Four patients who changed my life
In the early 1980s MD and I were laboring away in anonymity in our clinics in Little Rock, Arkansas. By that time I had gone through my thin-to fat-to thin again metamorphosis, and I was starting to treat patients for obesity. My own transformation had been fairly striking, a fact not lost on many of my overweight patients, a number of whom were seeking my professional advice on treating their own weight problems. I was still doing a fair amount of general primary care medicine, but more and more of my time was being diverted to helping people lose weight.
When I, myself, had gotten fat, I had tried a few diets that were then being extolled (including the Pritikin diet) and had experienced pretty much the same thing most people did with these diets: I lost a few pounds, drifted from the diet, and regained the lost weight plus a little. I then started thinking seriously about obesity as a medical problem, and, in an effort to learn all I could about it, I turned to the medical textbooks on my shelves. Unfortunately, none of them contained any information I found particularly enlightening. The texts went into great detail about the risks associated with obesity and the many diseases that it either caused or made worse, but, other than recommending caloric restriction, none really discussed the treatment. None really discussed (at least not to my satisfaction) what happens metabolically that makes people store excess fat.
I next turned to physiology texts, which didn’t help a lot, either. I then grabbed my old medical school biochemistry textbook (I hadn’t been out of med school all that long at the time, so it was fairly current) and struck gold. I started tracing out all the pathways for fat storage and noticed that in virtually every one insulin turned up somewhere. Then I started reading about all the pathways involving insulin and realized that excess insulin had to be the agent driving the storage of excess fat. I then went back to the physiology texts, reread them in light of my new found knowledge, and discovered that they reinforced what I had learned from the biochemistry text. I just hadn’t realized it, until I had made the insulin connection. (I drew out all the different pathways insulin worked through on piece of paper that we’ve saved, but I can’t lay my hands on it right now. If I find it, I’ll post it.)
















