Apollo at 50

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July 20, 1969. I was two months shy of my fifteenth birthday and the warm afternoon sun was coming through the dining room window as I set the table for Sunday dinner in a house that no longer exists. The television had been on most of the day as the world and I waited for Neil Armstrong and Buzz Aldrin to land on the moon.

Almost seven years previously, John F. Kennedy had urged the United States to commit to sending astronauts to the moon and back. “We choose to go to the Moon in this decade and do the other things,not because they are easy, but because they are hard…”  The Soviet Union had launched the first satellite, Sputnik 1, in 1957 and the first man into space just four years later. At the time most of us did not realize Kennedy’s lofty goal was less about establishing a long-term presence in space but more about beating our mortal enemy, those godless Commies.

Back then we saw science and technology as tools for creating a much better world. Education and knowledge were respected, not dismissed as a liberal conspiracy to undermine our sacred way of life. So, the country rallied around the President and the space program. It seemed our civic duty to follow each mission from launch to splashdown. The three (and only) major networks provided nonstop television coverage of each mission. Some schools brought TV sets into classrooms.

On February 2, 1962 John Glenn became the first American to orbit the earth in his Mercury capsule, Friendship 7. Alan Shepard’s and Gus Grissom’s fifteen minute suborbital flights seemed less important; Glenn became a national hero and the one we all remembered. Kennedy’s issued his famous challenge on September 12, 1962.

In January 1963, my grandparents sent me a cardboard Mercury capsule, complete with a helmet and a battery operated control panel with blinking lights and dials that whizzed around for a few days before breaking down. Still, it was thrilling to pretend I was an astronaut.

The Gemini program’s first manned launch was in March 1965 almost two years after the last Mercury mission. I watched Frank McGee and David Brinkley, their calm, comforting voices, covering the Gemini missions for NBC, “sponsored by Gulf Oil Corporation.” (Click here for the NBC Special Reports open and close, which preceded any major announcement, from space shots to LBJ’s health status.) Brinkley’s droll delivery reminds me of Obama, especially in this clip, (at 1:30), when he remarks, “It seems to me, um, the age of the computer had to arrive before the age of space, didn’t it?”  (I’ve found the networks’ breathless coverage of the 50th anniversary rather irritating.)

Among my few memories of Gemini are building Revell’s plastic model and watching SPECTRE’s bad guys capture a Gemini capsule in orbit at the beginning of the fifth Bond film, You Only Live Twice. Ed White stepped outside of Gemini 4 on June 3, 1965, becoming the first astronaut to walk in space, another milestone. But I think interest started to dwindle over the next year, as we became concerned with the turmoil on earth. The war in Vietnam was ramping up. Newark, Detroit, Minneapolis and other cities  would explode in rage and fire in July 1967. The world I’d known was disappearing. Or maybe it had always been this way and I’d been oblivious.

On January 27, 1967 astronauts Gus Grissom, Ed White and Roger Chaffee died gruesome deaths after a spark from faulty wiring ignited the pure oxygen environment in the Apollo 1 command module during pre-flight testing.  We heard about it the next evening when Jules Bergman, ABC News’ Science Editor, somberly read a script from the ABC News desk. There were no 24-hour news channels back then; no instantaneous and continuous coverage. It happened, it was over, and we went back to our lives. (Nineteen years and a day later the space shuttle Challenger exploding 73 seconds after liftoff; we watched the disaster on an endless loop.)

I didn’t follow any of the Apollo missions during the next two and a half years, having descended into the depths of teenaged angst and cynicism. Apollo 8’s Christmas Eve broadcast from lunar orbit seemed quaint and hollow after I’d watched Chicago cops beating protestors and CBS news teams during the 1968 Democratic Convention.

But then came Apollo 11 and the moon landing.

Apollo 11 launched on July 16, 1969  and, after making one and a half trips around the earth, the third stage ignited, sending the modules and the astronauts towards the moon. The CSM separated from the third stage, turned around and extracted the LM. All this happened within a few hours. Neil Armstrong and Buzz Aldrin entered the LM on July 18 for preliminary checks during the three-day trip to the moon; the craft entered into lunar orbit on July 19. (Vox has an excellent summary of the mission here.)

And we waited.

On July 20, 1969 the LM Eagle undocked and separated from the CSM Columbia at 12:44pm CDT. The two would stay in orbit together until Eagle entered its descent orbit at 2:08pm CDT. The descent engine fired at 3:05pm CDT and Eagle began the nail-biting final trip down to the moon’s surface. Hundreds of millions of us were now glued to their television screens. (You can watch a long version, 19m 52s, of the final approach here. If you want the Cliff Notes version, 4m 30s, click here.)

I remember watching the black and white pictures on our console TV. As Eagle neared the surface a long probe, looking like a needle about to pierce the skin, appeared at the top of the screen, growing larger until the module’s shadow blotted out most of the view. At 3:17pm, Neil Armstrong uttered the first of two famous phrases, “Houston, Tranquility Base here, the Eagle has landed.”

Neil Armstrong finally stepped onto the moon’s surface six hours later, delivering those unforgettable words: “That’s one small step for man, one giant leap for mankind.” The video quality wasn’t the best, but coming from 250,000 miles, it was awe-inspiring and humbling. The world was one for a brief time.

AFTERWORD

Jethro Tull’s album, Benefit, hit U.S. shelves in May, 1970. I’d been listening to it for forty-some years before actually reading the lyrics to “For Michael Collins, Jeffrey and Me.” The verses rival Steely Dan in ambiguous, but chorus is Michael Collins, the man who stayed in the CSM, telling Armstrong and Aldrin to be careful and lamenting he couldn’t be with them

 “…I’m with you L.E.M.
Though it’s a shame that it had to be you
The mother ship
Is just a blip from your trip made for two
I’m with you boys
So please employ just a little extra care
It’s on my mind
I’m left behind when I should have been there
Walking with you…”

So, have a listen before you go.

Apollo image (c) Can Stock Photo / merlin74

Field Report

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I’ve been on the new job for more than three months now and it’s been a delight. I don’t regret walking away from the chaos into which my profession has descended. I don’t have to deal with ill-tempered administrators expecting the impossible. My visits aren’t rushed and there are no productivity targets.

And I have a lot of stories to tell.

Dead Men Walking
I’m astounded by how willing men are to put their lives and balls in jeopardy by lying like a cheap rug in front of their wives. I’ll ask the husband a question about health status he’ll say, “Of course, I’m fine!” She will roll her eyes, snort or say, “You didn’t tell him about this!”

I’ll ask men, “Are you under any stress right now?” They will shoot furtive glances at their spouses, sitting a mere few feet away, and snicker. I’ll shake my head and mutter, “Don’t poke the bear,” while thinking you’re living on the edge, fool.

Another question on the list is: “Are you short of breath at night when you’re in bed?” An eighty-one year old guy chuckled and said, “It depends on what I’m doing.” His wife narrowed her eyes and said, “Don’t go there.” You want to sleep on the couch?

There’s a memory test near the end of the evaluation.  I give members three words to remember before asking them to draw a clock face and hands to indicate a random time. I then ask if they can recall any of the words.

One woman got two out of three. Her husband, two rooms over, and in a wheelchair, blurted out all three words.

She yelled, “You shut the f*ck up!”

I thought, she’s going to beat his ass as soon as I leave. It’s best if I’m not around when the cops find the body.

And That’s When the Fight Started
I evaluated an octogenarian Hispanic couple with the aid of a translating service I call on my cell phone. It’s not as efficient as an in-person interpreter; often one side doesn’t hear the questions or answers. I make sure I look at the person directly rather than telling the translator, “Would you ask him/her…?” It’s far more polite and lets them know I recognize them as individuals rather than anonymous subjects.

Her answers were short with few explanations. Her husband, however, responded to every question with a dissertation before getting to “yes” or “no.” It went well until the end when I foolishly asked, “¿Tiene preguntas?” – “Do you have any questions?”

She began a tirade in Spanish to which her husband responded just as vociferously. The interpreter waited a few minutes before translating the argument.

“She says her husband is always tired because he watches the television too much and then can’t sleep, and isn’t that bad for him? He wants to know what is wrong with watching TV because he enjoys it.’”

Their son, who’d been sitting at the table during the entire interview, just snickered.

I said, “I’m not getting involved in this; thanks for your help” and hung up. The couple and their son paused to bid me adieu before resuming their, uh, discussion.

No Good Deed Goes Unpunished
I saw a woman in her mid-70s one afternoon. I had time to see her two hours earlier, but she didn’t want me to because “I have to finish doing my nails.”  When I arrived at the appointed time, her husband greeted me when I arrived and graciously offered me a seat at their dining room table. A red-headed ball of fire who reminded me of Gladys Kravitz joined us a few minutes later, snapping at her husband, who appeared to be the perfect Abner. “Where’s my insurance card? It was here on the table! Go find it!”

She had a badly infected toe, purple and swollen. She’d also had both hips and knees replaced, running the risk of infecting the bone around the replacements. When I pointed it out, she said, “I don’t want to go on antibiotics because they give me diarrhea. And I don’t want to go to the hospital to get IV antibiotics. Can’t they do it here at home?”

“Well, it looks pretty bad to me. If you don’t get it treated, you’re likely need it amputated.”

She scowled at me.

Being a conscientious sort, I called her primary care physician and relayed my concerns. She said she would call Gladys and prescribe antibiotics for the infection.

The woman called me the next morning on my way to another evaluation. “This is Gladys Kravitz. Are you the doctor that snitched to my primary care doctor?”

“Yes, I did. Yer gonna lose that toe if you don’t listen to your doctor.”

“I told you I don’t want to take any antibiotics.”

Well, one can only go so far…

Curiosities
Halfway between Harlem Road and Ridgeland Avenue, on US 30, the Google Map lady says, “Welcome to Indiana.” A hundred yards or so farther down, she says, “Welcome to Illinois.”  Indiana is a good fifteen miles to the east as the crow flies. A wormhole, maybe?

A hypertensive, obese Pakistani man spent much of the evaluation extolling the virtues of natural medicine, telling me how things like turmeric and lime would cure my own hypertension and obesity.

Only the Good Die Young
She was an adorable 88-year-old with a charming smile and a voice like Georgia Engel. She was legally blind and used a walker. And, like the Little Old Lady From Pasadena, she could be a terror.

I met her with her daughter and one of two caregivers who always stayed with her. I introduced myself and the first thing out of her mouth was, “Are you going to give me my driver’s license back?”

Her daughter said, “We had to take it away because she’s now legally blind and it’s not safe for her to drive.”

“Well, no, I can’t give you your license back.”

“Then what good are you?”

I continued with the usual questions.

“Have you had a heart attack?”

“Not yet.”

“Have you had a stroke?”

“Not yet.”

“Have you had any kind of cancer?”

“Not yet.”

“You sound like you’re looking forward to it.”

Before I left, I said, “Well, you are doing pretty well for 88.”

Her caregiver replied, “She can still give you the finger,” which prompted her to flip us off with both hands.

Tea and Sympathy

It’s not all fun and games. Sometimes I act as bartender or father confessor, listening to sorrows, regrets and frustrations.

A man from Pakistan brought his extended family to the U.S., along with their bitter familial feud. When I asked if he had any regrets during the depression evaluation, he said sadly, “I’ve begged my family to forgive me for bringing them here, but they refuse. Some of them won’t talk to me.”

A woman’s worsening arthritis left her unable to walk more than a few feet without agonizing pain. When her adorable, diminutive Shih-Tzu wanted a potty break, I let her out (and had to coax her back in because she wanted to play). We continued the evaluation, but she started to cry.

“Look at me! I can barely move. I used to go out all the time and now I can’t. I’m in so much pain all the time and there isn’t much they can do.”

A man only a few years older than me had lost his wife one month earlier after a short but horrible illness. He sat next to me on the couch, his late wife’s two Shih-Tzu puppies by his side, wagging their tails as they looked me over. He looked like a biker, big and burly, but he was completely lost without her.

“I have to get the house ready to sell, but I don’t have the energy.” His voice trailed off and he looked as if he could cry.

Early in my career I learned I couldn’t fix all the ills of my patients. Often, just listening without judgement or reproach is sufficient therapy.

Midwest Seasons

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We have a saying here: “If you don’t like the weather, wait five minutes.” Midwestern seasons can be unpredictable, ranging from tranquil to brutal. Here’s my guide.

Winter

Midwestern winters…SUCK. There’s no other way to put it. It’s not the cold; it’s the unending grey that stretches from early November through March and sometimes beyond. We start the long, slow crawl to more sunlight on December 22, but the darkness just sucks the life out of everything. Christmas is bittersweet; the day after Christmas is the hangover from the night before. New Year’s Eve is the last hurrah of the year. I still hate trying to stay up past midnight, watching one of the local newscasters trying to slip her co-anchor the tongue as “Sweet Home Chicago” plays during the fireworks at Navy Pier.

Groundhog Day Blizzard 2011

I keep telling myself, “I just have to make it through January and February.” The Superbowl means spring is about six weeks away, if we’re lucky.

Spring
Just when I think about hanging myself rather than enduring one more week of winter, the sun suddenly comes out and spring arrives, right on schedule! The trees seem to go from delicate buds to full bloom overnight and the grass is once again green. The pungent scent of fresh (not frozen) dog turds wafts through the air on our morning walk. Praise the Lord and pass the potting soil! It’s time to take the covers off the patio furniture and the air conditioner, hook up the garden hose, and think about how I’m definitely going to power wash the deck this year along with all those other warm weather tasks. I’ll be lucky to check a quarter of them off the list. Life is good again, eh?

Budding trees

Not so fast. This is the Midwest, remember. March is supposed to come in like a lion and go out like a lamb. But Mother Nature is a bitch; it’s more likely Scar and his friends will show up for the next couple of months and remind us we are idiots for maintaining any sense of optimism. The Cubs postponed their 2018 Opening Day game because of snow, while the White Sox, a much hardier bunch, played and beat Kansas City 14-7

We can go from turning on the furnace to turning on the AC in the same week, sometimes in the same day. We sat on the deck on St. Patrick’s Day in 2012 when the thermometer hit 81° and froze our butts off the following March.  This year we got five inches of snow on Palm Sunday and 70° less than two days later, setting a record. Two more inches of snow fell on April 27. I’ve seen snow in Michigan on Mother’s Day and Peg had snow Memorial Day weekend when she was living in Minneapolis

Palm Sunday Snow, 2019

Spring 2019 has been particularly brutal. The lousy weather has dragged on well into May with cooler than normal temperatures and endless rain and may continue into June. It was sunnier the last two weeks of March than all of April and May. The rain has jacked up mold levels, assaulting my lungs and adding to the misery.

There are momentary respites. The crabapple trees at the neighborhood park blossom for a few weeks. Lombard’s Lilacia Park  lilac trees bloom sometime in May. Chicago kicks off the approaching summer when meteorologist and WGN’s Weather God Tom Skilling flips the switch on Buckingham Fountain.

Crabapple blossoms

Every year I tell myself, “Well, this winter wasn’t so bad.” And nine months later I’ll wish we were living someplace warm and cheap.

Summer

Our one week of spring gives way to summer. The urchins are out of school; Baxter no longer goes berserk at 7am when he hears the school bus. I wish the first day of summer was somewhere in July instead of June 21 when the Summer Solstice marks the beginning of that long, slow slide into darkness. But the change is gradual enough that it’s hard to notice, until mid-August when the sun sets before 8:20.

The weather can be hot and dry, hot and steamy or any combination. Those first few muggy days remind me of being out of school for the summer, listening to the mostly unintelligible words of the Hollies’ “Long Cool Woman (In a Black Dress)” or the Beatles’ “Get Back” while riding around thinking about one of my classmates I just saw washing the family car. She wore shorts and those sleeveless blouses that through which one might glimpse the side of her bra.

We don’t have to suffer brutal heat like Phoenix where it’s so hot construction crews have to pour concrete after midnight. Chicago issues heat advisories when the heat and humidity become dangerous and the city opens cooling centers for the poor folk with no air conditioning, minimizing the risk of death. That approach developed after the devastating heat wave of July 1995, when triple-digit temperatures combined with an inadequate electrical grid resulted in more than 700 deaths, mostly among the elderly people who were isolated from the rest of their community. 215 died on July 15 alone.  The Cook County Medical Examiner’s office had to rent refrigerated trucks to store the surplus bodies.

Summer is mostly tolerable, except for the occasional deluge or tornado. July 1 means football pre-season starts in a month; college football in two. Baxter and I walk either early in the morning or late in the evening. Or we just say, “screw it” and go to Dairy Queen. (Last year we ran into an old guy in the DQ parking lot with a parrot on his arm and a cone in his hand, singing “Let’s all go to the lobby” on his way back to his truck.)

Autumn

This is easily my favorite time of year and it’s not just because I have an autumn birthday. What’s not to like? Labor Day signals summer’s official end. The kids go back to school and the adults put away that summer belligerence for another year. College football season starts, and I can look forward to another year of watching the Michigan State Spartans win instead of the Fighting Illini losing. Pro football starts as well, but it isn’t as exciting. Baseball will come to an end and the WGN 9 o’clock news won’t be postponed for a Cubs game.

There’s also nothing like the first time the wind shifts, and a Canadian high pressure system pushes the humidity back to the swamps in the South. The leaves start to turn (sometimes as soon as August) and eventually I’ll have to play “Find the Dog Turds” when Baxter decides to do it under the crabapple tree at the local park. Soon we’ll be knee-deep in pumpkin spice everything, from that overpriced coffee from Washington State to Culver’s Pumpkin Shakes.

Autumn leaves, August 2018

The weather is fickle. We can go from crisp, sunny mornings to cold and drizzle. It snowed October 30, 1997, three months after I moved back to Illinois. It wasn’t much but enough to win a cynical bet I made with Peg.  An EF4 tornado hit Washington, Illinois, on November 17, 2013. I’ve seen 70° two weeks before Christmas, followed by 15” of snow in January.

The cluster of holidays makes the early nightfall far easier to take. Halloween sits on the fence between Indian summer and the first snow. Thanksgiving is a great holiday because there’s a lot of food and no gifts to buy, at least until Black Friday kicks off the annual shopping frenzy. I start looking for stuff online before the Cyber Monday insanity and breath a sigh of relief when the last gift has been wrapped. The family once again ignores my suggestion to go on a Caribbean cruise for Christmas.

A new year begins. A new cycle begins.

Coming up: A report from the field.

(Almost) Free at Last!

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I’m now semi-retired.

Even though I feel like I’m in my thirties mentally, I feel like a dinosaur next to physicians that are my kids’ ages. (Aaron would probably say, “Yeah, a T. rex!”). After 36 years, delivering babies is like riding a bicycle, but I started riding that bike when obstetrics was a Schwinn 5-speed I bought in high school. Now that bike is made from exotic materials costing thousands of dollars and requires an engineering degree to operate, even though the destination hasn’t changed.

I was ambivalent about leaving hospital practice when I started writing this, but I’ve gotten used to the idea of maybe never delivering another baby. Letting go has been easier for me than it would be for those whose identities are inextricably tied to their professions. I’ve become increasingly skeptical about the direction health care has taken; I’m more than happy to pass the baton to the next generation and wish them luck. They’re going to need it.

However, I am not just sitting around watching Matlock or yelling at kids to get off my lawn. I’ve been doing health assessments for seniors for the past two weeks and it’s been a fine experience. If nothing else, I’ve gained an appreciation for seniors and insight into what is to come.

Fifty years ago, we didn’t see people in their eighties or nineties. The seniors I knew as a kid were grey, wrinkled and tired.  Most people, especially those who did manual labor their entire careers, retired at sixty-five and had a few good years before dropping dead from a massive heart attack or a stroke. I was shocked to discover LBJ was only 55 when he became President and died at 64, my current age.

But by 2020, the percentage of people over 65 will have doubled since 1950, from 8% to almost 17%.  Ten years ago, people 80 and over were the fastest growing population segment. More people are working well into their 70’s and 80s, often out of necessity but sometimes by choice.

So, I’ve been driving around the Heartland making house calls. I have a rolling case with the equipment I need: a scale; an automatic blood pressure cuff; an ophthalmoscope; a pulse oximeter; a reflex hammer and a penlight; gloves; a 10g monofilament diabetic neuropathy tester; and company paperwork.

The people I’ve seen so far have all been warm and welcoming. They seem genuinely happy to talk with me and are far more relaxed than they would be in the intimidating confines of a physician’s office or a hospital room. The evaluation takes about an hour, longer than the fifteen to twenty minutes allotted to primary care visits. Several have remarked “This is the most thorough exam I’ve ever had!” I can only see six to seven people in a day and no practice would be able to survive at that rate, so it’s a nice service to provide.

While I’ve seen a few people my age, most of them are mid-seventies to early 90s.  Despite chronic illnesses and the infirmities of age, they don’t complain. Yeah, the back hurts and getting around is tough, but any day one wakes up above ground is a good day.

One of my clients on the first day lived in an assisted living facility. I passed a group of women around a table in the hall on my way to his apartment. One of them noticed my white coat and asked in a loud whisper, “Is that a doctor?”  The gentleman was a 93 year old veteran who still drove his own car and liked to play games on his computer. He’d been retired for 27 years, lived by himself, and still had more energy than I do some days.

An 89-year-old man learned keyboards when he retired at 62 and now plays for community events. I asked him what kind of music: “Swing, country, jazz, blues…”  He pointed to his keyboard and microphone, sitting next to his treadmill. He gave me hope that I might be more than a mediocre piano player before I die.

A couple of the men were still running their own businesses. A man in his mid-70s needed a new computer monitor and snagged a 43” UHD TV for four hundred bucks just before I met with him. Another man, 80, had rental properties to check on later the afternoon I visited him. I called a few days later to make sure he’d gotten his blood pressure rechecked and he recognized my voice.

“My blood pressure was much better. Thanks for calling me!”

I saw a couple for my last visit of the day near the end of the second week:  A 99-year-old man and his 92-year-old wife, who both looked like they were in their seventies. They were still relatively active; they’d been waiting for better weather so they could start working in their garden.

The husband went first. I confirmed his identity, entered his medications into the record, and then started with a long list of standard health history questions, which includes asking about past alcohol use.

He became a little defensive and said, “I never drank that much. When you’re Italian, there’s always wine on the table.” 

Sensing his unease, I replied, “My late father-in-law, Mike, was from the South Side of Chicago. After the war, he and his buddies used to crash Italian wedding receptions because the food was great, and the women loved to dance.”

He brightened up and replied, “We used to get trash can lids and bang them together in the middle of the night. People would throw money at us to get us to go away. They never threw quarters, though, only nickels and pennies.”

The conversation became a little more somber when I talked about Mike’s war experience.

“Mike was a tail gunner in a B-17.”

“Was he in Italy? If he was in a B-17, he must have been in Italy. I was the crew chief on a P-38, that fighter with the machine guns in the nose. We flew in the Ploesti raid in 1944.” The memory angered him. “Someone ratted us out; the Germans were waiting there for us.”

I was surprised to talk with someone who knew of that campaign, but I shouldn’t have been since he and Mike were born the same year.

“Mike was on that raid, too! Their plane had been hit pretty badly and they were going down. He’d been injured and his harness was shot up, so the bombardier, David Kingsley, put his own chute on Mike, dragged him to the bomb bay doors and told him ‘Put your hand on the ripcord and pull it once you’ve cleared the doors.’ He went down with the plane and Mike spent three months in a Bulgarian P.O.W. camp.”

Before I left, he showed me a large frame on the dining room wall with pictures of him and his buddies standing in front of their plane. “You know, it’s sad. We can’t get any of the younger guys to join the VFW or the American Legion. I guess it’s not that important to them.”

I started my career bringing lives into the world. Ending it by working with people on the other end is rather fitting, I think, and just as rewarding.

© Can Stock Photo / 3D_generator

Fat Chance

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January – the month when millions of people engage in that time-honored bald-faced lie known as the New Year’s Resolution. “This year I promise I will exercise more, get in shape and lose weight.” (I resolved to get this posted in January, and you can see how well THAT worked out!) It’s about as successful as when my sister-in-law vows to give up throwing F bombs for Lent. One year she made it to 4:30pm on Ash Wednesday; usually she doesn’t make it out the door. Most people have given up on their resolutions sometime between January 12 in Australia and January 17, known as Ditch New Year’s Resolution Day.

Losing weight is one of the most common New Year’s resolutions but often remains an exercise in futility. The New England Journal of Medicine acknowledged the problem in the January 1, 1998 issue, noting ”the vast amounts of money spent on diet clubs, special foods, and over-the-counter remedies, estimated to be on the order of $30 billion to $50 billion yearly, is wasted.” Twenty-some years later the weight loss industry rakes in over $60 billion a year but only about 5% of dieters manage to keep from regaining weight.  Most of the Biggest Loser contestants regain most of their weight over time.

So how did we become so obsessed with weight?

In 1901 Dr. Oscar Rogers, Chief Medical Director of the New York Life Insurance Company, reported that overweight men had a 35% higher death rate. Insurance companies latched onto this finding and assumed the obese presented a higher actuarial risk. Rogers also discovered overly tall and underweight men suffered a higher mortality rate, but conveniently left out those data.

In 1930, Louis Dublin, Metropolitan Life Insurance Company’s vice-president and statistician, linked obesity to long-term illnesses – heart and kidney disease, diabetes, atherosclerosis and stroke – and obesity became permanently stigmatized. The obese stood accused of a variety of psychological disturbances, including depression, gluttony, homosexuality, laziness and anxiety.

Met Life published “ideal” weight and height charts for men and women in 1959 and 1983, but they were based on very sloppy data obtained from white collar people who could afford life insurance policies. Some of the data were self-reported; men over-reported their heights and women under-reported their weights. Dublin’s body frame sizes – “small, medium and large” – were arbitrary. No one considered muscle mass and physical activity; by these measures, many highly trained athletes would be considered overweight.

I’m six feet tall with a “large” frame. The Metropolitan Life Weight Chart for Men says my “ideal” weight should be 164-188 pounds. This is what I looked like in 1991: 175 pounds with a 34-inch waist.

I looked pretty good, right? Well, I was in my 30s and had lost 35 pounds because I’d stopped eating for days at a time when I was going through a painful divorce. Over the next few years I gradually gained most of it back, stabilizing at 220 pounds. I gained another 40 pounds from job stress eating in the late 1990s; my weight fluctuated between 260 and 270 pounds for the next fifteen years. A few years ago, I dropped below 250 pounds, but that was the result of two relatively severe respiratory illnesses. I could eat or breathe, but not both.

The hysteria over obesity was compounded in 1993 when two public health researchers, J. Michael McGinnis, MD and William H. Foege, MD,  published “Actual Causes of Death in the United States” in The Journal of the American Medical Association, from which the media erroneously concluded “obesity kills 300,000 people each year.”  If one bothered to read the article, one found the authors reported “diet and activity patterns,” not obesity, per se, contributed to mortality.  The authors cautioned “no attempt was made to further quantify the impact of these factors on morbidity and quality of life,” and the “numbers should be viewed as first approximations.” 

McGinnis and Foege compared the National Center for Health Statistics’ (NCHS) list of the most common causes of death – heart disease, cancer, strokes, accidents, diabetes, and others – with factors that contributed to mortality, such as tobacco, alcohol, guns, cars and the aforementioned diet and activity patterns. The NCHS found almost twice as many people died from accidents as from diabetes; however, no one suggested we had a national epidemic of stupidity or clumsiness.

NCHS
Causes of Death 		Annual
Deaths 		   McGinnis/Foege
Contributors to
Mortality 		Annual
Deaths
Heart disease 720,000   Tobacco 400,000
Cancer 505,000   Diet /activity patterns 300,000
Cerebrovascular disease 144,000   Alcohol 100,000
Accidents 92,000   Microbial agents 90,000
COPD 87,000   Toxic agents 60,000
Pneumonia/influenza 80,000   Firearms 35,000
Diabetes 48,000   Sexual behavior 30,000
Suicide 31,000   Motor vehicles 25,000
Liver disease 26,000   Illicit drug use 20,000
HIV 25,000      

ARE THINGS REALLY THAT BAD?

Data from the NCHS and other sources suggest the answer is “no:” 

So why is it so difficult to lose weight and keep it off?

For decades physicians told us if we all just ate less and got more exercise, we’d all look like Adonis and Aphrodite. If you were fat, it was your own damned fault because you were gluttonous or lazy.  Researchers have only recently started admitting that weight gain is far more complicated than “calories in – calories out.” Weight regulation is a complex interaction of genetics, environment and biology, and long-term weight loss is nearly impossible for most of us.

The magnitude of genetics’ role in obesity isn’t entirely clear, but we know susceptibility to “common obesity” involves multiple gene variants, first identified on chromosomes 16 and 18. Studies of familiar relationships found the correlation for BMI in identical twins is twice that of fraternal twins and decreases as genetic separation increases: siblings, parent-child, spouses, and adopted children. Pick your parents carefully if you want to look like a cocaine waif your entire life without the drug risks.

Thousands of years ago, when we chased our dinners across the savannahs (or ran to keep from becoming some critter’s lunch), humans adapted genetically (so-called “thrifty genes”) to hang onto whatever calories they ingested as a hedge against times of famine. Western civilization has brought us a surfeit of food along with soul-sucking jobs that have most of us sitting on our butts for 8-10 hours a day (more if you factor in 2-hour daily commutes in large cities). Our bodies have not adapted to this relatively sudden change.

The Pima Indians of Arizona provide an extreme example of environment rapidly overwhelming centuries of a lifestyle that had kept a genetic propensity for obesity in check. Robert Pool, in his book Fat: Fighting the Obesity Epidemic, described the Pima this way:

“When the white settlers first arrived, they found Indians straight out of a Frederic Remington sculpture. The bodies of the Pimas were thin and sinewy, their legs chiseled by regular running, their arms strong from the bow, the war club and the plow. Today the Pimas are fat. Not just chubby or overweight, like the average American couch potato, but obese.” (Pool, p. 140)

A century and a half after being consigned to a reservation, the Pima have gone from being fierce warriors protecting the weak to a tribe devastated by high rates of diabetes, obesity and kidney disease. Their life expectancies are fifteen to twenty years shorter than the average American. Much of this appears to be the result of a sedentary lifestyle and a diet that has changed from a high-fiber, low-fat, low-calorie diet to one with a lot of empty sugar calories and triple the fat content.

Our own lurch towards diabetes and obesity appears to be linked to the low-fat craze that started in the mid-1970s. “Fat is the enemy!” “Carbs are good for you!” The food industry capitalized on this, producing a large range of low-fat foods, which we all gobbled up – and got fatter. Decades later, we learned the sugar industry started paying off researchers in the 1960s researchers to blame fat for obesity. Ironically, European countries with higher-fat diets had lower incidences of heart disease.

While it’s convenient to blame genetics and environment, biological mechanisms don’t help much. Researchers debate whether there is a single “set point” or multiple “settling points,” but most people who’ve lost weight will tell you how their bodies will fight like hell to get it back. Columbia University’s obesity researcher, Rudy Leibel, compared energy expenditures of twenty-six obese people with static weights, averaging 335 lbs., to those of twenty six normal weight controls. As expected, the obese required more calories than the normal subjects to maintain their weights. (Calories per day/weight (lbs.) = calories per pound)

However, when the obese lost significant weight (about 115 lbs. each), they required FEWER calories than expected to maintain their weights. Their metabolisms slowed in an effort to return to their original weight. Kevin Hall, a researcher at the National Institutes of Health, found the Biggest Loser contestants’ metabolisms remained low even after they started to regain weight.

What should you do?

First, weight alone is a poor indicator of overall health. Jim Fixx, the man who got America running, died of a heart attack in 1984 while jogging in Vermont. Dana Carvey, a perennially skinny guy whose genetically high cholesterol levels (familial hypercholesterolemia), has required four angioplasties to stay alive.

On the other hand, in 2002 the San Francisco Chronicle did a story on Amanda Wylie, a 250-lb. aerobics instructor in San Francisco who had a black belt in boxing, did yoga and the splits, and could probably wipe the floor with me. That same year, Jennifer Portnik, another obese but physically fit aerobics instructor, sued Jazzercise for refusing to sell her a franchise. She opened her own business after being certified by the Aerobics and Fitness Association of America, and Jazzercise dropped its requirement for skinny instructors.

Steven Blair and others at the Cooper Institute for Aerobics Research, found that skinny couch potatoes were at greater risk of dying than men – skinny or obese – who maintained cardiovascular fitness. Exercise isn’t going to make you lose a lot of weight, but it’s great for your heart.  So, go take a walk, find a physical activity you like, and minimize couch time.

Recently (February 13, 2019) Samantha Bee took on how media and physicians stigmatize fat people in a Full Frontal segment called “Thicc not Sick.” (I was appalled to find out news outlets refer to stock footage of the obese as “guts and butts”). Twelve years ago, a genetically scrawny medical school classmate badgered her husband into losing weight (I didn’t think he was terribly heavy). I found a Facebook photo from last year. He’s back to his original weight and still looks pretty good.

Realize diets don’t work in the long term because they are merely a temporary change. Anyone can lose weight eating 800 calories per day, but are you willing to do that for the rest of your life? Probably not. Your metabolism will adjust to compensate for the weight loss, rendering permanent weight loss an exercise in futility for most of us.

There is no single, optimum diet for everyone, so find what works.  Peg and I have a low-carbohydrate, high-protein diet, but she can eliminate carbs more easily than I can. My blood sugar will plummet in an hour or two if I don’t have a little carb with my meals. (That, and I get really ugly.) The best thing you can do is eat a relatively healthy diet and give yourself rewards in moderation.

Finally, I think the unrelenting stress of our jobs presents the greatest risk to our overall health (Midwestern winters run a close second). Obstetrical nurses often live on chocolate because they don’t have time to eat while working on chronically understaffed units. Corporate America learned how to squeeze more work out of fewer people for less money and they dare not squawk. “If you don’t like it, you’re free to leave and we’ll find someone who is more of a team player.”

Misery loves company. We’re stuck with work but socializing outside of the workplace and fostering supportive relationships will make life a lot easier. And wine. Everything goes better with wine.