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America the Trendy prefers to pursue improvement fads, rather than come to terms with the underlying systems that are defective. The Poverty/Obesity link is not trendy, because the fad must be epitomized by a cute photograph, and obese people are not cute.

What’s the matter with Caitlyn Marie Jenner? Nothing that millions of dollars and fame and admiration can’t fix. Jenner simply stayed in the class of American Royalty, going from a Prince to a Princess – a far smaller jump than the invisible, common people face every day in leaping the abysses that are everywhere in their lives.

Caitlyn Marie awakened the ultimate trendy question – where does she pee?  The answer, depressingly, is into a toilet that you and your people will never be allowed to use, in fancy places and enclaves of the wealthy, surrounded by the paid sycophants of royalty.  Versailles has no “Ladies'” or “Mens'” room, don’t worry for Miss Jenner.  Whether Jenner is bewanged or unbewanged, there will be a footman to powder her/his butt after peepee.

Every “New Movement” in the press requires a codex of sensitivity, and authoritative resources so as to write about the object in a universally recognized polite fashion. The Transequality Site, publisher of Transgender Terminology® reminds us – tactfully – “Terminology within the transgender community varies and has changed over time so we recognize the need to be sensitive to usage within particular communities.” Since in our modern society, there is no existential humanity, and person-objects are merely a concatenation of labels, LISP-style (the computing language, not the verbal,) the Media which defines our reality must follow the style manual published by a recognized authority.

But what should the proletariat, the lumpenvolke be ordered to do?  The spotlights have been trained on transgender only recently; the beauty industry hadn’t realized what a windfall they were ignoring.  Men who wish to look like women have many physical features that evidence a male phenotype; same as for women who wish to look like men.  Often, these people are yearning and unhappy, and tremendous profit can be made off of them.  The industry has turned the Mass Media Market onto transsexuality, and transsexuals need to be told by the benevolent government where to take a leak.  Throughout history, transsexuals have had to pee previous to this.  Certainly, they peed where they saw the least risk of being beaten up, same as Colored People in the South, “then” and now.

Unlike the public’s New Princess of Transgenderism, obesity remains an ugly stepsister.  Obesity is the new Race. It has long been known that personal wealth is shown by the lack of serious obesity, for various reasons. Obesity fulfills many of the criteria that race used to. These people can bear comfortable assertions of contempt towards what “they” are like – shiftless, lazy, selfish. One need not understand any more than the superficial glimpse of the problem to wave it away.

“Trans” has no particular medical interest, other than the complex subspecialty surgery of SRS. I find that I have nothing to comment on, trans qua trans, other than the particulars of the physical examination, which merit no emphasis. Yes, often MTF persons have penises.  So? But obesity, unlike race, is very much in the province of medicine, a highly complex matter.  Although it still is in the dark ages of treatment, as compared to other processes, hopefully, there can be treatments that can help the obese who care – and those who don’t, well, devil take ye, as with other diseases.

My clinical experience: I have stumbled on a remarkably effective treatment for obesity management. Quite a large minority of my obese patients are losing weight in a substantial way. I am pleased. At least once a week I see a patient who has achieved substantial weight loss, moving down from the BMI ranges of the 40’s into the 30’s, or 30’s to the 20’s, or the 20’s into normal range. Last week I talked with a ‘loser,’ 60 lbs.

My secret? It has nothing to do with me. I wish it were from my brilliance, or from some miracle ingredient, or such. It is inaccessible to the pharmaceutical companies, but is the mainstay of direct primary care. It is continuity of care. Seeing the same person, addressing morbid obesity the same as other medical threats to wellness, and discussing my desire to make it better seems to be the magic ticket. Of course, many don’t care – but that’s the way many patients will be, no matter what I want. I find most of the obese patients experience a clinic visit as something different than what they get everyplace else. I have no prejudice against them. I see a behavioral problem to be addressed on medical terms, and I approach knee pain, almost universally, with a suggestion to lose weight, even 5 or 10 lbs.

Without continuity of reliable human contact, medicine means nothing, and that is for hypertension, breast cancer and obesity. Pfizer and Merck just cannot purify that answer, or make a monoclonal against it. Obesity is epidemic because the treatment has been lost, and since we live in the Dark Ages, we replace reason with superstition. DPC is a refreshing alternative, but I fear it will be burnt out with the pitchforks and the torches, by the terrified mob – a heresy which cannot be permitted any more.

Obesity is a symptom, but one far more serious than just fatness. It is societally end-stage.

I certainly hope I will get complaints from someone on this posting, someone from the twilight.  If they are too far down the Glasgow scale, they will not read this; if too high up, they will understand it.  Many Americans live in the gentle crepuscular limbus of the faintly awake, and will respond instinctively, as programmed, to any stimulus.  I write about others; therefore, this must be offensive to someone.

My patient was Cathy, is now known as Mike

Now a transgenderman, once was a dyke

ICD-11 will someday pigeonhole this,

To command where to go where (s)he takes a piss,

or being called “Mister” “Missus” or “Miss.”

Meanwhile, what do I really care

if I care for reflux, Hashimoto’s or rare

diseases that plague both women and men?

How to address the patient transgender or gay?

“Hi, how are you, Mike?”  is all I can say.

all else is irrelevant.

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