprecedented dilemma. They were not raised or taught to see their father naked or care for his diaper and spilled feces. Their beloved father was humiliated by the helpless staff members. Female nurses are not that strong to move a heavy patient, nor does the hospital offer security to those who hurt their backs on the job. The panic and despair on the faces of the two young daughters is still itched in mind and for many years to come.

In another nursing home setting, a man in his late forties was transported to the nursing home due to having high blood pressure and his need for immediate care. The man was red pink, with large distended belly. Upon arrival and during placing him in his new bed, the man could hardly breathe or talk. He slammed into his new bed and immediately positioned his large belly to the side, while laying down in fetal position. While everyone else was busy getting him comfortable, the new patient telephoned a relative and started complaining about the scarcity of the food he was served. I could hear his voice requesting from the person on the other  end of  the line to deliver to him five steamy hot burgers with plenty of catchup. Within minutes after his telephone conversation, the man was already snoring into deep sleep. Myself, I had already been enticed into the steamy hot burgers with catchup. I could even smell their delicious zest in my nostrils. I bet that the man fell asleep immediately for the exact same reason: the  aroma of the steamy burgers. Aren't we all carnivores, to begin with?

While reciting those stories to a fellow of mine, he hinted to a movie that was made about a New York Bariatric hospital where overweight resident patients were bypassing the hospital security regulations and ordering pizza to be delivered to their hospital wards.

Obesity and Denial

Chris DeAngelo, a good friend of mine, once frowned at me for suggesting that he should suspend his school registration at the New Jersey Institute of Technology until he could get his body weight under control. Chris was already shooting over the 500 pounds. His breakfast consisted of two feet of Subway sandwiches loaded with every ingredient of Subway's menu. Chris's mom was a real Greek woman, filling Chris' tummy with plenty of sweet, cakes, and bakery. His dad was a heavy smoker, weighing barely 110 pounds.

At the age of 21, Chris could not fit in his tiny VW Golf. His weight was increasing faster than a growing newborn. After a fall and broken ankle, Chris still could not connect the two; his bodyweight and the bone fracture. He was a good software engineer, whose dream was to join the CIA after graduation. But, on graduation with a bachelor in engineering, Chris could barely walk or stay awake. His legs turned pink and black as he started skipping on showering and personal hygiene. Paradoxically, Chris was obsessed with planning and investing in securing his future after retirement. That was forty years down the road. On three occasions, Chris promised to join me in the Gym in order to deal with his overweight dilemma. He never made it. His excuse was lack of energy to get as far as the gym. He must stay close to the kitchen and the toilet. The only two places in the center of addiction to food.

Chris departed my life, yet another fellow with worse situation took his place. Joe Holbrook, a Jewish Russian friend who happened to get addicted to Vodka and good food. Holbrook weighed 550 pounds at the age of 65. He never slept in his bed for fifteen years. Sitting in his coach while watch the TV, 24 hours nonstop, was the only way for him to rest. Holbrook never even tied his shoes since his large belly has stood between him and his feet for many years. Holbrook's body profile was already shaped to his coach for as long as his close associates have known him. My suggestion to him for seeking immediate medical attention has never been received with any sign of comfort. Two major concerns were Holbrook's immediate reply. First, he has great and immediate attachment to a friend who drinks with him daily. Any disruption to such social setting was not tolerated by Holbrook. Second, he was ten years away from retirement with full pension. His fear of losing his job if he was to go for surgery was a more rational concern. Holbrook died at the age of 71 without benefiting from any pension. He had already surpassed the 600 pound mark.

But, top Olympic lifters are not an exemption from the perils of overweight either. The waistline to shoulder-width ratio of this weightlifter does not confer any health benefit despite his Olympic status. In fact, being extremely heavy afforded him the brief window of winning the Olympic medal when no sane person would risk his health for the sake of fake fame.

 In contrast, this lifter from the 1967 era, with very slim waistline and wide shoulders, has the greatest health benefits of breathing better and maintaining great muscle strength in proportion to his bodyweight. 

Similarly, Dimas Pyrros, represent the modern generation of top performance in weightlifting. With very slim waistline, great shoulder width and chubby quads, Dimas made history in the most formidable class of 83 kg.
   

Dogs are closer to top Olympic athletes as far as their waistline-to-shoulder width goes. Nature equipped that dog with the grace of agility and the aesthetic of motion. 

Even a clumsy dog could maintain such golden ratio between the shoulders and the waist.

Unmistakably, the slim waistline and wide chest make dogs jump with such great ease with the slightest fear. All the dog needs is to have large lungs and strong heart that could pump great amounts of blood and oxygen to his thighs. The strong abdominal muscles amplify the heart pumping and give the dog the extra energy boost needed to jump strong, high, and fast.

Body Mass Index vs. Waistline

Almost everyone I knew agrees that the BMI is simply a rough, crude index to second guess the general health of the individual. Athletes are heavier than non athletes, due to the heavy bone density and higher muscle density, compared to fat. How about the perfect BMI in heavy smokers with emaciated physique?

Nevertheless, an index is still a tool of judging health and disease, based on sound physical principles. The Body Mass Index signifies the ratio of the mass of the body to the surface area of the body. It is defined as BMI = bodyweight (kg)/ square of height (meters). Since the square of height is very closely associated with the surface area of the skin, the BMI describes the heat transfer from the body mass through the skin.  Example, if you take a cube of side length L, the ratio of the mass of the cube to its surface area is (LxLxL)/(6xLxL). That gives L/6 (at constant density). Where as a sphere of diameter L has the exact ratio of mass to surface area despite the smaller size of the sphere. Thus, the rounding of the sphere lends its mass greater access to the surface than in the case with the cube.

The waistline has been gaining greater significance as an index of the state of health as it represents the immediate stress on the vital organs that control the blood circulation and gas exchange. A greater waistline signifies strained kidneys, strained lower back, embarrassed lungs, and overburdened heart. Thus, the greater waistline affects the flow of fluids and gases within the lungs and belly, as well as the flow of nerve signals between the brain the lower body.

Greater waistline is closely associated with development of high blood pressure, diabetes, hyperlipodosis, heart attack, and stroke.  Yet, Both BMI and waistline is directly related to the flow of energy from the pumps (heart and muscles) to the terminal tissues of the body, in addition to the dissipation of energy of metabolic burning.  For example, an obese individual would fare better in cold weather than in hot weather, due to the limited surface area of the overweight person to his/her inner body mass. In birds, geese could tolerate this freezing pond better than birds that lack thick fat coat under their skin.

The waistline is a true index of the lifestyle of the individual. The belly gets congested and crowded with excess of food remains and fat when the individual consumes more calories and burns less. The crowded belly spills its pressure over the surrounding organs. The lower limbs suffer more of the tourniquet squeeze of the belly. The weakened limbs limits the mobility of the individual with great waistline. The limited mobility worsens the congestion of the belly. The vicious circuit continues, with more organs suffering from the crowded and distended belly. 

Things get really nasty when the individual with troubled belly attempts to alleviate his suffering with alcohol or smoking. Alcohol aggravates the motor function of the locomotive limbs, which were already strained with distended belly. Smoking deprives the blood from its oxygen carrying ability and thus worsens the strength of the limbs to endure mobility. With such double insult, with alcohol consumption and cigarette smoking, the individual with large waistline digs deeper and deeper into illness and poor health.

Now, the crammed belly induces pressure trauma on the kidneys, spine, and blood vessels in the vicinity of the destined intestines. The trauma causes a vicious circuit of healing, scarring, weakness, and shrinking of tissues. 

On the opposite side, exercise improves circulation and breathing and assists the belly in riding itself from the crowing food remains or fat deposits, or enables the belly to function better with such burdensome intruders.