Is Obama’s Surgeon General Too Fat?

44 responses so far

• 1 Moderate // Jul 16, 2009 at 6:41 am

  Sorry it took me so long to post. I was at the gym. For 26 straight hours. Gotta work on the temple.

  My bod.

  This woman’s ideas obviously aren’t worthy of consideration. Uh, she’s fat. I’m sure the Adonic commenters on this fine blog will join me in scorning her.

  Blog.

  Bod.

• 2 ottovbvs // Jul 16, 2009 at 8:18 am

  ………I’m going to have to stop attending Jessye Norman concerts……I saw her in a New York restaurant once like a galleon in full sail…..the smaller waiters looked nervous……..All the Pavarotti CD’s have to goo too……..aah well

• 3 barker13 // Jul 16, 2009 at 9:40 am

  “Do what we say, not as we do…”

  (*SHRUG*)

  You have a point, David.

  Hey… Frum opened himself up to ridicule here, but he has a point. In fact, now that he brings it to my attention I agree… in the “Age of Obesity” – which the government tells us is certainly not a positive social development – shouldn’t the Surgeon General of the United States be something of a role model?

  Hey… I’d be interested in reading SERIOUS criticism of this question that David has brought up. No knee-jerk politically correct responses, but reasoned debate.

  BILL

• 4 sinz54 // Jul 16, 2009 at 10:30 am

  When Republicans who proclaimed “family values” were found to have fallen short themselves (Vitter, Sanford, etc.), Democrats called hypocrisy on it. And they had a point.

  Earlier, when parents who smoked tobacco and got plastered with beer told their kids not to smoke marijuana, their kids called that hypocrisy. And went right on smoking pot.

  Now Democrats have appointed a fat Surgeon General to be the spokesperson for America on public health, in which obesity is one of America’s biggest public health problems. I call that hypocrisy too.

  Obesity is a choice. You can choose to go to Weight Watchers, or you can choose to stay fat. Let Dr. Benjamin explain why she never joined Weight Watchers or undertook any other weight-loss program.

• 5 balconesfault // Jul 16, 2009 at 10:34 am

  Were Benjamin seriously obese, I’d say that this would be an issue. She’s definitely overweight, and I hope that she understands that and is taking positive steps to keep her weight under control as she gets older … one thing a lot of people don’t think about (including a lot of the “Jezebels”) is that you can get away with carrying an extra 50 lbs when you’re in your 30’s and not have it destroy your quality of life – but as you get into your 50’s and 60’s the same extra weight can severely limit what you can accomplish on your own, as your bodies ability to carry the extra weight starts to fade due to the inexhorable progress of aging and muscle loss. By your 70’s and 80’s the extra weight can mean the difference between taking care of yourself, or requiring assisted living.

  I’d say that this is a great teachable moment, and the Administration and Benjamin should take advantage of it. She shouldn’t be disqualified because of her size, given that she appears to keep up an activity level that would leave many gym rats worn out … ever notice how some really fit people need a LOT of vacations, for example? … but it would be a brilliant move for her to announce early on her committment to working herself down to say a size 14, and tasking overweight Americans to come along for the challenge with her.

  Now, if she doesn’t believe her weight is a problem, that’s another issue – and most certainly would be like a irresolute smoker being given the job.

• 6 Rodak // Jul 16, 2009 at 11:21 am

  Is Obama’s surgeon general too fat? Yeah…but she’s has a good sense of humor and she’s a great dancer!

• 7 barker13 // Jul 16, 2009 at 11:22 am

  Re: Sinz54 // Jul 16, 2009 at 10:30 am

  and

  Re: Balconesfault // Jul 16, 2009 at 10:34 am

  “…never joined Weight Watchers…

  “…a great teachable moment…”

  You know… you’ve both hit on something!

  Benjamin should be confirmed… HOWEVER… the day she’s confirmed and swears the oath of office, she should commit to losing “X” lbs. within the first year of her Generalship and get to her “ideal” weight by the end of her second year in office.

  Hey… and speaking of “teaching moments”… the three of us all thinking alone the same lines is progress!

  BILL

• 8 sinz54 // Jul 16, 2009 at 11:23 am

  barker13: What happens if she fails to get down to her goal weight? Does she resign from her office?

• 9 barker13 // Jul 16, 2009 at 11:37 am

  Re: Sinz54 // Jul 16, 2009 at 11:23 am –

  YES! ABSOLUTELY!

  Not as “punishment,” but to send the message that “failure” has consequences.

  Jeez… wouldn’t it be wonderful if more politicians – both elected and appointed officials – took their responsibilities as seriously as they do their positions of power?

  Yeah… why NOT expect her to lay it on the line for the principle? I for one would greatly respect her for doing so. And of course I’d be rooting for her to lose the weight.

  Again… not punishment for punishment’s sake – but setting a bar and setting a penalty for failure… that’s LIFE. That’s real life.

  What do you think?

  BILL

• 10 dacookson // Jul 16, 2009 at 11:54 am

  Strangely, I agree. No point excessively demonising overweight people but this would be a good move I think.

• 11 ottovbvs // Jul 16, 2009 at 12:20 pm

  sinz54 // Jul 16, 2009 at 10:30 am
  ” I call that hypocrisy too.”

  …….Being overweight and cheating on your wife…..now there are equivalent sins……This thread does open a window on the conservative mind……just when you think they can’t get any smaller or more fatuous they surprise you…….how about a weight test for all doctors……..talk radio and cable tv personalities would be covered too of course…..not sure where that leaves Limbaugh and Bennett both of who shut out the sunlight when they move

• 12 dacookson // Jul 16, 2009 at 12:59 pm

  But she’s a figurehead Otto, she has to acheive higher standards. And to have her go on a public weightloss programme to highlight the problem with obesity and the ways to tackle it would be a wonderful thing. She could put videos on YouTube, run a blog and generally use that as a forum to promote important medical messages. It’s quite an elegant idea I think.

• 13 ottovbvs // Jul 16, 2009 at 1:56 pm

  dacookson // Jul 16, 2009 at 12:59 pm

  ………Speaking as someone is about 6′ 1” and has never been overweight(why these guys walk around with 100 lb bags of cement on their guts has always been a mystery to me) I can address the issue with the requisite amount of moral self righteousness……….I don’t have any problem with all you suggest in fact some of the ideas are very good …….. but that’s not what this is about is it as you could tell from numerous cheap shots for example equating adulterous hypocrisy with weight hypocrisy……Nor for that matter do we know if there are extraneous factors at work as some people have glandular problems etc.

• 14 balconesfault // Jul 16, 2009 at 2:06 pm

  “It’s quite an elegant idea I think.”

  Thank you, thank you.

  But does proposing an “elegant” idea make me an elitist?

• 15 dacookson // Jul 16, 2009 at 2:15 pm

  fair enough otto, I think it’s more about undermining the message rather than a moral equivalence but I don’t like cheap shots either.

  yes balconesfault, yes it does…

• 16 brutus1791 // Jul 16, 2009 at 3:21 pm

  wait wait wait…

  Otto said: All the Pavarotti CD’s have to goo too……..aah well

  …This. Means. War!

• 17 girlwright // Jul 16, 2009 at 4:38 pm

  I thought the exact same thing. The Surgeon General while not a critical post of late is supposed set an example of good health for the nation and Obama’s nominee is definitely overweight, which isn’t healthy. If I’m not mistaken, Dr. Benjamin said diabetes ran in her family. Just looked it up and her dad whose dead had diabetes and high blood pressure. Gosh.

  I agree with David, how does this fit in with the First Lady campaign against obesity? I mean really, it’s a bit funny but I bet No mainstream media will even make a mention of it. Something else no one has observed is while Obama may be the first black president, besides Attorney General Eric Holder, to what high profile posts has he appointed blacks ? Yes, he’s appointed many blacks to non-criticcal posts such as Susan Rice, UN Ambassador, but not what I key cabinet positions like Secretary of State, CIA , Chief of Staff. Why is it that the HUD Secretary always has to be a black or hispanic person? Come on. Many of these posts have gone to former Clinton administration folks. Doesn’t look like much change to me.

• 18 midcon // Jul 17, 2009 at 8:22 am

  On what is apparently a slow news day, this should at least raise some eyebrows:

  http://voices.washingtonpost.com/virginiapolitics/2009/07/delegate_candidate_fight_dems.html

  Do I want to be in the same party as this person? Instead of dealing with the fringe elements in the party we spend our time on much more “weighty” matters. Excellent choice of priorities.

• 19 barker13 // Jul 17, 2009 at 8:41 am

  Re: Midcon // Jul 17, 2009 at 8:22 am –

  I lost you…

  What exactly are you proposing?

  (BTW… are we hijacking this thread?) (*GRIN*)

  BILL

• 20 midcon // Jul 17, 2009 at 8:46 am

  What I am suggesting is that we pay attention to those things that matter, such as fringe, conspiracy candidates who want to represent the GOP and conservatives, instead of whether someone should belong to Weight Watchers or whether the South Beach diet is better than Atkins.

  So, yeah I’m hijacking the thread in that sense.

• 21 brutus1791 // Jul 17, 2009 at 8:53 am

  Midcon: a Delegate, really?

  So I am at a bit of a loss here. I should then, jump ship (abandon the Republican boat… err, canoe?) because you found an example of a fringe State Delegate and are using this anecdote to potray the entire Republican party in her image? I don’t mean to start a querrel, but I am just not finding the fairness here. There IS something to be said about the fringe factions of the Republican Party, the neo-libertarians really, that have become synonymous with Alex Jones, Coast to Coast AM, Ron Paul and the fringe neo-libertarian left. Is there a difference between her and the Democrats that argue Senator Wellstone was assassinated? Or since Jesse “the Mind is a Terrible Thing to Waste” Ventura is a self-described Independent (and full card carrying nut job) should we abandon the Independent ship (bigger than the canoe;) There are people on the national level that espouse similar crack-pot theories and have much more weight than a nugatory State Delegate from the 99th District of Virginia.

  In the end, I am trying to see what it is you want me to do. How are we suppose to respond? Do I agree with her, no. Would I vote for her? Nope. Do I want her in my party? No, I would kindly ask her to join the Libertarian Party or the Tea Party (those exist yet?). Please explain what I’m suppose to do with this. Leave the party?

  Happy Fridays all.

• 22 barker13 // Jul 17, 2009 at 8:57 am

  “What I am suggesting is that we pay attention to those things that matter, such as fringe, conspiracy candidates who want to represent the GOP and conservatives…”

  Ahh… I gotcha!

  I disagree. (*SHRUG*)

  Oh, I’m not saying ignore stuff like this. I’m not saying I wouldn’t discuss it. What I am saying is that when *I* prioritize I put policy issues at the top of the pyramid and work my way down to philosophical issues.

  Example:

  http://cboblog.cbo.gov/?p=328

  http://www.cqpolitics.com/wmspage.cfm?parm1=5&docID=news-000003168293

  http://www.breitbart.com/article.php?id=D99FO5880&show_article=1

  …and so on and so forth.

  But, hey… if you believe that our focus should instead be on:

  “Catherine Crabill, a political neophyte running for the House of Delegates in the Northern Neck, VA…”

  Then off ya go! (*GRIN*)

  Frankly… I actually find THIS thread (re: Dr. Regina Benjamin) of greater import.

  (*SHRUG*)

  But, hey… to each his own.

  BILL

• 23 midcon // Jul 17, 2009 at 9:01 am

  brutus,

  Nope you are right there is no difference between her and the Wellstone conspiracists. But then, we aren’t trying to resurrect the Democratic party. And these are the people that get the media exposure. Remember, it’s not what you are, it’s what people perceive you to be. And this is the perception they get. I admit it’s not right but it is what it is. I do not propose you leave the GOP, but what I do propose is that the GOP disavow people like this as representative of the party.

• 24 brutus1791 // Jul 17, 2009 at 9:30 am

  Barker: What I am saying is that when *I* prioritize I put policy issues at the top of the pyramid and work my way down to philosophical issues.

  For once, we are in disagreement. By starting at the top, you are starting with the philosophical issues. You are looking at the whole. You have to come down the pyramid to reach the low and stable ground of policy.

  Midcon, we will not be able to help if Chris Matthews and Ed Schlitz (Schultz) want to use these sorts of examples to define Republicans. They will do so no matter how we respond, because she has an (R) next to her name, and honestly, the national party cannot keep tabs on all of the Delegates everywhere. Besides, if the people of the 99th District want her, they have every goddamn right to elect her to Represent them. We must stress that she represents JUST them, remind people about the division of powers and federalism, and move on. Similar example is from Clear and Present Danger when Jack Ryan explains to the president what to do about his relationship with a shady college friend who was connected to the cartel: “No I would go the opposite direction: if they ask if you were good friends say, ‘we weren’t good friends, we were great friends.’ If they ask if you were great friends say, ‘we weren’t great friends we were life long friends.’ Give them no where to go, nothing left to dig for.” Not exacting, I know. But I don’t see why WE should make a spectacle of people and at the same time defend ourselves by saying they are small fries and don’t represent us.

• 25 midcon // Jul 17, 2009 at 9:51 am

  brutus, it is just my opinion but I believe we acquiece when we remain silent and unfortunately the (R) she wears means she is accepted by the party. And yes I agree with you that the GOP can say things like “We WERE lifelong friends” “We WERE great friends.” Until the GOP marginalizes the fringes, they do not control their own fate.

• 26 Oneon1isto // Jul 17, 2009 at 9:55 am

  Here’s my problem with this story:

  It’s crass. It’s fairly objectionable. Yes it has a kernel of truth, but that doesn’t make it any less crass and stupid. This is headline grabbing and tawdry. Frum, you are better than this.

  What about her symbolism as a start-up PCP who did house calls and rebuilt her practice from the ground up (twice) because of hurricanes? What about her dedication to patients?

  It is this drivel that will continue to marginalize the GOP and whatever alternative you’re trying to create here.

• 27 furrydoc // Jul 17, 2009 at 10:50 am

  As the endocrinologist here who actually treats obesity and its consequences, photos of Dr. Benjamin would place her among the overweight though certainly not morbidly obese. The Endocrine Society e-mails me their news summary related to my specialty each weekday morning, drawing this service largely from general publications rather than medical journals. The feature article this morning had to do with distribution of obesity in the general American population. Prevalence among African-Americans far exceeds those of caucasians and hispanics and there is persistence of a geographic distribution that has been present for many years leaving prevalence in the Dixie higher than elsewhere. This being a political rather than science or medical site, I’ll leave the comments as my thoughts on public policy.

  First, I think Dr. Benjamin’s body habitus and geography illustrates that this problem appears in all walks of life. People who struggle with this problem can be quite accomplished, not obviously gluttonous or slothful, and when interviewed and examined in the privacy of my medical office appropriately concerned about their health and that of their dear ones who share this problem. There are certainly a lot of medical studies giving results of intensive diet and exercise management with fairly uniformly disappointing results, usually buried into the protocols of diabetes prevention trials.

  As an affected person of prototypical ethnicity and geography, she may have the extra passion needed to address this as a public health problem. There is also some evidence that this is an economic and educational problem. The medical literature is replete with studies correlating health outcome in the middle to later years with educational outcome achieved in the late teens or early twenties. Some oncology data from my home state’s colonoscopy initiative finds that the greatest predictor of a colon cancer being lethal is failure to complete high school. When my son took his SAT’s early this decade, I stood at the entrance of the testing center and counted the visibly obese kids taking the exam as they passed by. That number was a lot less than commonly reported percentages of late teens, suggesting to me that the real obese kids have sleep apnea, social promotions and not enough academic achievement to justify taking SAT’s and moving on to college.

  Many thanks to my electronic friend David for his interest in this subject and to his colleagues at AEI whose knowledge and insight have added to the appreciation of this problem and its p0tential solutions, irrespective of any other political agendas they may derive from this.

• 28 barker13 // Jul 17, 2009 at 10:57 am

  Re: Brutus1791 // Jul 17, 2009 at 9:30 am –

  “For once, we are in disagreement.”

  Well… (*GRIN*)… to paraphrase former congressman and NYC Mayor Ed Koch… “Anyone who agrees with me 100% of the time has got to be nuts!”

  (*SMILE*) I’m glad you’re not nuts, Brutus! (*CHUCKLE*)

  “By starting at the top, you are starting with the philosophical issues.”

  Well… YOU’RE RIGHT! Mea culpa.

  Re: Oneon1isto // Jul 17, 2009 at 9:55 am –

  “Frum, you are better than this.”

  (*LAUGHING MY ASS OFF*)

  (*WIPING TEARS OF MIRTH*)

  Actually, Oneon, Frum is “innocent” on this one; it was Midcon who provided the link. Yes, this is Frum’s thread, but the actual thread topic is Dr. Regina Benjamin’s nomination for Surgeon General.

  (See, David…! Never say I’m unfair to you or think I’m just “out to get you.” When you deserve my “defense” you get it – as would any contributor or poster.)

  BILL

• 29 chephren // Jul 17, 2009 at 1:01 pm

  To barker13, sinz54, balconesfault, dacookson, girlwright, and other would-be judges of the new Surgeon General’s health and character, based on her photo: please post a link to a photo of yourself, so that all may judge how you’re doing in the weight/character department.

  Failing that, please post your height, weight and Body Mass Index (BMI, a standard indicator of obesity).

  I’ll go first. I’m male, 6′2″, weigh 230 lbs and my BMI is 29.5. I know that’s too high and I’m working on it.

• 30 barker13 // Jul 17, 2009 at 2:18 pm

  Re: Chephren // Jul 17, 2009 at 1:01 pm –

  “…please post a link to a photo…”

  usalyright.blogspot.com

  (*SMILE*)

  Next…

  If Obama were to appoint *ME* Surgeon General I’d pledge to do EXACTLY what I’m suggesting Dr. Benjamin do.

  (*SHRUG*)

  For what it’s worth I also think cops and military personnel should “look fit” as well as be fit. “Looking the part” is in terms of representing “authority” is often the “first impression” which serves to buttress that authority so that it is respected.

  So… now that I’ve responded to your “chiding,” any other challenges you’d care to offer?

  BILL

• 31 Oneon1isto // Jul 17, 2009 at 2:56 pm

  Bill: ah, perhaps I was a bit too soon in my heated response. A crass headline though! I shant renege on that one.

  I’ll circle back to the core of my argument. Ahem, here goes:

  “Really? REALLY? Come on guys and gals. I could’ve sworn I was browsing US Weekly in the aisle of my local supermarket when I happened upon this thread.”

  Next up: “Dems side with Brangelina over distraught adoption woes! Why can’t they just adopt an AMERICAN baby? Details inside. Plus new photos of Trig!”

• 32 chephren // Jul 17, 2009 at 3:02 pm

  barker13 –

  That’ll do for now – though your photo does not indicate whether you carry a ‘middle-aged spread’. I’ll give you the benefit of the doubt.

  I’m tempted to tell you to hit the deck for 40 push-ups. That would mean I’d have to do the same at my end. Maybe some other time.

  Cheers,
  F.

• 33 barker13 // Jul 17, 2009 at 7:24 pm

  Re: Chephren // Jul 17, 2009 at 3:02 pm –

  “I’m tempted to tell you to hit the deck for 40 push-ups.”

  Sorry… just returned from playing four straight games of racquetball – that’s enough exercise for me today! (*WINK*)

  BTW… I am overweight. Grossly overweight by the stats. But it’s “big guy” overweight. I’m 6′4″ with a large frame.

  I’ve got a gut. It grows… it shrinks… over time the growing outpaces the shrinking. Still, I keep up with my examines, did a full cardiac work-up last year – the heart doc said “all clear.”

  My own doc is a nagger. That’s actually good! I like that! He’s right to be a nagger. Still… he goes a bit overboard. I could swear he was actually PISSED when my last general exam (blood, urine, all the good stuff) showed no sign of pre-diabetes. (He’s always trying to scare my ass into getting a “stomach job;” I wonder if it’s a friend or relative he’d refer me to!) (*GRIN*)

  Anyway… the deal is still the same. It’s one thing to be Bill Barker and have a gut; it’s quite another to represent in your person the best healthcare advice of the government of the United States and be… er… kinda round.

  (*CHUCKLE*)

  Hey… think about it… I bet you that the Surgeon General of the United States could actually get a military DI (drill instructor) or other PT (physical training) specialist assigned to her just for the purposes of getting her to her proper weight. (Hey… Obama offers me that deal… I’m taking it!)

  (*WINK**)

  BILL

• 34 Smother Your Cheesecake Factory With A Thick Frosting Of Baconnaise And You’ll Get A Potbelly « Around The Sphere // Jul 18, 2009 at 4:53 pm

  [...] David Frum: I ‘ve scoured the Intertubes pretty thoroughly this evening, and I can find no evidence of any mention of this point by anybody other than a stray anonymous comment on a newspaper website. But now that you mention it… it’s not completely crazy. Would the president choose a visible smoker as SG? The post has few responsibilities, it is almost purely symbolic. So, if obesity is indeed a serious public health challenge, an “epidemic” as the First Lady among others strongly argues, wouldn’t it make sense to select for the most visible public health job somebody who has overcome this problem – rather than failed to do so? [...]

• 35 sinz54 // Jul 20, 2009 at 9:19 am

  America would never accept a Surgeon General who admitted to being a current illicit drug user. That would set a terrible example for our young people. So why should we accept a Surgeon General who is obese–meaning she can’t stop eating too much?

  FYI: My Body Mass Index is 23.2

• 36 furrydoc // Jul 20, 2009 at 9:46 am

  Forgive me, sinz54, but illicit drug have a publicly accepted means of discouraging them, a legal mechanism to imprison those who trade in them and the users whose purchases have a bloody, antisocial legacy. Hiring a smoker for this would also be problematic now that public opinion has shifted to make smokers a subset of deviants, something that would not have been the case prior to the 1960’s. The tobacco companies have taken their lumps in court and indirectly fund most of the antismoking campaigns. There advertising is highly restricted.

  While food may be where smoking was in the 1960’s, there is a lot of public support for agricultural policies that keep food plentiful, purchases of inexpensive food reasonable accessible to Americans irrespective of income, legal tolerance of advertising that encourages people to eat more, and gutting of school requirements for a certain amount of physical activity mandated by the school system. And there is a body of medical study that consumption of that available food may be regulated in a manner that maintains weight in adults and promotes size in children.

  So while eating generously and beyond one’s caloric needs is currently encouraged by public policies, gluttony has been discouraged from the time of Pope Gregory, something uncool. A good public illustration of this took place on the Aunt Jemima Pancake box over the last generation. This morbidly obese icon of my childhood slimmed down in one or two stages, though more to eliminate stereotype than to promote dietary restraint.

• 37 barker13 // Jul 20, 2009 at 9:47 am

  Sinz,

  Do you know what the heck these “white box” comments (example: Comment #34) are all about or where they’re coming from?

  Anyone…???

  BILL

• 38 brutus1791 // Jul 20, 2009 at 12:03 pm

  My body-mass index…. hmmm, apparently it doesn’t measure for Bullsh**.

• 39 furrydoc // Jul 21, 2009 at 8:27 am

  From today’s NY Times a thoughtful article by Dr. Perry Klass, a reknowned pediatrician/journalist on this subject.

  http://www.nytimes.com/2009/07/21/health/21klas.html?_r=1&ref=health

• 40 barker13 // Jul 21, 2009 at 9:31 am

  Re: Furrydoc // Jul 21, 2009 at 8:27 am –

  (Just curious… or you a vet… a very hairy doctor… or is it just a weird handle?)

  OK. The article –

  First. We’re talking schmucks. The doc… the mom… schmucks. Lazy. Stupid. Irresponsible. Weak.

  “When she gets home from a long day at work, she told me, she knows she really ought to tell her three children to turn off the television and ride their bikes, while she is cooking broccoli and salmon for dinner.”

  Then frigg’n DO IT! Jeezus frigg’n Christ… laying aside the meal choice for the moment, what the above sentence tells me (the inference being…) is that the ADULT can’t take it upon herself to PARENT her three children properly. Period.

  Next…

  “But I was as conscious of my own body as I was of hers. How on earth, I was thinking, am I supposed to give sound nutritional advice when all they have to do is look at me to see that I don’t follow it very well myself?”

  Whine… whine… whine; me… me… me…

  Jeez! Suck it up, doc! “Do what I say, not what I do.” There’s a REASON we’re all familiar with that line.

  Here… pro bono advice to that doc: Tell your patient, “Just because I’m a schmuck doesn’t mean you have to be a schmuck.” Simple. To the point.

  “The advice we’re supposed to give in pediatric clinic, it boils down to ‘Eat less, exercise more,’ ” said Dr. Julie C. Lumeng, an assistant professor of pediatrics at the University of Michigan Medical School and an expert in childhood obesity. “This is such blasphemy, but when I deliver this advice to families, my heart’s not in it, because I just feel like so often the families are just glazing over, and when that advice is delivered to me, I glaze over, too.”

  Perhaps Dr. Lumeng should seek a new and different career. Hey… I’m absolutely serious. If I were her boss reading this… let’s just say it wouldn’t be good for Dr. Lumeng’s career.

  We tolerate NONSENSE. That’s the bottom line. We have doctors who won’t do their jobs, parents who won’t do their jobs… what the hell is the matter with people…?!?!

  “Back in the exam room, with that 8-year-old, I took some early and unsure steps toward discussing the topic. I showed her her growth chart, on the pink (for girls) graph paper. See, I said, you’re growing — you’re getting taller, and you’re adding muscle to your body as you grow. But we need to give you time to get taller before you add more weight. And we talked nutrition (cut back on sweet drinks, fast food, eating in front of the TV), and we talked exercise (how about tap dancing, soccer, swimming lessons?). And finally I looked the mother in the eye and said, without planning to say it, “If this were easy, I would be thin and fit.””

  Schmuck. (*SHRUG*)

  Schmuck. (*SHRUG*)

  Hmm… with my ZERO years of pre-med coupled with my ZERO years of med school and my NON-EXISTENT medical license allow me to “prescribe” a mother-daughter (whole family preferably) appointment with the nutritionist… dietitian… personal trainer – whatever.

  Furrydoc – Thanks for bringing the article to our attention.

  BILL

• 41 furrydoc // Jul 21, 2009 at 2:13 pm

  ans to question: hirsute endocrinologist who treats hirsutism when it comes along, which isn’t all that often. obesity does come along a lot. the average patient weight on my office scale is well above 200 pounds.

  My perspective differs from that of the doctors noted in the article largely because the people I see already have weight related disorders. Nothing gets a person’s ear like having a trusted primary doctor creating added seriousness by referring to a specialist. The approach I take, which I hope a Surgeon General of any dress size will endorse, is to first correct the immediate medical problem, meaning insulin or other drugs to correct the diabetes even if the weight control has to be sacrificed. Smoking cessation even if weight control has to be sacrificed. Then we talk about weight control which takes four stages: Step 1, self-directed diet of their choosing–whichever they think they are most likely to actually follow with a second self directed diet if the first one fails, which is most of the time. But at least they got to convince themselves that it’s time to bring in another person. Step 2, the assistance of another person, usually a diet program. Any commercial program or church group will suffice, though for people with really serious medical problems I send to my top dietician and her superb program. The medical literature supports the advantage of supervised dieting over self-directed dieting, at least while the supervision is in force. Step 3, medication. This one is filled with misadventures: amphetamines of the 1960’s,fen-Phen, redux of blessed memory, Accomplia in Europe. At the moment we have orlistat which is not really patient friendly stuff but reasonably safe, sibutramine which is n0t really all that much better than prozac that you can now get for $4 a month and stuff they sell without a prescription but occasionally gets pulled from the shelves to protect public safety. There are clinical trials of several others that give consistent weight reduction though with 50% failure rates if you call 5% weight reduction a success. Step 4, surgery. This really does correct medical problems at reasonable risk relative to the diabetes, sleep apnea or immobility.

  As people go through these steps there is an element of determination and an element of frustration and often self-blame. For the children it is particularly difficult since underperformance in school from sleep apnea driven sleep deprivation is not always obvious and the trump card of surgery really isn’t there until one reaches the late teens. And when you take histories of obese diabetics who you would recommend gastric bypass, you frequently find that they were the fat boys in school, decades before the epidemic of obesity and diabetes arrived in our current medical consciousness.

  Public policy, which is what David suggested I comment upon? At the risk of stigmatizing people, sloth and gluttony need to be made uncool, much the way smoking has been. A certain amount of empathy has to go with those patients and people have found a way to make a buck on the prevalence of obesity as well. As a resident in the 1970’s a 500 pound patient would send the medical student on an errand to the hospital maintenance unit to get a couple of C-clamps to construct a bed from two standard beds. Now we have large enough beds, commodes, lounge chairs, machine lifts that a petite nurse can operate and a bed scales that have now replaced the hospital loading dock as the source of accurate weight measurement. At K-Mart et al, one can now be fashionably obese. While these measures reflect kindness to people, which probably should continue, it also reflects a public acceptance of obesity as inevitable and intractable.

  If the goal is less disease and more productivity of its citizens, which I think is the purpose of public policy, then some key decisions have to be made. Does fast food and Shabbos morning breakfast cereal advertising need to be regulated? The State of New York in the 1960’s required me to take gym a certain amount of time from grades 1-12. The Talmud obligates a parent to teach his son how to swim. In high school I had to take an annual test of agility, strength and endurance. My kids did not. There is a pervasive medical literature spanning many illnesses correlating health at age 50 with educational attainment at age 20. So maybe a public effort should be made to identify all those underperforming overweight sleep apneic kids, get them C-Pap machines and prod them through high school or bring back the draft so at least the male half of the population gets their physical condition upgraded. Ultimately though, I regret to say, that drug therapy will need to emerge if weight reversal is to occur to a large enough extent to reverse established weight related disease on a population wide basis. There has to be publicly generated funds or public policy to encourage private corporations to undertake this research and development.

  Limiting pediatric medical care to slim doctors or requiring surgeon generals to camouflage their girth by purchasing a uniform one size above what their tailor recomments doesn’t really reduce the scourge of obesity related illness, now or into the future. My guess is that given the recent track record of the public’s perception of republicanism, this type of political capital may reinforce that perception of a party that chooses the trivial symbol of the reality of tackling a difficult problem.

  I hope the perspective of a lot of time in the exam room has been of benefit.

  furrydoc

• 42 barker13 // Jul 21, 2009 at 5:16 pm

  Re: Furrydoc // Jul 21, 2009 at 2:13 pm –

  “…hirsute endocrinologist who treats hirsutism…”

  Ahh! (Thanks!)

  “At the risk of stigmatizing people, sloth and gluttony need to be made uncool, much the way smoking has been.”

  I totally agree!

  “Now we have large enough beds, commodes, lounge chairs, machine lifts that a petite nurse can operate and a bed scales that have now replaced the hospital loading dock as the source of accurate weight measurement. At K-Mart et al, one can now be fashionably obese. While these measures reflect kindness to people, which probably should continue, it also reflects a public acceptance of obesity as inevitable and intractable.”

  Yep. Where do we place the line between “kindness” and “enabling?” (*SHRUG*)

  “If the goal is less disease and more productivity of its citizens, which I think is the purpose of public policy, then some key decisions have to be made. Does fast food and Shabbos morning breakfast cereal advertising need to be regulated? The State of New York in the 1960’s required me to take gym a certain amount of time from grades 1-12. The Talmud obligates a parent to teach his son how to swim. In high school I had to take an annual test of agility, strength and endurance. My kids did not. There is a pervasive medical literature spanning many illnesses correlating health at age 50 with educational attainment at age 20. So maybe a public effort should be made to identify all those underperforming overweight sleep apneic kids, get them C-Pap machines and prod them through high school or bring back the draft so at least the male half of the population gets their physical condition upgraded.”

  I too believe that our schools need to SERIOUSLY deal with our childrens’ physical as well as intellectual development. (Now given the piss poor job they do at the later, even as they insist that’s where they’re really trying, only God knows how viable my call is… but, hey… let’s TRY it!)

  And, yeah… I’m all for bringing back the draft. (And yeah… before someone posts about how the military itself doesn’t want a draft because they feel an all volunteer force is more professional and therefore will be more proficient and effective… I’LL TAKE MY CHANCES and vote “aye” for a draft anyway.)

  “Ultimately though, I regret to say, that drug therapy will need to emerge if weight reversal is to occur to a large enough extent to reverse established weight related disease on a population wide basis.”

  Yep. No doubt.

  “There has to be publicly generated funds or public policy to encourage private corporations to undertake this research and development.”

  I don’t see why; if any effective drug therapy seems like it would be a huge profit center, truly effective weight loss drugs with few side effects sounds like they would fit the bill.

  Doc. I’m interested in why you feel that private corporations would have to be “encouraged.” Please expand upon your statement. (Also… question: I’m a big believer in EXPANDING AND EXTENDING Patent protection; would you mind sharing your view?)

  “Limiting pediatric medical care to slim doctors or requiring surgeon generals to camouflage their girth by purchasing a uniform one size above what their tailor recomments doesn’t really reduce the scourge of obesity related illness, now or into the future.”

  Perhaps not… but it’s a step in the right direction – it send a message. “Dress for success” isn’t just about clothing – or at least it shouldn’t be. The Surgeon General of the United States should look fit. Very few fat people truly look fit. No offense, but Dr. Benjamin doesn’t look fit.

  HOWEVER… as previously noted… neither I nor as far as I know is saying she shouldn’t be appointed period; what I’m saying and what others have signed on to is that if she’s going to take the job, she should publicly pledge and publicly act in such a way as to lose weight and get fit. In other words, she should serve as a role model, of a “I practice what I preach” role model.

  Anyway… I hope you can make time to pop in occasionally and post.

  BILL

• 43 furrydoc // Jul 21, 2009 at 6:05 pm

  BILL posts: Doc. I’m interested in why you feel that private corporations would have to be “encouraged.” Please expand upon your statement. (Also… question: I’m a big believer in EXPANDING AND EXTENDING Patent protection; would you mind sharing your view?)

  My wife is a patent agent with one of the worlds most prolific patent generating corporations. Very few have serious commercial value. Current patent duration was changed not that long ago from 17 to 20 years but the starting clock was set at a different point to bring American patents into conformity with the rest of the world. We’ve not yet succeeded at lengthening football fields to 100 meters. There are more advantages than disadvantages to handling discovery globally than provincially now that the producers of these patents are multinational entities.

  The biggest financial complaint I hear from patients is sticker shock when they go to the pharmacy. I myself allowed one of my own prescriptions to lapse after a month because I didn’t think it was worth what the pharmacy charged. If you look at the shelves of my sample closet there are almost no unique or innovative products developed this decade, only extended release forms of products of the 1980’s repackaged to keep the price higher. I can say the same thing about the anti-obesity drugs that look most promising: repackaged items of combined old products. The companies are really not developing, or bringing to market, the products like SSRI’s, statins, ACE inhibitors, H2-blockers that transformed not only the diseases that we treat but the way we look at fundamental disease processes. There are some useful things out there but they are often niche products misrepresented by company representatives as things all people should be taking.

  The development of new compounds has shifted over two decades from exploratory work of corporate labs to university or small start-up projects where discovery can then be sold to larger enterprises for the studies required to confirm safety and efficacy. Much of the pioneering work is too high risk for stockholders to tolerate so it has to be funded from taxpayer grants. The regulatory and development process costs are also too high with the rest of the world not sharing those high prices that American patients are asked to pay to subsidize development of the next stage of marketing. If you look at the history of the pharmaceutical giants over a generation, CIBA and JR Geigy caused quite a stir when they merged in the 1960’s. In the last two decades most of the large players have consolidated in some way with the combined research force numbering much less than would be the case if each company maintained its independence. For the first time, profit margins far in excess of other industrial companies are far less assured.

  furrydoc

• 44 barker13 // Jul 21, 2009 at 11:46 pm

  “My wife is a patent agent with one of the worlds most prolific patent generating corporations. Very few have serious commercial value.”

  In case the direction I was coming from was unclear, I was specifically referring to patent protection for pharmaceutical products – drugs. I’m not following how a successful new drug patent could fail to possess serious commercial value.

  Obviously I’m aware of the fact that for every new “wonder drug” there are dozens (hundreds?) of failures, millions, tens of millions, even hundreds of millions of dollars “wasted” on research that never pans out, but when the research DOES pan out… I want the innovator – the discoverer – to get the reward, to make back the R&D costs plus substantial LONG TERM profit. I don’t want the generic drug manufacturers getting fat and happy on the intellectual property and risk of the developer.

  As I understand it, “the clock” on drug patents starts prior to full FDA approval and mass market consumer sales. (Correct me if I’m wrong.) But in any case, I’d say that those who come up with the “wonder drugs” should be the ones to control sale of THEIR drugs for a bare minimum of 20-25 years – perhaps even 30… even 40 years.

  Basically, doc, I want to spur innovation – keep the best and brightest churning out brand new wonder drugs. The effectiveness of the medicine – and of getting lots of effective new medicines out into the market – is what I’m concerned with.

  “There are more advantages than disadvantages to handling discovery globally than provincially now that the producers of these patents are multinational entities.”

  Hmm. Yes. I see your point. My buddy is a drug rep for Genentech – now wholly owned by Swiss pharmaceutical conglomerate Hoffmann-La Roche.

  Still… that’s the finance end of the business – the “business” end of the business. Although we’re not what we once were, it’s my understanding the American is still at the forefront of pharmaceutical research and product development. There must be a reason for this. It must have something to do with America and Americans. (Or do you think I’m wrong?)

  The last thing I want is for a “multinational” pharmaceutical industry and world standard that does to drugs and medical research what the UN has done for Peacekeeping. (*SMILE*) (In other words… largely failed.)

  Frankly, I’d like American pharmaceutical companies to remain American pharmaceutical companies (or reemerge AS American pharmaceutical companies if they’re presently part of multination’s as Genentech is) and I’d like our government to protect our pharmaceutical companies interests – yes, including profits… profits that all them to keep on doing what they do best.

  ANYWAY… (*GRIN*)… we got kind of sidetracked there, huh? (*SMILE*)

  “The biggest financial complaint I hear from patients is sticker shock when they go to the pharmacy.”

  I hear ya!

  “If you look at the shelves of my sample closet there are almost no unique or innovative products developed this decade, only extended release forms of products of the 1980’s repackaged to keep the price higher.”

  Yep. I’m aware of this also.

  But this is what I’m getting at… HOW do we address these concerns so as to change things for the better – not screw things up for the worse. (*SHRUG*)

  “The companies are really not developing, or bringing to market, the products like SSRI’s, statins, ACE inhibitors, H2-blockers that transformed not only the diseases that we treat but the way we look at fundamental disease processes.”

  Why not…???

  I mean, assuming that the pharmaceutical didn’t just “decide” all of a sudden to “lead with greed,” what’s different nowadays compared to days gone past?

  Is it taxes…??? Is it the patent system…??? Is it our litigiousness society…??? Is it the FDA…??? Is it the politicians…??? Is it the doctors… the hospitals… the patients… the insurance companies…???

  Do. I want “good drugs at fair prices” and I want as much if not more “innovation” than we’ve ever had in human history. How do we achieve this…???

  “Much of the pioneering work is too high risk for stockholders to tolerate…”

  Yes. So you say. But WHY…??? What’s different about 2009 vs. say 1999… 1989… 1979… 1969… 1959… and so on and so forth back as far as you wanna go?

  Put another way, if you were “King Furrydoc,” unchallenged ruler of America, how would you command “the risks” be lowered to a level where stockholders could and would tolerate them?

  “…with the rest of the world not sharing those high prices that American patients are asked to pay…”

  Ahh… now we’re again making progress. We’re back to the logic out of which my original patent question came out of! How do we MAKE the world “pay their fair share?”

  It seems to me THIS is why we need an AMERICAN pharmaceutical industry whose rights are PROTECTED by the full resources of the United States government. If an American company creates a cure for AIDS (or whatever) that drug should be protected by patent. The Canadians and the Russians and the Chinese and EVERYONE should be paying the same costs for the drug as Americans do. And if foreign companies – backed by foreign governments – violate our patent laws… then we come down on them like a ton of bricks.

  Anyway… (*SHRUG*)

  BILL

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