Comprende: The obesity-is-a-disease message is getting through loud and clear. This is not necessarily a good thing. During one of my encounters yesterday, I noticed my patient had lost 12 pounds in the past month. I asked him if he'd been trying to lose weight. He smiled proudly and said "Nope." Then he recounted how wonderful it was to be twelve pounds lighter. He was less short of breath, his knees didn't nearly as much, his pants were loose. Everything about his demeanor said, "Congratulate me. I'm finally healthy." I wish I could have shared his joy, but I couldn't. Unexplained weight loss is a bad sign, a very bad sign. Although it can be the symptom of a benign, easiliy treatable disease such as an overactive thyroid, it can also be a manifestation of a lurking cancer. And that's the first thing that comes into a doctor's mind.

I thought of two of my aunts who had always struggled unsuccessfully with their weight. They were happy, too, when they lost weight unexpectedly. The last time I saw one of them was at a family reunion. This particular aunt was always so self-conscious about eating in public, but here she was unabashedly eating a slice of apple pie - a la mode. She noted that this was the first time in her life that she could eat anything she wanted and not worry about gaining weight. And she looked so happy. She was in an advanced stage of emphysema. The work of breathing was so hard for her that it burned up more calories than she could take in. She had to wear oxygen all the time, and she could barely rise from the table, but her weight was no longer a burden. (She died a few months later.) My other aunt was absolutely ecstatic when for the first time in her life she began to effortlessly shed pounds. But after thirty pounds and three months, she was diagnosed with metastatic ovarian cancer. She's no longer with us, either.

So you can understand why I wasn't excited about this weight loss. I explained the importance of investigating his changing weight, but he would have none of it. He knew only one thing. I was raining on his parade. He pointed out to me how dangerous obesity was. Why, don't I know it's a disease? But the look he gave me was the worst of all. It was an "I-can't-believe-you're-this-stupid-didn't-you-go-to-med-school-or-at-least-read-the-papers?" kind of look. I hope he follows through on the work-up I ordered, but I have a bad feeling the next thing I'll be seeing from him is a request to transfer his records.

UPDATE: A reader notes a key difference between obesity here and obesity in Europe:

I have just returned from a trip to Europe. I noticed that there were significantly fewer morbidly obese people (at least in public). Those who were obese seemed to be older. Another interesting fact was that a member of our party who has trouble with weight lost weight during the trip as well. There are two interesting things with respect to this. First, most things including food cost about twice as much in Europe. Secondly, there are many fewer cars and a much wider use of public transportation. Obviously, most people eat less because of the cost and walk farther because they use public transportation. Rather, than obesity being a disease, cars and cheap food are a disease!