In this twenty-first century date
Americans are quite overweight
It cannot be beat,
This food that we eat
But fat is not inevitable fate.
A lot of my patients over the years have had problems with overweight.
Twenty-first century Americans have access to the cheapest, richest foods in the entirety of human existence and things just keep getting richer and cheaper. On the one hand this overabundance of convenient calories brings political stability, as well-fed people don’t really want change. On the other hand Americans are getting fatter and fatter.
It’s hard for me to write about weight loss because I was a fat kid. Most people who know me might agree I could lose a couple of pounds and can’t imagine me seriously overweight, but I was. When I graduated high school I weighed fourteen pounds less than I did when I was thirteen. Though most people see me as slender, maintaining my weight has been a struggle eased by love of exercise.
During the weekend we had a visit from Jeff and his wife, Lindsey. Jeff had lost a moderate amount of weight over a couple of years the last time I saw him. He’s kept up with his program, pounds have continued to drop off, and when he stopped by he looked great. His eyes were clear, his skin glowed, and he looked four years younger. He’s now lost over a hundred pounds
I’ve also been following a blog, by a friend and patient, Charlie: heavythoughts-lightliving.blogspot.com/ He’s now lost a hundred pounds. He writes well and eloquently about how he got to be overweight, how he’s lost the weight, and what the weight loss has meant emotionally.
Many years ago I had a Jewish patient who was wandering through life. When he came to see me for new onset diabetes he was working in a dead-end job which did not require any of his considerable intelligence. At that time he was more than a hundred pounds overweight. After a short hospitalization and some rudimentary education about diet and exercise, he started keeping kosher, and the weight started to come off slowly. When he’d lost fifty pounds he realized his work would take him nowhere and he started having friction with his boss. He began making school plans, and when he’d lost eighty-five pounds he got himself fired, commenced to collect unemployment, and left town. I heard from him briefly a few months later, when his weight loss totaled one hundred pounds. His diabetes had disappeared; his blood pressure was under control and he was working towards a degree.
When topiramate (brand name Topamax) came on the market for migraines and seizures, the drug rep mentioned the side effects of weight loss and appetite suppression. At that time my first choice migraine treatment involved no medication, and my first choice medication then, as now, was generic propranolol. After the drug had been on the market a year I met an overweight patient with seizures and migraines who, for various reasons, needed to change medications. I wrote the prescription for a Topamax starter kit. A month later the seizures and migraines were gone. At six months follow-up the patient had lost 87 pounds and had remade herself with a new color scheme, clothing pattern, speech rhythm and gait. She returned to school and got out of a bad relationship.
Though topiramate has helped some people lose weight, I’ve never seen another patient lose that much since, but it’s a good migraine drug.