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Excess Weight Doesn't Serve as a Cushion in a Car Crash

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"I know plenty of people that weigh more than me, and they don't have any health problems. I might be fat, but I'm doing fine." This is a refrain I hear from patients a few times a year when I talk to them about their weight and how it impacts their health. Usually the patients that say this to me don't typically have that many health problems, so in their mind, they don't see the connection between their excess weight and health problems that might manifest themselves 10 or 20 years later. So with those patients, I have had to develop a new strategy. Instead of talking directly about health problems like diabetes, high blood pressure, cancer, and heart disease, I talk to them about traffic accidents.

What do I mean? Consider this: If you are overweight or obese, you are more than 50 percent more likely to die in a traffic accident. And don't think I'm only talking about men; in fact, obese women fare the worst. We are not completely sure why that is the case. And there are several hypotheses such as seat belts that might not fit well and therefore don't adequately restrain, or perhaps seat belts are less frequently worn if you are overweight. Or it could be that the impact of the airbag on an obese chest can cause problems. And the risks of your body being banged up certainly can wreak havoc on your spine. And if you do survive, often there are underlying medical problems with lung and heart function that make life-support strategies less successful.

Now I know some of you might be thinking that the excess weight creates a cushion of safety. Kind of like a giant pillow! And some patients have actually said that to me. But it doesn't work that way. It is basic physics -- force equals mass (weight) multiplied by acceleration (speed). The excess weight actually creates a greater force that causes more serious injury.

And what about CPR? Several of my friends in law enforcement and emergency medical services have told me that performing CPR can be more challenging when the victim is morbidly obese. Keep in mind that the first step in successful CPR is to make sure the person is on his or her back. If you are over 250 pounds, it might be difficult for rescue personnel to turn you over. And even if they can, it can be harder to do effective chest compressions. I've performed CPR on morbidly obese patients and it takes much more work to do it right. And in car crashes, moments count.

The reality is that one's risk of being involved in a serious car accident is less likely than the risk of developing diabetes if one is obese. And as a physician who is interested in helping people understand risks, I have some angst about focusing on a risk that is not that common. But given the health problems associated with obesity, I will do what it takes to get someone's attention to make lifestyle changes.