Well, when you look at processed food, it’s taking a large amount of calories and condensing them into this small volume. It’s also often packed with salt and/or sugar. People become addicted to it. They need to keep eating the same way a heroin addict needs to continue doing heroin.

I don’t buy that. We all eat plenty of junk food and we all know it’s bad. When it starts making us too fat, we stop. Why can’t they?

I’m telling you, it’s a chemical addiction. 

Fuck that and fuck them. I say let them die. I’m a free-market guy. No bank is too big to fail and no person is too big to die.

So just tell them you’re not going to treat them?

Yes. At that ER, there was a woman who was so fat, her giant tits sat under her chin like a TV tray. She was maybe 35 and she was resting her Game Boy on her boobs while she played video games. At the same time, she was talking about her new baby to a friend and bitching about how the doctor promised these pills would take away her bedsores but the sores are still there, seeping.

She wasn’t talking about bedsores, but I know the wounds you’re talking about. They come from lack of circulation.

I don’t get why it’s the doctor’s job to deal with her holes. That’s not what he went to medical school for. Tell her to you’re not going to treat her until she loses 200 pounds.

First of all, if you refused to treat obese people, you would become obsolete. I’m not talking about losing money, though I’m sure that’s a factor with many physicians. I’m talking about practicing medicine in general. To not treat obese Americans today is to ignore about 60% of the population.

But to treat them is to enable their behavior.

What about when the patient you ignored comes in a few months later and now she’s having a heart attack? Do you just let her die on the floor in front of you?

I guess not. I guess you’d have to operate, but that would send a message to other fat people. “They don’t fix your sores anymore. They only help if you’re dying.” It could act as a deterrent.

Well, let’s ignore the obvious immorality of not treating a patient and focus on your “free market” analogy. It’s much cheaper to treat someone early and nip it in the bud than it is to let things get far worse. It’s better for the economy to treat them early.

Treat them how? Give them an electric shock every time they look at a Twinkie?

The only thing that’s been working so far is gastric bypasses.

Don’t they rip those out sometimes by overeating anyway?

Yes, they will expand the smaller stomach until it rips the enclosure off the bottom but for the most part, they work really well and patients end up leading a normal life.

So the only cost-effective thing to do is start kidnapping fat people and forcing them to have gastric-bypass surgery?

That is an impossible scenario but for the sake of argument, I would say doing that would save billions if not trillions of dollars in this country. It would also save the lifespan problem you’re talking about by ending the obesity epidemic and stopping this huge increase in diabetes.

I still say you should just let them die.

Yes, well, that’s why we lead slightly different lives.

What’s that supposed to mean? You’re a brilliant surgeon who makes millions of dollars saving thousands of lives and I’m some asshole who rants on the Internet about things I know nothing about?

You said it.