A DOCTOR’S PERSPECTIVE ON CHILDHOOD OBESITY PREVENTION

Now here is a book that delivers. You’re promised bones, and bones you shall get.

take 300,000 of them placed end to end to span the space inside this “o.”

WE CAN’T SIMPLY IGNORE IT

I’m starting to see a trend of podcasts and articles that seem to be raising the white flag of surrender against childhood obesity. We should all agree that these conversations should be approached carefully and thoughtfully. We should agree that there are clear reasons to promote regular exercise and a healthy diet. We should agree with the clear health benefits of maintaining a healthy weight. There are clear mental health benefits as well. I didn’t think I would see a day where these points would be debated.

Suddenly I see an argument that we should give in to any diet; any weight is acceptable. Recently, one podcast went as far as to say doctors are to blame for poor outcomes in obese patients because we treat them differently and poorly. After all, we make assumptions based on their body shape.

What about the stigma that doctors don’t have their best interests in mind? That’s a battle we fight daily; we don’t care, lack empathy, and want to make money. Those who try to help our pediatric patients lose weight are doing it because we want our patients to be healthy. We battle every day to fight the chronic conditions created by obesity, knowing that weight loss isn’t realistic for most patients due to the complications of their conditions, orthopedic issues, and so on. I almost have to ignore their obesity because there are so many other issues to address. So to say I’m focusing on that is outrageous.

I worry this is another example of doctors giving in to what patients want to hear. They don’t want to be told what they should do better. There is not enough personal responsibility in every corner of society. Our job is to honestly – yet thoughtfully – coach patients toward goals that will improve their quality of life. If we’re going to quit helping them eat better and exercise, we might as well quit our profession completely.

As a child, I was overweight and grew up lacking self-esteem. I remember constantly pulling my shirt out so my belly would stick out less. It was impossible to talk to the opposite sex. My entire life made a pivot when I got to college and succeeded academically, but I also lost about 40 pounds. I had confidence I never imagined.

Fast forward to 2020, when the pandemic hit. Like most of us, I had a lot of anxiety to deal with and, surprisingly, extra time as our appointments were canceled to keep everybody home. I started running – a lot. The resulting 50-pound weight loss and the marathons I’ve finished are things to be proud of. Seeing the number come down on the scale was one of the few things in my life I could control, and it gave me a sense of satisfaction in a chaotic world.

Did my dieting in college put me at risk for disordered eating as an adult? Possibly. Did my obesity as a child lead to anxiety and potential depression that has been lurking somewhere ever since? That’s possible too. I actually consider myself lucky that my anxiety manifested in exercise rather than a controlled substance like alcohol, gambling, or even physically harming my family. I came out of the deal healthier than ever.

Most of my anxiety came from everything I learned as a doctor being flat-out ignored during the pandemic. When things go right, it’s because somebody without qualifications has “done their research.” When times are tough, the doctor is mean and doesn’t know what he or she is doing.

I’ll have to learn to be mindful of how I react to this new war – or list of excuses – against childhood obesity.

Nathan J. Hemerly is a family physician

You and I might not be able to fill more than 300 pages with what we know about bones, but then, neither you nor I happen to be orthopedic surgeons, or clinical professors thereof at UCLA. Roy Meals, MD happens to be all that and then some. The good doctor has been practicing his trade for forty years, and it shows.

The problem with someone who knows his craft ”Inside and Out” is that they sometimes forget that what is ordinary, everyday knowledge to them is totally Greek to the uninitiated.

Fortunately for those fortunate enough to read this book, Dr. Meals goes easy on medical terminology — real easy — and when he does throw in some 14-letter word (sometimes he apologizes for doing so, explaining that it was unavoidable), he not only explains how to pronounce it but then explains its job within bones using an analogy a ten-year-old would easily understand.

For example, early in the book he explains that bones are built from individual collagen molecules that resemble corkscrew pasta. They connect with each other extremely tightly both mechanically and chemically like, he writes, tiers of Legos smeared with Super Glue before being snapped together. It isn’t difficult to picture than word picture.

The same is true for his explanation of the extremely minute scale at which bone building occurs: It would take seventeen hours of collagen molecule building at the rate of one molecule per second to build a stack as thick as this page is thick. Another word picture he paints for us about collagen molecules: “It would

The book is liberally sprinkled with these kinds of gee whiz facts, and Meals’ favorite word may well be “remarkable.” As it should be.

But this is far more than just a book about bones. It is also a thorough history of the medical treatment of bones and the assorted troubles they sometimes give us, and the medical pioneers who have refined and improved the art and practice of orthopedics over the centuries.

Also covered in detail are the many practical uses of bones when they aren’t inside a body anymore. Human and animal bones have been used for centuries as tools, art, weapons, religious objects and talismans, musical instruments, and clues for paleontologists and homicide detectives, and much more.

Bones is a fascinating book, one that anyone (including practicing orthopedic doctors) will learn from and enjoy.

Bones: Inside and Out by Roy Meals, MD, 304 pages, published in October 2020 by W. W. Norton & Company

What are you giving up for Lent?

Be serious! I’m giving up on all my New Years resolutions. Hope.

If you insist, I’m giving up lunch meat for Lent. All of it.

Cold turkey?