Wednesday, July 8, 2015

Feed me, Seymour!

Poor Audrey II (the voracious blood-eating plant from Little Shop of Horrors). I completely identify with her/his appetite. Mine is insatiable. Truly. I can -- and have eaten a full turkey dinner with all the fixings while nursing an infected throat and then, half an hour later, wolfed down pie à la mode.

And then, after everyone had gone to bed, I had a little more.

I've written about my appetite before and about the poorly understood distinction between appetite and hunger. Ever since I was diagnosed with diabetes (about seven years ago) I've wondered why my doctors won't help me by prescribing an appetite suppressant, especially since, for me, the drive to eat seems to be disconnected from actual hunger.

Instead, they have prescribed statins (for cholesterol) and blood thinners in addition to the medications specifically to treat my diabetes. Meanwhile, my liver has developed "non-alcoholic fatty liver disease" (FLD) -- pockets of fat sprinkled throughout my liver that can lead to cirrhosis. The treatment for FLD is, you guessed it, to lose weight.

With the significantly increased activity since I retired and adopted Kane (our high-energy dog) I've managed to keep my weight steady within a 5-pound range, but have not lost weight. (Please spare me the 'muscle weighs more than fat' lecture. I've heard it. I don't think that accounts for my lack of weight loss.)

My appetite seems to increase in synchronization with my activity level. And my appetite is something like an obsession or an addiction. Indeed, to be successful on any of the diets I've tried, I've had to pursue them with an obsessive zeal. Because once I start thinking about food, god help me, I'm going to eat. Sooner rather than later. And it is not likely to be wisely-chosen food. I've tried so many diets and spent so many dollars on them that I am fed up. (Excuse the pun.)

And yet every primary-care doctor I've asked about prescription appetite suppressants has lectured me on diet and exercise.

It baffles me. According to the WHO report on global health risks, here are the top 10 risks for people in high-income countries.

List showing the following: 1. Tobacco use 2. High blood pressure 3. Overweight and obesity 4. Physical inactivity 5. High blood glucose 6. High cholesterol 7. Low fruit and vegetable intake 8. Urban outdoor air pollution 9. Alcohol use 10. Occupational risks
From the World Health Organization report,
GLOBAL HEALTH RISKS: Mortality and burden of disease attributable to selected major risks

I exclude physical inactivity as a risk factor for me because I do get physical activity for at least 30 minutes a day, usually more. I could do more, but I don't think I'm what they are talking about when they say 'inactivity.' I also exclude low fruit and vegetable intake because I eat a well-balanced diet. (Just ask my kids who think I'm a salad nut.)

But I still have four out of the ten risk factors (numbers 2, 3, 5, and 6). That's bad, folks. Especially when you consider that number 3, overweight and obesity, exacerbates or causes the other three.

In her New Yorker article, Diet Drugs Work: Why Won’t Doctors Prescribe Them?, Dr. Suzanne Koven quotes George Bray of the Pennington Biomedical Research Center.
Bray points to the work of Adam Drewnowski at the University of Washington, who has shown that obesity is, disproportionately, a disease of poverty. Because of this association, many erroneously see obesity as more of a social condition than a medical one, a condition that simply requires people to try harder. Bray said, “If you believe that obesity would be cured if people just pushed themselves away from the table, then why do you want to prescribe drugs for this non-disease, this ‘moral issue’? I think that belief permeates a lot of the medical field.” [Emphasis mine]
My body mass index is 27.6, which puts me in the 'Overweight' range, but I really don't need a fancy calculator to tell me that. But it is a number -- and we know how physicians like numbers! -- that indicates I am a candidate for appetite suppressants. If I let my self go and gained 15 pounds, I would be a candidate for gastric-bypass surgery.

I realize I bear some responsibility, but I'm doing the best I can and could use a little help over here.

I've decided to ask my doctor or my endocrinologist about appetite suppressants at my next routine follow-up. We'll see what happens.

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