Modern Medicine: An overweight lady stars in the popular press


There was an item a few years ago regarding a 235 kg lady in Bangkok. This lady had become ill and they had to transport her to the hospital by removing the railing and evacuating her via the balcony. This is, of course, an extreme example of obesity, called “morbid” obesity. However, you do not have to wait until you weigh 200+ kg to be at risk.

The western world currently has an epidemic of obesity, and guess what, the Asian world is rapidly following. Forty years ago, it was rare to see an overweight Thai. Not any longer. What has happened?

Quite simply, our diets are far from healthy, and that includes both food and drink, especially the kinds of drinks that come in dark green or brown bottles. I am sure you know the types.

The problem here is the fact that being overweight puts a strain on the cardiovascular system, which sends the blood pressure up. That in turn affects all the organs and systems, and everything goes pear-shaped from there on, as well as your body shape.

You are entering the world of Syndrome X. Unfortunately Syndrome X, which is otherwise known as the Metabolic Syndrome, is a classic example of what we medico’s call ‘co-morbidity’. This is the situation where one disease process or ailment affects, or “X”aggerates, another disease process you may have. In these situations, the combined effects can be life threatening. It is also a syndrome possessed by around 40 percent of adults over 40.

For example, the combination of diabetes and obesity is a disaster waiting. The combination of diabetes, smoking, obesity, hypertension and high triglycerides (blood fats) is cardiac dynamite. Your conclusive heart attack is a matter of ‘when’ not ‘if’. The risk factors stemming from all those conditions become not a case of simple addition, but are multiplied.

The problem from your point of view is that most of these factors come on very slowly, and become part of your daily living. You’ve smoked for years and never had a smoker’s cough, so why stop now? Every time you get some trousers made the waistband has to be that little larger. Your belt has been let out two more holes over the past two years. Your doctor said you had a “Little bit of blood pressure” three years ago, but you haven’t been back to check, as you feel quite OK in yourself. Your ‘triglycerides’? “My what?” Your blood sugar? “It was OK last time it was checked five years ago!”

The big problem is that the “Little bit of blood pressure”, even say 150/100, can produce a very dangerous situation when the person with that BP has elevated blood sugar as well. Or smokes. It is the multiplication effect again. Whereas you can (almost) ignore mild elevations like 150/100, if you have nothing else wrong, ignoring it when there are other conditions co-existing brings up that co-morbidity problem again. And the likelihood of a cardiac calamity.

Likewise, the “little bit of extra weight” that we all excuse ourselves for carrying, may (just ‘may’) be fine for someone with no other medical conditions, but represents an enormous risk factor for someone with the Metabolic Syndrome.

Here are some chilling truths. Between 87-100 percent of people with fatal coronary heart disease, or a non-fatal heart attack had at least one of the following risk factors – smoking, diabetes, increased blood fats and high blood pressure. The Metabolic Syndrome is characterized by having diabetes, increased blood pressure, and raised blood fats. Can you now see the importance of doing something about weight, blood fats and blood pressure? I for one would not like to be sitting with a condition that gives me between 87-100 percent chance of a cardiac problem.

So what is this week’s message? Quite simply, if you have diabetes, do something about the other risk factors. Stop smoking and get your BP and blood fats checked. If you don’t even know what your blood sugar level is, then get a check-up and find about all of it!