Fat

Difficult problem to deal with the other day.

I was at Mauro, the youth prison, seeing kids and one of the last patients was this big seventeen year old, called Amos. He's got blond hair and blue eyes and he looks a little bit like you'd imagine Charlie Brown would look - appealing, that kind of phlegmatic but tortured look you see on big, sensitive kids. He came to see me about his weight.

Apparently in the last six or eight months he's put on fifty kilos. That's over a hundred pounds in the old language, a weight gain easily equal to the size of many of his fellow prisoners. His weight gain has not gone un-noticed by his fellow prisoners. Several of them are encouraging him to fight Ted Mulden, the other big kid in Mauro. Amos doesn't want to fight Ted Mulden, and I don't know that Ted Mulden would want to be hit by Amos, because Amos has shoulders twice as broad as mine, but it's pretty boring in Mauro, and the kids have to make their own fun.

Anyway, he came to see me about losing weight. And we came up with a plan. Diet. High intensity rapid cycling exercise. They can't have barbells and dumbells at the prison because someone is always trying to kill someone else with them, but they've got exercise bikes and so on. I told him I was unable to prescribe the slimming tablets he asked for, and that his mum was raving about, because they were basically low dose speed, (and he was in prison because of the high dose speed), but we had some pharmacological options. Cutting back on some of the medications, because I reckon and he reckons he'd feel better if he lost weight and he might not need his antidepressants or the antipsychotics he's on. I even told him I'd look into getting one of the two more widely marketed medications - the orlistat or the sibutramine. He left, as far as I can tell, feeling positive and empowered.

But I don't know. His dad is huge. His mum was huge before she started taking the low dose speed, Amos himself was fairly big before he started the high dose speed. Everyone in the family has type two diabetes and buggered joints, they are all shy. He doesn't eat fat, the food at the prison isn't that bad, but he's just always hungry, always with an empty belly. I've tried imagining what it would be like to be hungry when I get up and when I go to bed and almost every minute in between, but I can't.

I'm not excusing what he did, but you can understand how a kid in this situation might look at speed, and how someone who wanted to look better and be less shy can take megadoses of the stuff, and end up behind a wheel of a stolen car and drive it into a traffic light at three AM.

Anyway, I am going to do all I can to get this kid thinner. Diet, exercise, meditation, motivation, drugs. If there was a temple around here I could sacrifice in I'd sacrifice a chook or something, to Nibblia, Goddess of Slimming.

I don't know that it would do any good to tell him that in other days he would be a fine figure of a man, a figure of power, someone whose body evoked ideas of good fortune and wealth. Instead, he is someone behind whose back people smile.

Where five hundred years ago we had brands and bridles for sinners, nowadays we have a more enlightened system. Fat is a sin now, a sin of itself and a marker for other, equally damning indictments: Amos is self-evidently lazy. He doesn't look after himself. He lacks ambition. He doesn't "go hard", he isn't "being all he can be", he isn't "just doing it".

Anyway, diet, exercise, plus meditation (and possibly medication, if it will help). But I reckon we've got Buckley's chance. Standing behind him, shadowy and indistinct, I can almost see his father, arms like cornsacks, his broadhipped mother, his generously proportioned sisters and strongly built brothers. For two and a half billion years we've tried to get fat in times of plenty so that we can survive the famines - Amos is a victim of his ancestors' success.

The depressing thing is I fear I know what will happen. He gets out in three months. He'll still be fat. We might hardly have made a dent in it. He'll be fat and shy, with the additional burdens of time in Mauro (not a good conversation starter) and extremely poor job prospects.

And the same people will be there as were there before, with their medications that can do what mine cannot. Solve all his problems. Energise him. Blow-torch away all his fat. Light a bright white light inside his head, fire him up. He's got someone who'll give it to him cheap, "mate's rates". He might have to do an occasional favour for him later on, but nothing too harsh.

And next time it's not Mauro, which is relatively drug free, and a juvenile sentence, which does not fuck up your life for ten or twenty years. It's the big house. Things, I am told, are very different there. Steal a car, drive it high speed, an habitual offender, maybe this time kill some-one: he could be in there a while.

Anyway. I'd better get on the computer. Orlistat in juvenile populations. Sibutramine and mood disorders. We did his fasting blood sugar, that was good, that'll be some good news to motivate him with. I have to get onto the Mauro staff, see about getting a punching bag, couple of them. Write up an exercise programme.

And check the phone book for temples to Nibblia.