really important thoughts on obesity

really important thoughts on obesity

Jason Cooper, Registered Nurse and owner of CrossFit Enoch in Conroe Texas, published a compelling article in the CrossFit Journal yesterday about the relationship between genes and obesity. 

Long story short, Cooper tells us that genetics can cause obesity, but that it is far less common than people think. And even when genetics do play the primary role in one’s obesity, lifestyle changes, like a major diet change and exercise change, can still make a big difference in that person’s quality of life and body composition.

The sad and difficult truth is that many obese and overweight individuals are being told by their doctors and healthcare providers that their condition is primarily genetic, and very often they aren’t getting any real counseling on nutrition and exercise — the components that we know can make a significant, life-changing (and oftentimes life-saving) difference.

Read Cooper’s incredible story of twin boys below that illustrates this difficult point. And if you want to go to the original post to see all of the links and photos, click here.

The man in the bed weighed 555 lb.

He was in his 30s, a black Southern Baptist preacher. His father was a preacher and his wife’s father was a preacher. Both families were morbidly obese and the kindest of people.

Collectively, they discussed how the one cardiologist who treated all members of both families had told them their Type 2 diabetes and obesity were genetic conditions common to the African-American community.

“Mr. Jason,” the man’s aunt cried, “we have already had four of our family die this year. Why, Mr. Jason? Why? Why has God stricken us with this disease?”

The man came to be my patient on a weekend. They couldn’t fly him to me in a helicopter because he was too heavy. He barely fit into the EMS bus.

The man was experiencing lymphedema, a condition caused by blockage of the lymph nodes and common to Type 2 diabetics and the morbidly obese. The man’s legs were so big with adipose tissue that his lymph nodes were blocked, causing massive swelling in both lower limbs. The man went to a lymphedema clinic his physician owned and ordered him to visit. There, he had his legs wrapped—a profitable treatment that does not cure. Wrapping the legs tightly squeezes the edema/swelling out and pushes the fluid into the lymphatic system to drain.

Like most obese patients, the man lived with cardiomegaly, an enlarged, fatty heart weak from obesity and deconditioning. The wrapping of the man’s massive legs forced retrograde lymph into his heart and upward into the lungs, causing him to experience exacerbation of congestive heart failure. His heart could not effectively pump and he could not breathe.

He went into cardiorespiratory arrest, and CPR was started in the field. The hospital’s intervention consisted of an Impella ventricular assistive device (VAD), also inserted by the very cardiologist who treated the man’s lymphedema in his lymphedema clinic.

An Impella VAD is a small pump used to circulate blood in the body when the heart is so weak that it can no longer circulate blood to the organs itself. The use of VADs and LVADs (left ventricular assistive devices) is controversial because the cost is US$22,000-$35,000 and the devices are used in the terminally ill as a temporary life-extension device, most often a bridge to a decision: Do we allow the patient to pass or do we keep using technology to extend a life of bedridden suffering? The Impella VAD is most often used in patients so diseased that its expense and efficacy are questionable at best.

As a nurse in the cardiac ICU, my job was to keep the man alive. The education I am to provide such patients supports the protocols the hospital has in place to ensure profit and limit excessive spending. Hospitals limit nurses to provision of nutritional counseling that is supported by Eli Lilly and other insulin manufacturers. This practice is highly questionable and limits choice and transparency. Educating the family about whole food, metabolic conditioning or energy systems is outside my scope of practice and deemed inappropriate. We are taught to treat the symptoms, not to cure the disease.

So whom do hospitals and manufacturers serve if their expensive procedures and devices cure nothing?

Day after day, the man lay in the ICU. He was on several IV drips of medication to keep his blood pressure up; without them, he would die rapidly. He was on a ventilator at maximum support. His family came and went.

“Is there any change, Mr. Jason?” they would ask with somber, tear-filled eyes. Day after day after day, I would deliver bad news.

“I’m so sorry. He’s actually worse. He is on maximum life support and there are no more drugs we can start to support his heart or his lungs. And the longer we keep these medications running, the more damage we cause to the kidneys and to the liver.”

They would cry and collectively pray over the man’s failing body, begging God for a miracle.

After eight days, the man began to smell like he had died. His sugar-filled, diabetic skin and wounds began to rot, and the vasopressor drugs were squeezing his periphery so tight that his toes and legs turned black with necrosis. His swollen tongue was sticking out of his mouth and began to split open on his teeth like a hot dog overcooked in a microwave. Blood filled the man’s oral cavity, and we had to stuff his mouth with gauze tissues to soak up.

His kin coordinated a large family meeting to discuss the plan of care with the cardiologist, the neurologist, the ICU doctor, the internal-medicine doctor, the kidney doctor, the endocrine doctor and the case manager. The family did not know the man was overextending his stay in the ICU. He had limited insurance, and all this expensive care was now a liability for the hospital. As it often happens in the ICU, the meeting time came and no physicians showed up as promised. I was alone with the grieving family to answer questions hospital administrators deem outside my scope of practice. So I did not answer.

Against policy, I broke protocol and asked a simple question: “Has anyone ever discussed how your family eats?”

The only sound in the room was the ventilator that was filling the patient’s lungs.

“Mr. Jason,” the man’s aunt began, “I don’t understand what you mean.”

“There is a link between what we eat and obesity, Type 2 diabetes and heart disease. I can show you.”

“Mr. Jason, are you telling me that this is his fault?” she asked.

The moment she asked the question, I knew they couldn’t unhear what their physician, “Dr Heart,” had told them.

No. It’s your doctor’s fault. Dr. Heart killed your nephew by wrapping his lymphedema legs and flooding his heart. Your doctor intentionally sought your family out as a target market and sent you all to his heart clinic, his lymphedema clinic and to this hospital. And he lied to you about your genetics. Your doctor is targeting the obese and selling a lie about genetics.

“No, ma’am. That is not what I am saying,” I responded.

“Our cardiologist said that our diabetes, our heart disease and our obesity are all genetic,” she asserted.

“How do you know? Did they test your genetics?” I asked.

“So as a nurse you know more than our doctor? You know more about obesity than our cardiologist?”

And with that, she asked me to leave the room.

“Yes ma’am, I do know more than these physicians about food and its role in chronic disease,” I said, and I walked out.

A Different Life

“Cooper, pick up Line 2276. Family holding on 2276,” the tech barked over the intercom.

The entire family is either at the bedside or in the waiting room. What family is on the line?

“ICU. How may I help you?”

“Yes, sir. My name is Brandon, sir. My brother is in Bed 19. I’ve been told he is critical. Do I have time to make it to his bedside before he dies?”

“Sir, you are not on the family list. Do you have his four-digit code to receive information about the patient status?” I asked.

“No, sir,” he said. “I am at Camp Pendleton, sir. I was on deployment in Japan. A Red Cross case manager pushed the paperwork through for me to leave active deployment to be at my brother’s side. Seventy-two hours ago I was on a mountain training. I literally just got back to the States. Please, sir. I need to know, is he still alive?”

“Sir, what is your brother’s birthday?” I asked, hoping he could answer correctly.

“Sir, that’s easy, sir. We are twins.”

He gave me the correct birthday.

“I am sorry to inform you, sir, your brother is critical. He is on maximum life support. His heart is in total failure, and he is not a candidate for a heart transplant. Your family is deciding to withdraw his ventilator in the next couple of days. They are waiting for more family to get here from Mississippi. You need to hurry, sir,” I said.

“Roger that, sir. I’ll be on a plane and inbound in the next 24 hours. Thank you, sir. My family does not talk to me any more. I am so thankful you told me how things are.”

He hung up the phone.

They don’t talk to him anymore. What kind of brother does not talk to his twin?

It was not even 24 hours later that I met Brandon, the patient’s twin. I was shocked at what I saw. Brandon could see it on my face. Brandon was a wide-shouldered, square-jawed, ripped-up Marine. He arrived in battle-dress uniform, and like a good Marine he had his cover in his hands. I could see his Force Reconnaissance pin; he was a special-operations Marine.

“I’m sorry to meet you like this, sir. Your family is in the room. I can take you in,” I said.

“I need a minute. My family has not seen me in six years,” he said, staring through the glass door from afar.

“What happened with you and your brother?” I asked. “With the exception of your brother’s obesity, you look exactly the same.”

“The Marine Corps happened. I told my family that I wanted to live a life of service, and they told me to be a preacher. I didn’t feel that my calling was in the church. I told them I wanted to be a Marine. No one in my family has ever been in the military. Ever. And against my family’s wishes, I went to Parris Island just after my 18th birthday. I was an obese, scared kid, and when I returned home from boot camp, I was a confident athlete. I lost 45 pounds in boot camp alone,” Brandon said to me.

“I was so excited to tell my brother about my experiences in boot camp. I wanted to show him how to lose the weight. And when I did, it caused a rift in my family. They said that our disease is genetic. They said that it’s not their fault and that Dr. Heart knew more than I did about obesity,” Brandon said.

I nodded in agreement, having just heard the same statement from his aunt.

“So I left home for good that Christmas. I never looked back. I requested to try out for the teams. When I made it through Force Recon, I knew there was nothing I could not do. I knew everything I thought growing up was a lie. I called my brother and told him that. And he stopped communicating with me after that. The years went by and we lost touch.”

“I’m sorry to hear that, sir. I’m so very sorry.”

Brandon eventually walked into his brother’s room. He was polite and he was caring. Not many of his family members looked him in the eye.

Two days later, we removed the breathing tube and put the patient on full comfort support. The family allowed Brandon to be at the bedside. Despite my best efforts, the patient gurgled and gasped for air until his heart stopped 15 minutes later. It was a ghastly death, and his entire family was at the bedside to witness it.

Nature Versus Nurture Versus Fitness

Brandon was an identical twin. He was a human machine in Marine Force Recon.

His brother was an obese preacher who died from obesity his doctor said was genetic.

Did Brandon change his genetic code? Did Brandon control his gene expression by choosing a life of metabolic conditioning over sedentarism and processed food? Or was his family disease simply cultural and emotional, a condition self-inflicted through poor lifestyle choices?

We know true genetic disease exists. Take, for example, trisomy 21, aka Down syndrome. No matter how hard he or she exercises, no matter how well he or she eats, a trisomy adult cannot reverse the condition caused by a third copy of Chromosome 21. It’s genetic and permanent.

Genetics can cause obesity, but it’s far less common than people think.

Prader-Willi syndrome and Bardet-Biedl syndrome are the only obesity-causing conditions science has linked directly to genetic deletions. Both conditions are rare: It’s estimated 17,000-22,000 Americans express Prader-Willi and about 3,000 North Americans have Bardet-Biedl.

Compare those small figures to the approximately 170 million—70 percent—of American adults who are overweight or obese. How many of them have been wrongly told their condition is genetic?

We don’t even know exactly how genetic and environmental factors affect obesity, Type 2 diabetes, congestive heart failure and other conditions, and we don’t know how lifestyle affects the expression of imperfect genetics even if they exist. For example, CrossFit Founder Greg Glassman recently suggested that if a gene for alcoholism exists, you might prevent its expression if you simply didn’t drink. Even the support pages for Prader-Willi and Bardet-Biedl still mention positive benefits from proper nutrition and consistent daily exercise. They are genetic conditions, but lifestyle still affects their expression to a degree.

I’ll ask again: Did Brandon control his gene expression by choosing a life of metabolic conditioning over sedentarism and processed food? Or did he merely change his lifestyle to avoid a condition that wasn’t genetic at all?

We know he grew up obese, so he wasn’t free of the factors—environmental or genetic—that caused his family’s obesity. And yet Brandon lost weight and gained muscle in the military while his brother ballooned to 555 lb. and was told his fate was sealed by bad genes.

Here is what we know for certain: Healthy eating leads to massive fat loss when paired with metabolic conditioning. We also know diet and exercise reverse metabolic disease.

That’s not debatable. More than 14,000 CrossFit gyms are collecting huge amounts of data to support it. Our trainers are helping people lose weight, reduce disease symptoms, come off medication and avoid the hospital and the grave.

So if we can cure the chronic diseases caused by obesity with diet and exercise, why don’t we? Why has chronic disease been sold to us as genetic when the simple application of lifestyle changes cures the conditions or perhaps even prevents expression of faulty genetics? And why are more “care providers” not questioning the supposed genetic link to obesity and chronic disease in the absence of lab work and proof?

The idea of genetic chronic-disease predestiny was dictated to us by doctors and corporations that intend to maximize billing in a market full of sick people. The evidence is beginning to suggest that the medical system is keeping its patients obese and diabetic because those patients are profitable. What other explanation is there if we know that diet and exercise can cure obesity-related diseases and keep people off medications and out of hospitals?

Prevention simply doesn’t pay. Medications and procedures do, especially when they treat the symptoms but don’t cure the disease. A client for life—until death.

As CrossFit affiliates and trainers, we are the first line of defense, those who will save clients from obesity and chronic disease. We are the real providers of health care, and the hospitals are designed only to take advantage of those who fail to embrace us.

Politicians and corporations focus on how to make health care more affordable for people, changing nothing. Tomorrow, if health care were suddenly affordable it would just help people manage the cost of being ill and ensure hospitals and corporations keep their sick clients.

As CrossFit affiliates, we can give people something the corporations, the hospitals and the politicians cannot: true health. We give them the tools to end their disease and become something greater.

There is no rebuttal or retort.

There is just the sound of our mic drop.

xoxo,

Stephanie

PS…
Are you ready to try CrossFit? Our six week Beginner’s Course starts Monday, October 9th. Email Stephanie@CrossFitSOFLA.com for more details!

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