I am a magnet for angry obese people.

Seriously. I cannot count how many times I was yelled at last week. Everyone tells me that I am grace under pressure, that it looks on the outside as though nothing bothers me. (Score one for Lexapro!)

The scene, Information Session. Again. A patient and his wife waited to speak with me after the presentation. They both looked pretty tired. It turned out that they live over two hours away. with traffic, I didn’t envy their commute.

“We have already been to one of these things,” said the wife, gesturing towards the podium. “I just want to know how much our insurance will cover.”

Not 10 minutes earlier, the presentation included information on insurance benefits for weight loss surgery. Since one size does not fit all, our insurance department has to verify benefits for each and every patient at info session. But there are a few hard and fast exceptions to this rule, three or four companies that we cannot work with. I looked at the patient’s insurance page. Sure enough - he had one of the policies. I broke the news in what I thought was a gentle manner.

Wife screeched, “Whaddaya mean? Dr. X’s office in Beach Town told me that you accept our insurance and that tonight was a formality! That this surgery is a sure thing! Why did they make us come all the way out here?!”

Remember, there’s no sure thing except death and taxes. Before you start this journey, get yourself a nice three-inch, three-ring binder. Trust me, you’ll need all that space. Don’t rely on what you hear from other people, especially when it comes to insurance. Double-check everything so you won’t be disappointed. If the patient’s wife had only called head of time, we could have spared her a lot of grief and mileage.

Apparently I need to keep a bottle of Scotch at work again.

Eating disorders are a difficult problem to understand if you don’t have one. They’re difficult to treat and cure, too. And the person with the eating disorder isn’t the only one affected; family and friends also feel the pain and anguish. Affecting about 5 million Americans, eating disorders are a serious and growing problem in society today. Although eating disorders come in several forms, anorexia nervosa, bulimia nervosa, and binge eating disorder are the most common.

Anorexia nervosa
A person may have anorexia nervosa when she diets to the point of weighing only 85 percent of her normal, healthy weight; fears gaining weight; is preoccupied with food; develops abnormal eating habits; and stops menstruating, or, if male, experiences a decrease in sexual drive or interest in sex.

Anorexia nervosa is an eating disorder in which a person refuses to maintain her body weight at or above a minimally normal weight for her age and height. The person also has an intense fear of gaining weight or becoming fat, even though she is obviously underweight. Anorexia nervosa affects about 1 out of 100 people between the ages of 10 and 20 years old. Anorexia tends to develop in early to mid adolescence when body fat increases from 12 percent before puberty to about 20 to 25 percent after. This increase in body fat is not true weight gain in the adult sense, but a natural biological function of female development. Ninety to 95 percent of anorexics are female and 75 percent of the young women who develop anorexia nervosa do not have a history of being overweight.

In addition to the physical changes that accompany anorexia nervosa, pronounced emotional changes, such as irritability, depression, moodiness, and increasing isolation are also common. In fact, eating disorder experts have developed a profile of personality and family traits characteristic of a person with anorexia nervosa. Anorexics tend to be compliant, approval seeking, conflict avoiding, perfectionist, socially anxious, and obsessive/compulsive, with average or above-average intelligence. Their family environment may include a mother who is overprotective, critical, intrusive, and domineering, and a father who is passive, withdrawn, and emotionally absent from the family. Although not every person who develops anorexia exhibits all or even some of these traits — nor may her family — they help paint a picture of the issues that many anorexia nervosa sufferers must struggle to overcome.

Do you (or someone you know) have any of the following symptoms? The more “yes” answers, the greater the likelihood that you (or she) may have anorexia nervosa.

• Skips meals, takes only tiny portions, and will not eat in front of other people.
• Eats in ritualistic ways, such as cutting up food into extremely small bites or chewing every bite excessively, and creates strange food combinations.
• Grocery shops and cooks for the entire household but will not eat.
• Always makes excuses not to eat: “not hungry,” “just ate with a friend,” “feeling ill,” and avoids mealtime or situations involving food.
• Becomes “disgusted” with former favorite foods, such as red meat and desserts.
• Will eat only a few “safe” foods; boasts about how healthy the meals she does consume are; drastically reduces or completely eliminates an entire group of foods, such as carbohydrates or fats.
• Says that she’s too fat, even when this is not true, and has a distorted body image.
• Becomes argumentative with people who try to help.
• Has trouble concentrating.
• Denies anger, making statements such as, “Everything is okay; I’m just tired and stressed.”
• Withdraws into self, becoming socially isolated.
• Often exercises excessively and follows a rigid routine.
• Wears baggy clothing to hide thinness.

Bulimia nervosa
Bulimia nervosa is characterized by recurrent episodes of binge eating followed by purging behaviors, such as self-induced vomiting, misuse of laxatives or diuretics, fasting, or obsessive exercise, in an attempt to prevent weight gain from occurring as a result of the bingeing. Bulimia occurs in adolescents and young adult women but is relatively uncommon in men, and typically develops in the late teens or early 20s. Fifty percent of bulimics have or had anorexia nervosa.

Some authorities believe that as many as 10 percent of women are affected over their lifetimes. Clinically speaking, a person with bulimia nervosa binges at least twice a week, eats large amounts of food in a relatively short period of time, and then purges to rid her body of the unwanted calories. More than half of bulimics are severely depressed and often suffer from alcohol and drug abuse in addition to their eating problems. Unlike the anorexic, who is excessively thin, the bulimic’s weight is usually average or slightly above average and often fluctuates.

Do you (or someone you know) have any of the following symptoms? The more “yes” answers, the greater the likelihood that you (or she) may have bulimia nervosa.

• Gorges, usually in secret, and may also buy special binge food; is uncomfortable eating around others.
• Makes excuses to go to the bathroom after meals.
• Buys large amounts of food that suddenly disappear.
• Displays unusual swelling around the jaw and cheeks; knuckles may be scraped or calluses formed on back of hand from inducing vomiting.
• Has discolored or stained teeth due to vomiting.
• Eats large amounts of food on the spur of the moment and feels out of control, unable to stop eating.
• Withdraws from friends.
• Doesn’t seem to gain an excessive amount of weight given the amount of food regularly consumed.
• Often exercises excessively.
• Runs water to cover the sound of vomiting, may use mouthwash and breath mints excessively, and may have a foul-smelling bathroom.
• Can’t explain the disappearance of food in the home or residence hall setting.
• May engage in drug or alcohol use and/or in casual or even promiscuous sex.
• Experiences mood swings; may experience depression, loneliness, shame, and feelings of emptiness (although may pretend to be cheerful).

Binge eating disorder
Binge eating disorder can happen at any age, but it’s often not recognized until adulthood. It’s similar to bulimia nervosa, but without purging activities. Victims of binge eating disorder eat large amounts of food at least twice a week, often in a relatively short time. They eat to escape from emotions, yet food makes them feel out of control. They often avoid social situations where food may be served but are preoccupied — even obsessed — with food, dieting, and their body weight. Most binge eaters are overweight or obese and may have obesity-related disorders such as high blood pressure, high blood cholesterol levels, or type 2 diabetes.

Do you (or someone you know) have any of the following symptoms? The more “yes” answers, the greater the likelihood that you (or that someone you know) have binge eating disorder.

• Frequently eats an abnormally large amount of food in a discrete period of time.
• Eats rapidly.
• Eats to the point of being uncomfortably full.
• Often eats alone and in private to hide eating; in front of others, eats only small amounts.
• Shows irritation and disgust with self after overeating.
• Does not purge by vomiting, abusing laxatives, or vigorously exercising.
• Is usually sedentary.

Bingeing only at night isn’t uncommon and may not be an eating disorder. People with Night Eating Syndrome (NES) are often more than 100 pounds overweight, and eat more than half of their daily calories between dinner and breakfast. Unlike Binge Eating Disorder (BED), which is characterized by brief episodes, NES continues for many hours. Nocturnal Sleep-related Eating Disorder (NS-RED) is another kind of binge eating, but the person is often not fully conscious when eating. NS-RED is believed to be a sleep disorder, not an eating disorder.

Americans love their bottled water. You can find it everywhere and anywhere. It’s bottled under many different brand names, and it’s carried on store shelves across the United States. Instead of having a Coke with your Big Mac™ or your Wendy’s® Single hamburger, you can now have a bottle of water instead. That’s good news, isn’t it? With the craze about drinking bottled water, you would think that we Americans are drinking more of it. But, that’s not often the case. Soda is still ranked as the number one drink among kids. So then, the next question is, is drinking soda harming our youth?

Soda - no matter what brand or what flavor - is basically made up of flavored sugar water. There aren’t any nutrients in this popular beverage. Instead, besides the sugar, (or Aspartame™ or Nutrasweet™ in the diet versions), many kinds of soda pop contain ingredients such as carbonated water, caffeine, and phosphoric acid.

Sugar is known to cause a variety of health problems in humans. A twelve-ounce can of soda pop contains an average of 39 grams of sugars. With the increasing problem of obesity in kids and the popularity of drinking soda pop, the two seem to go hand in hand. Studies show that twelve-year-old kids who drink soda are more prone to obesity than kids who don’t drink the fizzy beverage. Sugar supplies empty calories. It also promotes tooth decay. You probably already know these facts.

What you may not know is that drinking soda is harmful to our kids because sugar lowers the immunity system. For five or more hours after taking in sugar, the white blood cells have a lower ability to kill bacteria.

Carbonated water, of course, is the key ingredient in soda. It’s the ingredient that gives soda it’s fizz. You wouldn’t think that drinking fizzy water could harm our kids. However, research shows that when you drink a twelve-ounce can of soda, the oxygen level in your body is reduced by 25% for up to three hours. This means that drinking carbonated water actually robs our bodies of vital oxygen. That’s bad enough for adults. But for growing kids who need plenty of oxygen, it’s even more harmful yet.

Now let’s look at caffeine. Caffeine is a known stimulant. It raises a person’s blood pressure, pulse rate, and the amount of acids in the stomach. It is also addictive. And, instead of replenishing the body, it causes dehydration. Drinking too much caffeine - as in soda - causes nervousness, restlessness, the inability to concentrate, and even insomnia. Do our kids need to feel like this? How can they perform their best in school when they are hyped up on caffeinated soda?

In order to maintain health bones, the human body needs a combination of calcium, magnesium and phosphorus. If there’s too much phosphorus, calcium is taken from the bones. The result? Bone-weakening Osteoporosis. What does this have to do with drinking soda harming our kids? Many sodas contain Phosphoric Acid. Not to mention the fact, that, since our kids are drinking soda pop instead of milk, they’re not getting the beneficial calcium from the milk.

So, in answer to the question, “Is drinking soda harming our kids?” Studies show that drinking an occasional soda isn’t going to significantly harm anyone, even kids. Soda doesn’t contain any beneficial nutrients, so it can’t be described as being “good for you.” However, as long as it’s drunk in moderation, it won’t kill you.

The real problem that’s harming our kids isn’t the soda, it’s the amount of this beverage that the kids of America are guzzling down every day. We can help eliminate this problem by taking some simple steps:

1. Be a healthy role model. Your kids are going to want to drink what they see you drinking. When you’re thirsty, choose water or fruit juices instead of non-nutritional soda.

2. Drink soda pop in moderation. Don’t keep cases of this beverage on hand at all times. Instead, buy bottled water and juice drinks.

3. Encourage your kids to drink plenty of water for their health. Also, make sure they drink plenty of milk and other healthy drinks instead of harming their bodies by drinking too much soda.