Poverty and Obesity

The hospital I work in is a hospital for poor patients. It was my belief that poor people have little money and they cannot afford to eat much. So they would be underweight if not outright malnourished. In recent years I find a different trend. A large number of women especially elderly ones, coming to us for treatment of gynecological conditions are quite obese. It becomes a nightmare to operate on them by whichever route. Vaginally one encounters little of that fat, but the postoperative course can be quite difficult. The trouble begins with having to shift them from the OT table to the trolley and from the trolley to the bed in the ward. The abdominal or laparoscopic route has the additional problem of having to go through layers and layers of fat. The time required for opening and closing the abdomen is quite long. The intraabdoominal fat makes surgery difficult. Wound breakdown rates are high. To find their veins for intravenous injections and transfusions can be a nightmare. Luckily we do not face deep vein thrombosis and pneumonia so often as compared to the US or Europe. I often counsel them to reduce their weight preoperatively, both for the sake of success of the operation and their future health. I am yet to find a single patient who managed that. All of them claim they eat virtually nothing. The diet they describe is virtually nothing. One would believe they gain weight by drinking water. But now I have found out that they consume a lot of coconut, which is not mentioned in the diet unless specifically asked for. Even then many of them avoid answering that question unless one insists on getting an answer. To get a solution to a problem that the patient herself does not want solved is beyond me. 'That is the way it goes' Schultz would have said about this issue, were his characters to bring it up in his comic strip 'Peanuts'.