End of story. Conversation Killer. Politically incorrect. Unsympathetic. I am the bad guy here.
But I believe in conversation. Keeping communication lines open is key in treating any problem irrespective of its causation. When there is no treatment, communication lines assume even greater importance.
Much of the interest that I continue to maintain regarding obesity is thanks to the weight gain that I see being induced in the patient who continues to gain weight for reasons other than or over and above lifestyle issues. Lifestyle changes facilitate weight gain and result in obesity. This can be exacerbated by other factors that are NOT lifestyle related. Such people could be considered to have a secondary obesity, obesity secondary to a particular problem. Consider the bilateral amputee, or for that matter, even the unilateral amputee who cannot exercise anymore. Weight maintenance suddenly is totally dependent on reducing dietary intake which is not easily achieved, if not impossible. A rapid weight gain post amputation surgery often happens which is at the end of the day lifestyle related, due to lack of exercise! Even more impressive is the argument about weight gain in men who undergo bilateral orchidectomy or anti-androgen treatment. Women on oral contraceptive pills, patients put on steroids, diabetic patients put on insulin, hypothyroid patients, women with polycystic ovaries are all people who gain weight due to a drug or a disease that facilitates fat build up. In many of these patients, lifestyle still has a part to play, but interestingly, the control that the patient has over maintaining an active lifestyle is often removed due to the illness or the treatment itself. Drugs that increase appetite or diseases that reduce mobility affect both sides of the energy equation. Welcome to secondary obesity.
But what about that possibility of a preferential diversion of calories to fat formation due to some of these drugs or diseases? What is known about fat partitioning in this setting with a visceral versus subcutaneous distribution?