Obesity in Patients in the E.R.

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Obesity Patients




By Philip L. Levin, MD, Copyright 2010


I was a skinny 125 pounds when I was nineteen. I gained a pound every year for the next thirty years, so by the time I was fifty I was approaching a plump 160. My cholesterol and triglycerides were climbing just as fast. The good thing is that even a small amount of weight loss can make a huge difference. With a determined diet and exercise program I took off fifteen pounds and my cholesterol levels returned to normal.

I see the effects of those extra pounds on my patients every day. Hypertension. Diabetes. Arthritis. Skin infections. Varicose veins. Sleep Apnea. There's a strong relationship between being overweight and certain kinds of cancers; specifically breast, uterine, colon, kidney, and esophageal cancer. Being overweight with diabetes and hypertension is so common nowadays, doctors have coined a term called “metabolic syndrome.” In metabolic syndrome patients have a much higher incidence of strokes, heart attacks, blindness, and kidney failure, the results of the interactions of obesity, diabetes, and hypertension.

In my E.R. patients, there are several medical problems specific to overweight patients. The extra fat under the skin makes procedures more difficult, such as starting IVs, intubating, and invasive surgery. Some of our diagnostic equipment, like the CAT scanner and the MRI machine, have specific weight limits.

I remember when I started out in family practice patients would come to me for diet pills. They would tell me, “It's not my fault I'm fat, I just have a slow metabolism.” This tends to be a self-fulfilling philosophy, in that objects at rest tend to stay at rest, and those in motion stay in motion. The best program to fight obesity is a regular exercise program meshed with a good diet. Of course, there are certain diseases that do cause obesity, such as low thyroid levels, and your doctor can check these out for you. Genetic and environmental factors play some part in the development of obesity -- children of obese parents are 10 times more likely to be obese than children with parents of normal weight.

Nowadays the most fashionable and effective treatment for obesity is surgery. There are a few different techniques, but basically the surgeon cuts out a section of the stomach or staples it closed, so that the person feels full sooner. This has been found to be the safest and most reliable treatment plan. There are some side effects, including a few nutritional problems and surgical complications, but the advantages to the person of losing a lot of weight has been found to outweigh the risks.

While no one comes to the E.R. just because they're obese, they often show up due to its effects. To help avoid being one of my patients, consult your doctor, trim down to your desired weight, eat right, exercise daily, and enjoy a long healthy life.


Philip L. Levin



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