Coronavirus Chronicles — Human Dilemmas

The previous post listed the very few reasons why a bariatric procedure would be considered an emergency. That word comes into play when something goes wrong with a surgery that has already been done, causing a situation that threatens the patient’s life.

Otherwise, metabolic/bariatric patients are expected to stay out of hospitals until further notice. The facilities and the personnel are needed to fight the COVID-19 pandemic, and for anyone who had scheduled elective surgery it is much safer to stay home.

Physical safety is desirable, of course. But what about the costs that transcend the physical? The obese person who signed up for a gastric sleeve or bypass has generally been thinking about it for years, and the preparation probably took months. A good deal of mental and emotional energy has gone into the steps that lead to such a radical choice.

The lives of bariatric surgery candidates had already been placed on hold, in anticipation of the operation itself and the drastic lifestyle changes that must follow. When a person has gotten all psyched up for a momentous event, delay can be very stressful. And… we’re talking about people who, all their lives, have dealt with stress by eating.

And who knows where history’s current trajectory will lead? These hopeful patients are stranded in a nerve-racking limbo for an indeterminate amount of time. It could be months or years until the circumstances are once again favorable and, in the end, it may turn out that they have missed their moment.

Extreme custody

We also talked about parents in the unenviable position of needing to be round-the-clock watchdogs, making sure their children are not exposed to the coronavirus, while also trying to keep them from turning into slugs because of enforced inactivity, and incidentally, to keep them from doing serious damage to each other while confined.

One challenge faced by the grownups is determining how far to go toward the ideal of avoiding all human contact. There are cultural pressures, like an expectation that the family will go to church.

Maybe the neighbors wanted to invite themselves over, and now they think the isolation routine is just a transparent cover for being stuck-up. Or the sister from out of town wants to seize the opportunity and make the trip. She’s off work anyway, and it could be a long time before the chance comes again. Dad’s friends want to defy fate and have a poker night, and when he declines the invitation, they mercilessly impugn his masculinity. People are having to cope all day long with unprecedented annoyances and aggravations.

Where the sharp things live

Pediatrician Daniel Summers is hyper-aware of how scary a medical visit is, and has always gone the extra mile, with patience and humor, to make kids comfortable. In a piece called “Under a Face Mask, My Patients Can’t See That I’m Smiling,” he wrote,

All they know is that an already frightening place has become more off-putting because of all the weird things I have to wear now. And smiling from within all of it doesn’t work as well as it usually does, no matter how warm and kind I try to make the tone of my voice.

Dr. Summers has performed the mental and emotional triage procedure to make some decisions about priorities, and these are the answers he came up with:

I tell parents they’re off the hook for trying to accomplish anything beyond the necessary. If they don’t have the bandwidth to potty train or work on getting their toddler to sleep through the night in their own bed, they can hit the COVID button as many times as they need. There will come a time when trying to get your picky child to tolerate cucumbers will once again seem worth tackling. Now is not it. Bring on the macaroni.

Your responses and feedback are welcome!

Source: “Under a Face Mask, My Patients Can’t See That I’m Smiling,”, 04/04/20
Image by Ivan Radic/(CC BY 2.0)

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Profiles: Kids Struggling with Weight

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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