The two biggest problems for future physicians (part 2)

So last time I rambled about the overuse of our health care system, now lets talk about the single biggest preventable drain on our healthcare system; obesity. The baby boomer generation has no choice but to be a big cost to our healthcare system, as they are old and we have made it so they can get older (unless we decided to "prevent old age" in a number of gruesome and dystopian ways). Obesity, however, is prevalent in all generations and ages, and is only becoming more common. It is really a fascinating problem, from an evolutionary point of view. We have done something that no species has ever accomplished, we have reached a level of dominance where our fitness literally does not matter. For the first time ever, people that once had disease and disorders that essentially prevented them from ever reproduced are now doing so. Bad recessive alleles are no longer being repressed as much. In the same way, we have also reached such a level of dominance and prevalence of food here in the Western world that we have the ability to gorge ourselves to obesity. Despite all of the wonderful mechanisms that our bodies have evolved to counter all sorts of problems, a mechanism to prevent obesity was not something that ever arose.

Why? Simply because it wasn't necessary. Abundances of food have occurred before, but ultimately if an animal got fat (assuming predators and omnivores here), they couldn't catch the food anymore. They would then starve until a point to which they were fit enough to catch food or die. Our obesity does not prevent us from obtaining food, due to the nature of being able to exchange food for money. Thus obesity can be a life long condition, rather than a temporary one.

So how does this effect the medical community? Cost. Obesity is an expensive chronic condition that costs lots of money to fix or mitigate its side effects. Heart disease, especially, goes hand in hand with obesity. Everyone knows about the health problems and thus healthcare related to obesity, but hospitals and our community have another problem. Just like our bodies weren't built to respond to rampant obesity, so is the current medical structure of our society not prepared for obese healthcare. Hospitals were not BUILT to handle the super-morbidly obese patients that are now rolling in (no pun intended). I've seen an obese person on a extra large rolling bed get stuck in an elevator and go into cardiac arrest. He was literally too fat for the hospital, and the doctors trying to get a crash cart into the elevator were more than happy to comment on it. I watched a surgery on an obese man recently. It was an intestinal surgery and the longest part of it involved simply getting through the fat to the target. After the fat clearing, the surgeon turned to me and said "I just go paid 700 dollars for cutting fat." Mark my words, smart hospitals will be soon instituting a midlevel specialist who's sole job is to clear fat out of the way for surgeons. I'm sure that this is just one of the many things that will need to change in order to make hospitals economically and physically viable for our obese future, and there are many people hard at work at the problem. Do you think its a coincidence that newer hospitals have much wider hallways and bigger elevators? I wouldn't be surprised if fellowships in Obese Medicine start popping up sometime soon.