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MEDICAL STUDENT

PERSPECTIVES

THE WEIGHT OF POVERTY

By Alexis Ramos

The news and media continuously describe obesity epidemics and overeating
trends in America, labeling the U.S. as a Fast Food Nation. The medical care costs
of obesity in the United States were estimated by the Center for Disease Control to
be roughly $147 billion dollars annually. During high school, I worked as a McDon-
ald’s cashier to better position myself in the future financially. I did not imagine the
impact it would have on me during my journey to become a medical student. I re-
member one encounter with a father carrying his small, blonde child around the
age of five in his arms. He approached the cash register and ordered one ice cream
cone. It is important to note that an ice cream cone was $1.08. The child muttered,
“but Dad, I want chicken nuggets.” The small chicken nuggets were $2.37 alone.
The father replied, “The ice cream will make you fuller.” I could tell by his eyes that
he meant they’ll crush any feelings of hunger quicker and cheaper than the chicken
nuggets. My heart felt empty that this man had to choose the less nutritious option
for his daughter. Being constrained to a limited income implies the options of eating
become limited as well. A fast food burger costs as little as $1, while a salad holds a
hefty price of $6. I empathize with families who feel the effects of poverty and obe-
sity because their time, access to grocery stores, and money are limited. It becomes
troubling when realizing medical professionals are the examples for the public, yet usually our knowledge and opportunity greatly out-
weighs most of the community’s — which may be why the public is outweighing us in Body Mass Index (BMI).
Many unaware adults see obesity as a sign of overeating and laziness. Most physicians even hold weight biases against patients, seeing
them as lacking self-control and being non-compliant. Obesity strikes those with low-incomes the hardest, therefore scare tactics and
shaming perpetuates the problem. If a patient who worked as a zookeeper came into the emergency room with leprosy, a resident
would not state, “you chose your occupation” or “maybe your illness would have been avoided if you stayed away from the animals.”
Most doctors treat the disease and tailor future prevention options to the patient’s lifestyle and situation. Yet we do not do this for
obese patients. The problem persists when medical professionals give patients meaningless advice on how to lose weight. Most patients
understand the ratio of “caloric intake” needs to be less than “energy out” while trying to lose weight. An average obese patient will
attempt to lose weight several times before even stepping foot in a doctor’s office. As physicians, we need to address this issue in full
context rather than stating to eat more protein, less salt, and incorporate fiber. This is as if we were bankers giving advice to customers
on how to be fiscally responsible, telling them to simply apply marginal utility theories and pay attention to sunk cost fallacies. Unless
realistic implementations are explained to patients, we are setting them up for failure (which is fiscally irresponsible for any doctor).
Some realistic tips for a Hispanic family, the major demographic in San Antonio, would be to ask about their diet. If they say tortillas,
tell them to switch instead from four flour tortillas at dinner to one corn tortilla. Limiting pan dulce and other sweets to a reward on
the weekend sets a realistic, attainable goal for the patient. Parking farther away at work so they become less sedentary is a milestone
for patients that should be celebrated. After all, health benefits can be seen when patients lose just 5 percent of their body weight. If
doctors become more responsible for our patient’s living circumstances, we can chip away obese mindsets with an ice pick, not a spoon.
Fast food prices that are congruent with healthy choices could tackle a great deal of the obesity in America. Having worked in the fast
food industry, most citizens do not make unhealthy choices purposefully. They make them because that is the convenient way to survive.
Changing the narrative from simply “eating better” to providing actual solutions lower-class Americans can put in place will help end
an obesity crisis.

Alexis Ramos is a second year medical student at UT Health San Antonio.

16 San Antonio Medicine • January 2018