Confronting Your Demons

Max Tomlinson, a doctor, has to create an action plan for a fictitious patient, Max Tomlinson, who is suffering from obesity and cardiovascular disease, and comes to him for a consultation. 

Dr: Hello, Mr. Tomlinson.

Mr: Hello, Doctor Tomlinson.

Dr: How’s everything going?

Mr: Cut the small talk, what’s the damage?

Dr: It appears your condition has gotten worse.

Mr: Worse? How?

Dr: You’re still smoking, eating chocolate and not getting out the house enough.

Mr: How dare you!

Dr: I’m making the professional diagnosis that you are obese – you’re 90kg and only 170cm.

Mr: Save the Latin nonsense for your friends at Eton and just give it to me straight.

Dr: Obesity is a medical condition where excess body fat builds-up due to excessive food intake, a lack of exercise and genetic susceptibility. The World Health Organisation have labelled it one of the leading preventable cause of death worldwide and the most serious public health problem of the 21st century. According to the National Health Service (NHS), obesity affects 1 in 4 adults in the UK, and if the current trends continue, nearly half the UK population will be obese by 2030.

Mr: I’m not obese, I just have a supple pair of love handles, which I know my wife is very keen on – so if you want me to lose them, you’ll have to take it up with her.

Dr: Surprisingly, I’m not interested in your wife’s proclivities, I’m concerned about your health and quality of life. Obesity will have more widespread effects on your body and this x-ray shows that you may be developing what looks like the early stages of an aortic aneurysm.

Mr: An optical prism! I’ve heard The Dark Side of the Moon and that self-masturbatory prog rock makes me feel a little queasy, so if you could you cut to the chase…

Dr: You are at high risk of heart disease. Heart disease is one of the major health consequences associated with obesity, which is a group of diseases that includes coronary artery disease, aortic aneurysms and myocardial infarction (stroke). It has become the leading cause of death worldwide despite estimations that up to 90% of cases may be preventable.

Mr: So, you can help me?

Dr: Lifestyle factors like an unhealthy diet, a lack of exercise, smoking and alcohol consumption account for the majority of the risk linked to heart disease. Therefore, to address your condition, we must understand how we can mitigate these factors.

Mr: Oh dear, I’m feeling a bit faint. Do you have any vending machines nearby? I need a soft drink just to raise my blood sugar. In the words of Mark Ruffalo, ‘you won’t like me when I’m hangry!’

Dr: Mr. Tomlinson, this is very serious. This is your life we’re talking about. Think of your children. They need a father and a healthy role model.

Mr: My children are too busy watching pirates twerking on Twitch to give a damn, sir!

Dr: A damaged aorta poses a risk to your life since it is the largest blood vessel in your body, which carries blood away from the heart to the rest of the body. Given you are a 45-year old man, I’m telling you that you are at high risk of heart disease…

Mr: 45 is the new 30, have you not read Cosmo lately? Besides, they had an article the other day that said fat is good for you, so you should really double check the facts before you lecture me.

Dr: This report says your blood pressure is in the upper quartile for a man your age.

Mr: My job at local garden centre is very high pressure.

Dr: … And your history of drinking and smoking.

Mr: Who doesn’t enjoy a trip down the boozer?

Dr: You have high cholesterol – most likely due to your fast food habits.

Mr: I’m loving it!

Dr: You put down 30 minutes of activity a day, but Wii Fit does not constitute regular exercise.

Mr: I’ll have you know that those can be very vigorous sessions.

Dr: When you add all these together with the fact that both your father and grandfather died from heart disease, it indicates that you are a severe case.

Mr: Save the jargon for Lord Sugar, what’s the prognosis?

Dr: According to the ASCVD score, you have nearly a 30% chance of experiencing heart disease in the next 10 years. You haven’t received any treatment yet, but I think it’s time we considered different approaches to managing your condition.

Action plan

Social context

Since you smoke, you need to give up as soon as possible. I understand that your smoking habit is situationally linked to going to the pub, so I suggest you avoid going for a drink and putting yourself in situations that you might find it difficult to ignore temptation. At present, 25+ units per week may well fit the guidelines put out in the 1970s, but these days we recommend a limit of 14 units of alcohol. If you do drink this much, you should aim to spread it over 3 days or more. This equates to a maximum of 2-3 pints an evening.

Familial context

At home, you seem to resort to the lazy option, and I don’t blame you, it’s in our nature. However, you should do at least 150 minutes of moderate activity a week such as cycling or brisk walking. If you find this difficult, you should build up to it, and increase duration and intensity as your level of fitness improves.

Political context

Reading the news is stressful, even at the best of times, and for someone on the left such as yourself, I understand that the current wave of populism and partisanship in the media can be highly stressful. In addition to these changes, I’m going to prescribe you amlodipine to reduce your blood pressure.

Personal habits

I gather that you’re a McDonald’s fan since you’ve continually tried to redirect this conversation towards a discussion about the secret ingredient of Big Mac sauce. I’m writing up a diet plan, which we will complement with caloric restriction and intermittent fasting as a drastic but potentially successful approach to improve your health. We will need to lower your intake of saturated fat, salt, sugar, and to replace those foods with plenty of fibre and wholegrain foods, as well as plenty of fruit and vegetables, eat at least 5 portions a day.