Messages of the Week 2009/10
	OBESITY AND SOCIAL DIVERSITY Michael Anchors MD PhD, July 11, 2010 I suspect that a big part of the increasing obesity of Americans is due to ethnic diversity. It's a paradox, right? Think of Hispanic families having a picnic or Asian families taking an after-dinner walk. You would think the inclusion of such family-oriented cultures into America would increase socialization and reduce obesity? I am sure it does in some places. In parts of West L.A. every word is in Korean, and half the former population of El Salvador lives in Hyattsville, Maryland. Fine, for the people living there. But outside those places, there are too many blocks of suburban homes where no one wants to know their neighbors because they don't share a culture. You think America is the "great mixing pot"? Ha! In my neighborhood when I run in the cool of the evening, all I hear is the sound of my footfalls and the chirping of birds. A car approaching, a long way off, appears, tinted windows rolled up, air-conditioned. The unseen driver opens the garage door by remote control and drives in. The door goes down, and there is silence again. No sounds of children playing or neighbors talking. When I do chance to see these Asian, Middle Eastern, African, Hispanic "neighbors", I see, they are always fat. Always stressed. Social isolation and cultural conflict. They eat their stress. INCREASING PROTEIN/REDUCING CARBS WORKS BY REDUCING EATING Michael Anchors MD PhD, June 27, 2010 Several authors recently have misconstrued the meaning of Sacks FM et al: Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009;360:859--. The authors said that the NEJM study shows there is no difference in weight loss between a high-protein diet and a high carbohydrate diet, implying that Atkins and the rest of us got it wrong. Indeed I agree there is no difference in weight loss when total calories in the diet are maintained constant. My colleagues and I have never disputed that. What we have said is that when protein is increased in the diet and carbohydrates reduced, people at liberty eat fewer calories. I don't know why. It's just so. My interpretation is that their hunger or their appetite is reduced, but that's just an interpretation. They only fact is experience and the numbers. The observation is that people eat less. VITAMIN B-12 Michael Anchors MD PhD, June 18, 2010 Many bariatricians give patients vitamin B-12 shots. Some tell the patients the shots may help with weight-loss. I love it. "May help!" Safe, right? Can't be disproven. But in fact there is no study anywhere showing that vitamin B-12 makes people lose weight. Moreover bariatricians sell these shots for up to $40 each. I want to tell you that each B-12 shot costs the doctor less than $2, including the syringe (I use an insulin syringe). Where do these doctors get off charging so much for B-12 shots? T'is true that family practice docs have known for a long time that B-12 shots make tired people feel less tired. The effect lasts from one week to three, and is independent of the blood level of B-12. All obese people feel tired because they are hauling around so much weight, and because they are all stressed and overworked. B-12 pills swallowed do NOT reduce tiredness. Such B-12 goes through the liver first and gets sucked out before reaching the general circulation. B-12 shots bypass the liver--that's why they work. BUT did you know? you can get sublingual 500 mcg B-12 tablets to melt under your tongue. I got 100 Nature's Bounty brand at CVS for $9; that's 9 cents per sublingual tablet. It works just as well as shots. THE ONLY THREE REASONS TO EAT Michael Anchors MD PhD, May 28, 2010 My daughter Rachel, a competition-dancer and motion-picture-animator, taught me that in good dancing and good animation, there is an illusion of continuous motion, but what we really see & remember is a series of poses. The brain does not easily remember smooth motion itself. Similarly, when I teach people how to live, I know people won't retain a blizzard of words. It is the interspersed catch-phrases that have impact. They stop the conversation. The art lies in choosing which catch-phrases to use, how to link them together, how to build up to them, pausing on the other side and letting the phrase sink in. I monitor the results by observing body language and listening to the verbal response if there is one. For example, in some conversations I remind fat people that there are only three valid reasons to eat. (1) It's breakfast time. (2) It's lunch time. (3) It's supper time. Well . . . four reasons to eat. The fourth is, if you're genuinely hungry. But there are NO other valid reasons to eat. Fat people are caught short by this. I hit the target, and they know it. Skinny people are unmoved; they think, "Well duh, that's obvious." ZEN AND THE ART OF LOSING WEIGHT Michael Anchors MD PhD, May 19, 2010 I reread Eugen Herrigel's wonderful 1953 book Zen and the Art of Archery, an 80-page gem about learning Zen through the process of learning to shoot arrows accurately in a relaxed, mindless manner. At one point Eugen asked the Master why he watched him as he shot, but the Master did not look where the arrow went. The Master gave two answers. First if the Master showed interest in the target, the student would be interested in the target, too, the very mistake the Master was trying to prevent. If the student cared too much about the target, he would surely miss it. Just as he might easily walk the length of a beam on the floor, but if the same beam were placed across a chasm, he would fall off. Anxiety is the enemy of life & performance. One's self is the only obstacle. Second if the Master saw the student shoot the arrow in a relaxed, mindless manner, the Master knew the arrow hit the target. For it will go where it is aimed, and the student would not aim anywhere else. I, a master of diet, do not focus on target-weight. I wish I didn't even have to weigh the patients in the office at all; I do so only to keep a chart for legal purposes. At the point the patient knows what I know and thinks as I think, I have won the weight-battle! It can take a year, or it can happen in an hour. HOW TO LIVE A LONG TIME Michael Anchors MD PhD, May 14, 2010 When you talk to very old people who are doing very well, ninety years old, ninety-five, a hundred, you discover they have three things in common. They are not obese. Obese people die young, but the body can handle a moderate degree of overweight pretty well. We are not as delicate as false experts claim. Second, the old-people-doing-well had parents who lived to be very old. Third, they handled stress well, because of their temperament and sometimes because of their religion, but more often because of their moderate philosophy-of-life posing as a religion. Women who handle stress well are always verbal and social, sharing their burdens. Men split about fifty/fifty. Some handle stress well by making friends; others eschew company, but still manage stress well. But the healthy-old are NOT doing well BECAUSE they ate the right foods or didn't smoke (that whole generation smoked, are you kidding!) or because they jogged regularly or did yoga or prayed. Ask them. Talk to them. Even a little evidence beats a scupper full of wishful thinking. HOW IT ALL FITS TOGETHER Michael Anchors MD PhD, April 30, 2010 It is amazing how well everything fits together when you understand the U.S. culture! The fact that it fits so well gives you the feeling there is a Higher Power directing the country. How could so much evil be so orchestrated unless someone directed it? My favorite candidate for the role is Richard Nixon and his dark angel, Rusty Butts. After they changed the farm loan program to one of paying farmers directly to grow corn, U.S. food output doubled and we lurched toward obesity. Scientists scrambled to develop processed foods & other products from the excess corn. HFCS & gasohol. Your toothbrush is made from corn silk, and the shine on your furniture and paperback books. Dietitians forsook moderation and preached low-fat. The D.O.A. Food Pyramid in school textbooks. Gallstones climbed due to the lack of fat in the diet to keep cholesterol in solution. More gout. More kidney stones. Vitamin D deficiency. You need a minimum of fat to absorb fat-soluble vitamins, and Americans deserted milk in favor of sodas. Esophageal cancer due to esophageal irritation from excess carbonated beverages. Carbs impair attention and cognition. Noticed any of that in your fellow drivers lately? in Congress? in the financial advisers who "didn't see it coming"? Consider the dominance of the Superhero theme in American culture. Reductionism of issues to simplistic dualism. Good versus Evil. Liberals versus conservatives. Capitalism versus the world. Stupid. Stupid. All directed from the center of hell by the Evil One, Richard Milhouse Nixon. CHANGE MY SHINGLE? Michael Anchors MD PhD, April 17, 2010 My approach has continued to evolve. At this point I'm not as focused on weight-loss as I used to be. I want my patients to lose some weight, but more than that, I want them to stop thinking like Americans. If they continue to be materialistic and distracted, there is no way they will keep weight off, no way they'll be happy. As I said before, nothing countable makes you happy, and that includes pounds. And as I said, nothing fungible makes you happy, and nothing borrowed. That includes someone else's diet advice. The patients must "get it" for themselves. The challenge is to help them "get it" when they are so used to be given everything. So used to valuing THINGS (pills?), instead of ideas or people. So focused on belief, instead of evidence. I would like to change my shingle from "Bariatrics" to "Life-Coach", but dare not do so yet. People arriving for the first time at my office know only the medical model: some talk, a little exam, write a prescription, next! They learn the meaning of "life-coach" only after talking to me for thirty minutes. Before that, if they saw only "life-coach" on the shingle, I don't think they would respect me. THE DENTAL DIET Michael Anchors MD PhD, April 9, 2010 The obese people I examine tend to have more dental caries and gum disease than the lean people I see. No surprise--fat people eat more sugar and more often. So how about the Dental Diet! Get compulsive about brushing and flossing after every time you eat. You would be less likely to snack then. And even if the "diet" didn't lead to weight loss, it would sure lead to healthier teeth. But I bet it would lead to weight loss. Anything that raises eating to the level of consciousness is for the good. MING LO MOVES THE MOUNTAIN Michael Anchors MD PhD, April 1, 2010 The small number of my patients who don't lose much weight are almost all incapacitated by stress. There is no point talking to them about the Six Lessons until the stress is reduced. One technique is to read from a children's book, Ming Lo Moves The Mountain. Like all good children's books, Ming Lo is entertaining to children, but contains an important message for adults. In Ming Lo a married couple in China living in a little house at the foot of a mountain are unhappy because rocks, falling off the mountain, make holes in their roof. They ask a wise old man to help them move the mountain. He gives them several suggestions that don't work. Finally, he tells them to take apart their house, put the pieces on their shoulders, and do a magic dance that involves walking backwards. The couple follows the advice, moving backwards across the land. When they reassemble their house, they see that the mountain has, indeed, moved away. Hearing the story, kids laugh, but the adults appreciate that the story is really about dealing with stress. Instead of dealing with it ineffectively with denial, anger or wishful thinking, they can handle stress better by getting away from the source or, buddha-like, learning not to care about the source. You have to care about the stress, though; it is the cause of most obesity, heart disease and a lot else. Read Why Zebras Don't Get Ulcers by Robert Sapolsky. AT A PARTY WITH DR. ANCHORS Michael Anchors MD PhD, March 14, 2010 Many of you have asked, "What's it like to be a famous weight-loss doctor?" Well actually no one ever did. But I'll tell you anyway. Last night, with my lawyer-wife, I attended a fund-raiser held by the Women's Bar Association. I knew very few people there, but I did spot several of my patients among the crowd. Some who had done well spotted me and came over to greet me, smiled, chatted and introduced me to their friends. Others who had not done well, recognized me and kept their distance. I gave no one a meaningful look; it's not my place to embarrass people or expose personal information. As a group, lawyers & politicians make poor weight-loss patients. They tend to be non-compliant and don't come back for follow-up. They are smart enough, but they work in a constant high-stress environment with heavy exposure to snack foods. I've previously written about what stress does to people. Doctors and nurses work in a high-stress environment, too, but they make excellent patients. Their daily exposure to the consequences of obesity in fat patients prevents them from engaging in denial in their own life. MAGNETS Michael Anchors MD PhD, March 5, 2010 A year ago I began giving students a reminder-magnet to stick to their refrigerator. Using my computer I printed a gleaming rendition of the Six Lessons (and my name & phone number) onto 4" x 6" white magnets from www.MagnaCard.com. The magnets considerably improved the students' learning and retention of the Six Lessons, and increased the frequency of follow-up appointments. I have added a second magnet with the following multicolor, beautiful text. "Dieting is about shopping & ordering. It is NOT about resisting temptation. It is about AVOIDING it. You cannot eat what you do not have. And you will eat what you do." I get so sick of patients buying junk, putting it in their house and wondering why they can't avoid eating it. Nothing in medical school prepares you for real people. Their behavior is astonishing. The third (and I think, last) magnet has the Anchors' version of Don Miguel Ruiz' Four Agreements. 1. Keep your promises. 2. Don't take anything personally. 3. Don't make assumptions. 4. Try to do your best. With appropriate short explanations. So much of American eating is driven by stress, overwork and poor values. I teach the Four Agreements. I teach that people who only work, eat & sleep are no better than slaves. I teach true humanity. BUDDHA TEACHES MARX & JEFFERSON Michael Anchors MD PhD, February 10, 2010 The fact that so many Americans are obese is strongly connected to the fact they are so unhappy. Listen to what fat people say. "Do no harm" is not the first principle of medicine (it can't be done); instead, it is "listen to the patients". That isn't done enough. You cannot make unhappy people stop overeating, but you can make some people happy. I'll tell you how in a moment. Though "earning" an annual average of $44,000 per person, Americans are not even in the top twenty of countries ranked for happiness. Few of the top twenty are rich, few are poor! Karl Marx and Tom Jefferson wanted to give workers the ability to pursue happiness. They succeeded! But though people in the worker's paradise got the right to pursue happiness, they did not, in general, become happy. The reason is, as Dan Ariele writes in Predictably Irrational, as Jesus taught in the Sermon on the Mount and as Buddha explained so well, people see things & situations only in relation to other things. So, no thing or situation has absolute value. As many things as people might have, as good as their situation might be, they always want more. I was going to tell you how to teach people to be lean and happy, but having heard this much, you can figure out the rest. Lesson 6 and moderation are the key. KEEPING IT SIMPLE Michael Anchors MD PhD, February 1, 2010 A good way to help people deal with a problem that appears, to them, complicated and intractable is to give them a simple way to think about the problem. Besides telling fat people to cut back on starch and sugar, the other helpful approach, I find, is to remind them that in a country like the U.S. where everything is so flaming big, you are not dieting or losing weight unless one of the following is true, really truly and for real: 1. You are eating less often, or 2. You are not finishing your food. Everything else is just phoney, wasting-time. EXPLORING THE MIND Michael Anchors MD PhD, January 28, 2010 #1. Patients returning for second/third visit who did not lose weight, I ask in a friendly way what changes they made to lose weight. If they readily give a meaningful answer, I do a TSH test to check for hypothyroidism. But more often, they have no answer and look confused. I repeat the question. If they still have no answer, I'm ready to throw them out the door. YOU should. #2 Showing them a diagram of vicious cycle #1 (see the MOW), I ask what's the difference between saying "I need something" and "I want something". Most Americans are unaccustomed to making the distinction. #3 I ask what the Appleby's ad means (Come to Appleby's. You get more for your money.) Europeans are baffled. More what? they ask. But Americans instinctively know the ad means quantity of food. #4 I ask if food is wasted when it's not all eaten and winds up in the trash. Americans answer yes. But would eating it have prevented it from being wasted? #5 I ask the name of their best friend and ask how much I can buy the person for? to show that many things have no price. People are happiest (and leanest) living in the world of social norms, not market norms. Read Predictably Irrational by Dan Ariele. HAZMAT Michael Anchors MD PhD, January 19, 2010 This morning I mailed a copy of Life Between Meals to Dr. Malcolm Kendrick whose book The Great Cholesterol Con convinced me, and would convince anyone, that cholesterol does not cause coronary atherosclerosis. The fact that so many "experts", editorials and "studies" have said otherwise, for so long, exposes the stinking rot in the way medical research is conducted by pharmaceutical companies and the people they pay. Note that this admission comes from an MD PhD (moi!) who participated in the development and testing of Mevacor in the mid-eighties. I took Mevacor from 1987 when it came out, and I still had a heart attack at age 55! I thought that was strange, but now I understand it. The principal cause of atherosclerosis is bad, mental or physical STRESS (not good stress). At the time of my heart attack I was finishing Life Between Meals, fighting with my publisher to let me tell the truth, fighting with CVS Pharmacy to get them to stop telling people that phentermine and Prozac should not be combined and fighting with the state of Florida for banning phen-pro. I was getting ready to take on the British Medical Association for banning phentermine. I'd say I had some stress. Today the postal employee accepting the package for Malcolm asked if there was anything in the package (my book) that was "fragile, perishable or potentially hazardous". I answered yes. Page 162. To avoid embarrassment, I have removed page 162 from the book I sent to Malcolm. VICIOUS CYCLES Michael Anchors MD PhD, January 5, 2010 Two vicious cycles play a major role in the eating of obese people. One cycle is biological, the other habit. The habit-driven cycle is this. People make or order extra food . . . because, well, god forbid, anyone shouldn't get everything they want. Then the people eat the extra food so none of it will "go to waste". (See "The Notion of Waste" MOW Dec. 16, 2007) The biological cycle I discovered as a result of my experiment on myself (see the previous message). People feel stressed, so they eat more carbs. I don't know why, but they do. All of them. Always. Overconsumption of carbs leads to persistent high insulin levels rendering people more emotional and less rational. I don't know why, but it does. Try it yourself! Being more emotional, the people feel more stressed. And the circle continues. Exposing these cycles to intelligent, motivated people allows them to interrupt the vicious cycles. Making or ordering less food fixes the first vicious cycle and non-purchase of carbs fixes the second. EXPERIMENTING ON MYSELF Michael Anchors MD PhD, December 28, 2009 I spent last week in San Diego, visiting my daughter, missed the snowstorm back home and gained 6 lb in six days sort-of-on-purpose as an experiment. At the free hotel breakfast, I made myself a waffle everyday, one only but it wasn't small. With the large intake of carbs at breakfast I found I was hungry by eleven, "ravenously hungry" or "starving" as my patients might say. I ate lunch and dinner in Mexican restaurants. I figure I was eating 5000 calories a day. I found I was much sleepier and more emotional (just ask my kids), less intelligent (I think) and less motivated. I took books, but didn't read them. On my return home, I have been having a fruit for breakfast, tuna salad for lunch and vegetables for dinner. Immediately I have seen the following: (1) rapid weight loss 186 185 183 182 181 179 179 so far, (2) sizable diuresis (large amount of dilute urine), (3) I'm more awake, (4) and less emotional. I think increased carb intake-->increased insulin itself impairs wakefullness and intelligence. There is basis for this belief in the literature besides my limited experiment. Someone should do a double-blind, glucose-clamp experiment checking IQ and sleep-latency. Such an experiment, in which blood insulin is the only variable, will likely show that IQ and sleep-latency decrease in inverse proportion to the insulin level within normal ranges of blood glucose. After lions eat a large meal, they sleepy. Insulin is the STORAGE hormone. Part of promoting storage is inhibiting activity. CHANGING PATIENTS TO STUDENTS Michael Anchors MD PhD, December 15, 2009 I'm not going to call my patients "patients" anymore; I'm calling them "students" instead. The word "patient" comes from Latin patior meaning 'to suffer'. The idea is that the doctor's sick patients are suffering. But most of my obese patients don't think of themselves as sick, though they should; they will be in the doctor's office or the ER soon enough. And my formerly-obese, now-cured patients think of themselves as still suffering, but I want them to think of themselves as healthy, restored to sanity; let them think of the rest of the country as sick. Besides that, the word "patient" often gets mixed up with the word "patience", and my patients are anything but patient. The word "patience" comes from Latin patientia a completely different root. American and indeed Western patients in general focus on pills. Students focus on studying teachings. That's where I want my students to focus. On the Six Lessons, and not on the phen-pro pills. It must be so because pills can only reduce hunger, but most of the bad eating people do has nothing to do with hunger. They eat merely because they're awake (snacks) or they always finish the plate no matter how big. Phen-pro alone won't stop that; study will. LEAVING THE NEST Michael Anchors MD PhD, December 11, 2009 Most of my patients graduate, reaching a point where they have lost so much weight that they feel less hunger, and by golly they have learned the Six Lessons. I nudge them out of the nest; they can fly on their own. They usually don't gain weight back, or lose a little more, or don't gain back much. How do we know? We do regular call-backs. Almost everything other bariatricians told me turned out to be wrong, or wrong for my practice. They told me to assign goal weights. I know that's counterproductive. I set goal attitudes instead. They told me that obesity and diabetes are incurable. That's wrong. They told me to discharge patients who don't perform adequately, but then I would not have saved the patients who kept coming and finally caught on. So much advice from other bariatricians was not based on any actual study, but on legal anxiety and the pronouncements of puffed-up experts. I think for myself. And I'm not the only one--I have many similarly thoughtful doctor-friends. You know who you are. BROWN LUMPS Michael Anchors MD PhD, December 7, 2009 Often, in teaching, it is helpful to give a visual image of an idea. An example is when I talk about brown lumps. Explaining Lesson #2 (the Anchors' Pyramid) I say, "Eat more fruits and vegetables, and by vegetables I don't mean potatoes [I can hear myself saying this]. You have to eat some salad, some soup. Everything fat young men eat is a solid brown lump. In a typical week--pizza, hamburgers, chicken, mexican food, pizza again. It's amazing those boys don't get scurvy. Didn't their mothers teach them how to eat? You can't lose weight if all you eat are brown lumps. You must eat something green, yellow, red . . ." Word for word it's what I say. And I remind you, my approach works well. Add visual images to your speech. Connect to things the patients have seen & noticed. It will add to your stature as a therapist and fix the ideas you're trying to teach in the patient's head. The human brain is a visual organ. MEDICAL MAVERICKS Michael Anchors MD PhD, December 3, 2009 Larry Hobbs sent me some books, Medical Mavericks, Vols 1 and 2 by Hugh Riordan MD, as a message of comfort. I'm prone to depression at this time of year and get tired of having success with patients but little success spreading phen-pro and the Six Lessons to other doctors. The Mavericks books deal with physicians whose contribution to medicine was ignored or disparaged at first, but recognized & appreciated later. I appreciate the compliment implied in sending these books to me. Many of us appreciate the contribution Larry himself has made to the field of bariatrics. But one should not get the idea from these books that there is a system in place to guarantee that valuable ideas aren't ignored. Many mavericks you'll never hear of, aren't in these books. When anthropologists examine the history of human species, they find that tool-making & agriculture were discovered, forgotten and rediscovered many times. Sometimes, in a locality, they weren't rediscovered at all--they stayed lost. The invention of writing was supposed to prevent such losses of knowledge, but writing can't do it alone. We need reading, too . . . followed perhaps, some day, by the re-invention of real publishers. THANKS GIVING Michael Anchors MD PhD, November 25, 2009 For Thanksgiving I give thanks for the intelligence and creativity of my patients which makes my high success rate possible. Something I did has ensured that nearly every one is realistic and sharp. Maybe because so many come by referral from other patients (smart people tend to have smart friends) or through the internet, patients travel from other cities to see me. Whatever I did, I don't want to change it. I did a MOW a year or two ago on how to handle Thanksgiving. I ask patients, "How are you going to handle it?" meaning that it is serious business and I want them to think about it in advance. It is NOT that fat people lack willpower and skinny people have it. Not at all. The situation is that skinny people set up the conditions so they don't need willpower. Fat people plan not, are taken by surprise and suffer remorse later. Need a third paragraph here, so I will dispose of a myth. Many people and most doctors believe that eating turkey makes people sleepy, because it raises brain serotonin. Not a bit of it. In fact, turkey has no more tryptophan (a source of serotonin) than any other meat. You can't raise serotonin by raising tryptophan anyway, because tryptophan hydroxylase is a tightly-controlled, product-inhibited step. If people get drowsy after a feast, it is because of alcohol or the gross overconsumption of carbs. I can't find any direct evidence, but I bet you'd find that high insulin levels promote drowsiness. Stands to reason it would. LABELING IN RESTAURANTS Michael Anchors MD PhD, November 18, 2009 On NPR today I heard that the state of Maryland passed a law requiring fast food chains to display on their menu the calorie count of the food items on offer. All studies agree that calorie counts on menus have no effect on calories eaten, in both high- and low-class restaurants. No surprise. The overweight people among the aristocracy as well as the hoi polloi ignore calories; and the lean people, who might be influenced by calorie counts, don't do much of the eating. Since this fact is so widely known, why did Maryland bother to pass the law? Why is the U.S. Congress considering a similar provision in the health care reform bill? Why don't calorie counts work here? In a related story on NPR, ordinary "folks" wondered how Khalid Sheikh Mohammed could have become so radicalized by living in North Carolina for seven years as a young man, among us, where he was treated "just like everybody else". I wonder? How could that be? . . . I don't know. You either see the elephant, or you don't. PIZZA Michael Anchors MD PhD, November 15, 2009 It's not true that the U.S. never developed its own cuisine. That illusion arises from the fact that so many of the foods we think of as Mexican or Italian or (you name it) were really developed in the U.S. The chimichanga, enchilada and hard-shell taco, all created here, the first in California, the rest in Texas. Caesar salad? San Francisco. Chop suey? Ditto. The hamburger? Not Hamburg. Pizzas in Italy were originally cooked in rectangular pans on holidays for children. Now in Italy round pizzas are sold in tourist areas, always as individual slices. The very word "pizza" comes from the Italian for 'piece'. Pizza there doesn't taste as good as it does here. No Dominos pizza delivery cars ply the streets, no boxed pizzas in stores. You wonder how those people live? It's debated whether pizza, as we know it, originated in Chicago or New York. Pizza in Chicago is thick. In New York thin. Like the people. Only Americans think of eating a whole pizza. That Pizza Hut would offer five whole pizzas for the price of one (they do) is emblematic of the greatest level of gluttony the world has ever seen. No pill could possible control such insanity. (They say, "it's for parties". Sure! like we have so many parties!) For the Scrabble players, "za" is the only two-letter word starting with "z" in the dictionary, and it means 'pizza' (don't ask me why). GETTING THE RIGHT FOCUS Michael Anchors MD PhD, November 6, 2009 The most frustrating thing I face is patients and doctors who focus on the pills and pay no attention to the Six Lessons. Such people will never lose weight or help other people lose weight. The greatest thing achieved in my life is not my plays and novels, not my scientific publications (textbooks omit that glucose-6-phosphatase plays a role in the brain), not my own children (my wife did most of that work). The best thing I ever did was the Six Lessons. The trouble is, in our materialistic society, no homage is ever paid to ideas or advice. But you cannot hold happiness or success in your hands. In the case of obesity, it is easy to understand why. Most of the problem-eating in Americans has nothing to do with hunger. I can kill hunger dead, but if the women keep eating cake & cookies and the men always eat everything on their plate, no diet-success is possible. Focus on hunger & hormones is misplaced. Obesity is a cultural issue. Many patients arriving in my office expect me to talk about calories and points and portion-sizes. I do very little of that, because the patients already know all about that. They aren't fat because they are ignorant. (Far from it. My patients are smart.) They are fat because they are bad, and don't know it. But they want to be good. Obesity is a cultural issue. MORE FUNNY DIET BOOKS Michael Anchors MD PhD, October 31, 2009 Twice before I gave you a list of funny ideas for new diet books. This year one of my funny ideas actually became a book, The Cookie Diet, and it is a best-seller, the most searched topic on the Internet. No publisher ever went broke banking on the stupidity of the American people--I am not the first to say so. Here are more funny ideas. Borrow any of them if you want to get rich. The Atheist Diet. Atheists weigh less than moral people. They have fewer holiday feasts. The Sleep Diet. The chief cause of obesity is wakefulness. This book tells how to stay asleep. The Ghandi Diet. People the world over admired Ghandi for his slim figure. How did he do it? Stay slim, I mean, not liberate India. The Space Diet. No American astronaut was obese. This book reveals how to get good food into old toothpaste tubes. BEING A LIFE COACH Michael Anchors MD PhD, October 28, 2009 I'm running out of new things to say. By now I am as good as it is possible to be with smart, motivated people, and smart, motivated people are all I see. Other doctors laugh and say, "What's the challenge in taking care of smart, motivated people?" and I reply, "I didn't say it was a challenge. They are just the only group I ever succeed with." Because most of the problem-eating Americans do has nothing to do with hunger. They eat because they are awake . . . self-focused . . . and because they never learn respect for self-restraint and compromise. Even when self-restaint is taught at home, television, movies and the example of most parents & politicans is enough to teach kids that only the crazy stuff gets any real attention. So Dr. Anchors had to become a life coach, a Changer of Culture. It was the only way. The reason I get so many smart, motivated patients is that 70% of my patients come from the other smart, motivated patients and 25% from the Internet. The patients who are not smart or motivated come to me from other doctors, who tend to send their biggest patients. Such patients should be referred for bariatric surgery, instead. I prefer to see the middle-weight people or those who don't have far to go. SOCIAL ISOLATION Michael Anchors MD PhD, October 15, 2009 The most common cause of diet failure in general is depression & social isolation. Among my patients the most common cause is social isolation, because the SSRI part of phen-pro takes care of the depression. Most patients do very well, but I continue to think about the people who don't, who do nothing real to change their life. Almost all are unable to comply with Lesson #6 because they have no friends or their only friends have four legs. It may be that such people would feel lonely even in Italy (oh no, here he goes again!), but I suspect they would not. The Italian family & neighbors don't leave you alone. Every restaurant has a terrace packed with tables & chairs, full of people eating shoulder to shoulder. Other diners join into your conversation. You make new friends. In the U.S., tables are as far apart as possible; heaven forbid people at one table talk to people at another. The "music" is so loud, you can't hear anyway. If you go to the restaurant lonely, you stay sad & lonely--no one talks to you. Even so, I press my patients to get out and be with people. I tell them people are interested in their experiences and what they have to say. Overweight itself is no impediment; hell, most people are overweight. Outside of Hollywood, the value of the person is in the mind anyway, not the body. I counter social phobia with the Four Agreements (see MOW Aug. 1, 2009). HIGH FRUCTOSE CORN SYRUP Michael Anchors MD PhD, October 1, 2009 The manufacturers of high fructose corn syrup (HFCS) are fighting back against public ignorance by launching a TV campaign and a website www.sweetscam.com. I have mixed feelings. Most of what they say is true, but some of it is misleading. Consider this from the website: myth: Overweight people tend to consume more sugar than lean people. Some research demonstrates that lean people actually eat more sugar (and less fat) than obese people. A 2005 study in Obesity Reviews found that in 91% of countries examined, overweight youth consumed sweets less frequently than normal-weight youth.. Do I really need to pick this apart for you? Okay, I'll get you started . . . it's not a study of the United States. High fructose corn syrup is nothing more than 55% glucose and 45% fructose. White table sugar is all sucrose, which is rapidly split by enzymes to 50% glucose 50% fructose. The impact on the body is the same. Within minutes the body cannot tell whether it got 100 calories of HFCS or 100 calories of sucrose. So, most of what you hear about HFCS is blubbering nonsense, and I feel sorry for the food companies trying to inform the public. Americans are fat because they eat too much. Period. After HFCS came out in the eighties, did U.S. consumption of sucrose go (A) up, (B) way up, (C) down or (D) stay the same? Answer: B. HUMOR IN BARIATRICS Michael Anchors MD PhD, September 26, 2009 My daughter the smart lawyer praised my recent MOW, but said it's "depressing as usual". This year has been my best year for MOWs, but do you think my MOWs are depressing? I don't find that the words "depressing" or "optimistic" apply to the truth. An "idea" can be depressing, one's "hopes" can be optimistic, but the truth is immune to such adjectives. Ideas and hopes are man-made, but the truth is not. A molecule can't be optimistic. A black hole can't be depressing. They are just nature. Just there. But as anyone knows who has been to my office, my patients and I laugh a lot. In my personal life I am a writer and producer of comedies on stage. You will laugh when you read my novel Ruby's Run available on Kindle. I'm a funny guy (in both senses of the word). But the doctor must be judicious in using humor in the office, because the obese patient, skilled in denial anyway, likes nothing better than to diffuse & deflect the truth. Okay. Well. Here's a funny thought. There are so many shiny new diet books offering stupid ideas affording comfort to the patients and $ to the publisher: the raw food diet, eat according to your blood type etc. Years ago I did a MOW of some funny book-ideas. Here's a couple more. (1) THE CHOPSTICK DIET. Because you can't eat fast with chopsticks and can't eat cake or ice cream with them. (2) THE GET SICK DIET. Lose without diet pills or exercise. Wasting diseases you can get and cure in time for that important party. THE REAL REASON TO LOSE WEIGHT THE MOST IMPORTANT MESSAGE OF ALL Michael Anchors MD PhD, September 25, 2009 From the Declaration of Independence. "We hold these truths to be self-evident that all men are created equal, and endowed by their Creator with certain inalienable rights, and among these are life, liberty and the pursuit of happiness." I'll let the beauty of those words reverberate for a moment, before getting to the real stuff . . . Now, seriously folks, no right is absolute. If you commit murder, your right to life is suspended. Felons give up their right to liberty. Similarly, Americans do NOT have an unrestricted right to the pursuit of happiness. They do NOT. With every right comes the responsibility to exercise the right appropriately. Life truly is NOT all about eating, NOT about money, and NOT about consuming. The collapse of the planet isn't only about global warming, pollution, exhaustion of resources & the extinction of species. It is also about the rot within US (pun intended). Certainly I want my patients to lose weight to improve their health and achieve their cosmetic objectives, but mainly I want them to eat less because it is the adult, right and moral thing to do. I MADE MY DOG & FISH FAT Michael Anchors MD PhD, September 22, 2009 I didn't tell you this before, but years ago I made my dog and goldfish fat in an experiment. "Experts" on radio & TV go on and on about hormones and "fat genes". David Kessler is on the radio constantly--I wish I had his agent! Louis Aronne was on ABC Nightly News last Friday. But the hormonal/neurotransmitter explanation is absurd. Americans were not fat in 1970 and Europeans aren't fat now. (WHO statistics. https://apps.who.int/infobase/report.aspx?rid=111) Don't Europeans have hormones & transmitters? Why is obesity so American? American researchers searching that closet are looking for justification, not truth. Disclaimer. I do not presume to tell scientists what to think. Dissension is vital in science. I'm not even talking about true experts; I'm talking about "experts" if you know what I mean. And I'm not saying Kessler and Aronne aren't true experts; I'll believe the media edited their statements.) Years ago I gave Spanky, my then dog, a whole bag of dogfood every day, and put excess food in my fish tank, to see what would happen. (I scooped out the uneaten food.) My animals always ate till they could eat no more, and they got fat. (To tell how fat a goldfish is, you have to look down from the top). Presumably human beings would do the same. Oversupply seldom occurred in caveman days so genetic evolution couldn't impose restraint. The only brake to human eating is modern knowledge, intelligence and self-restraint. Phen-pro helps, but the Six Lessons are the real ticket. So much American eating has nothing to do with hunger. WHERE IS THE MAINSTREAM? Michael Anchors MD PhD, September 18, 2009 To get Americans to lose weight, I had to unfasten myself from my moorings as a typical MD, to become a lay-psychologist or life-coach. Last Friday I treated patient #6000, still spending thirty minutes with each patient, tailoring my approach to each person. There's no other way to be successful, if by "successful" you mean getting people to lose weight and keep it off. The problem with America is that the mainstream is not in the middle anymore; it runs around the outside. Americans, through the eyes of the media, see only extreme sports, politics, celebrity, dancing, religion, gender, food-portions, etc. If you are a mature, socially-responsible, middle-class adult, you feel neglected. How much more fun to be involved in fantastic religions, bizarre politics and extreme eating! more fun (and less work) to believe than to know. You can't have a stable democracy composed of such people. Iraq can't, Afghanistan won't, and the U.S. doesn't. There is a reason we are continually at war. Did you see those town hall meetings? Self-restraint, modesty and thoughtfulness must be respected again. Only true adults can lose weight & be happy. There is a logical connection between all of this. Only ignoring reality can blind you to it. FROM GREECE Michael Anchors MD PhD, September 9, 2009 Many Americans are just faking it every day, and/or try to fake it in my office, but for those who like to think, here is ancient advice that has nourished & sustained me. "The greatest way to live with honor in this world is to be what we pretend to be; and if we observe, we shall find that all human virtues increase and strengthen themselves by the practice of them." SOCRATES "We are what we repeatedly do. Excellence then is not a single act, but a habit." ARISTOTLE Sounds a lot like my advice, given on the second visit, to work on a system of habits. The best diet is an unconscious diet, an automatic pilot diet, a system of habits that you, the adult, think about once, set and forever do. EAT WITH FAT FRIENDS? Michael Anchors MD PhD, September 1, 2009 I have been avoiding it, but I should answer the question patients have been asking me. I had emphasized Lesson 6, to get people to stop eating & snacking alone, getting them, instead, to eat meals (only) with friends and family. I learned the vital importance of this by observing the Italians in Italy. My American patients could see that eating with lean friends would help or eating with dieting-fat-friends, but how would it help, they asked, to eat with impenitent obese friends? Good question! I had to think about it, or better yet, collect evidence. I have now done that, and here is what I found. It depends on the personality of the patient. If my patient is a follower by nature, then eating with remorseless overeaters is bad. If my patient is a natural leader or anything in the middle, then eating with hopeless fat friends is good. Why? because of the "hypocrisy effect" described by psychologists. Teaching continence by setting a good example may help the fat friends, or not, but it sure helps the patient because she does not want to be a hypocrite. The differential point is pride. Do you have it or do you not? TEA PARTIES Michael Anchors MD PhD, August 22, 2009 While bicycling in Connecticut I stopped in a charming establishment called Helen's Teahouse, run by an Englishwoman. The store is filled with stuffed animals and lacy bricabrac. Helen is often hired to give tea parties for little girls. She expressed her dismay that this traditional English entertainment for girls does not work well in the U.S. Instead of happily talking and "making believe", the girls gulp down their cookies, slurp down their tea and ask, "What's next?" You should not be surprised. What do these little girls see their parents do? Do they see them linger over dinner, with friends or without, conversing socially in a relaxed manner? Seldom. It bothers me so many people focus on chldhood obesity, as though we could do anything about it without doing more about the adults. The best way to teach is to set a good example. No changes to the school lunches or curriculum will work for children going home to haste & gluttony. HEALTH CARE REFORM Michael Anchors MD PhD, August 21, 2009 Yesterday the serious effort to reform the U.S. health care system collapsed, when President Obama signaled he would accept a bill without the optional public health care alternative. Many people have asked me to comment on health care reform (there was one person actually), so I will. You will be surprised to learn that I agree with the subhuman mud people shouting at Senators at town hall meetings, but the reason I agree with them will surprise you. All qualified, well-meaning, well-informed experts in magazines, the only forum in which they can be heard, agree that the only effective way to reform health care is to adopt a single payor system like that in EVERY developed nation except Great Britain and the U.S. In the U.S. where the only common value is money, you cannot insert a profit-seeking body between patient and doctor and expect (A) the doctor to be adequately compensated, (B) the patient to be taken care of and (C) the insurance company to maximize profit. Even the mud people don't rebutt this claim; they just don't trust the U.S. government to do anything right. They don't really want government at all. "That government governs best that governs least," wrote Jefferson. Okay, you have that situation now. Do you like it? The U.S. government, in the pocket of big business, representing a solipsistic people, cannot manage health care. My fallback position is to hire Denmark to govern us for ten years, on a renewable basis. They could do it. I already have a bicycle. MY ANNIVERSARY Michael Anchors MD PhD, August 15, 2009 Today is the one year anniversary of my retirement from general internal medicine and my complete specialization in bariatrics. It has worked out well. My schedule is full. Today I saw only patients doing well, perhaps because it was mostly women. One amazing lady coming for her third visit has lost 48 lb in 4 months. A pair of sisters from New Jersey, a lady from Florida and a latina from New York City. About 20% of my patients are from out of state. About four new patients a day. This is August, so we are calling up the patients who have not returned since 2008. Almost all of them are doing well. They lost weight and learned the Six Lessons. They don't need me now. They'll call if they do. I salute my heros. 70% of my patients come from other patients. The single best source is hairdressers. 25% of my patients come from the websites. Only 5% come from local doctors. It is difficult to say why. A few doctors send me a lot of patients, but most doctors show a peculiar ignorance and disinterest in obesity treatment. They simply don't care. I make the same amount of money as I did before, only about 70% of what the average internist makes in Montgomery County. I don't mess with insurances. I take credit cards and cash; checks rarely bounce. I see patients from 9-12 and 3-5 some months. Other months I see them 9-12 and 2-5 and take Wednesdays off. I refuse to slave for money anymore. I practice everything I preach, especially Lesson 6 and the Four Agreements. I am a teacher. THE BEGINNING AND THE END Michael Anchors MD PhD, August 1, 2009 To get patients to lose weight, I make them uncomfortable with the U.S. culture. They must feel like strangers in a strange land. Complacent people do not lose weight. This first objective is accomplished by my first visit speech, accompanied by the evidence on display in my office. To keep patients from gaining weight back, I must render them comfortable again. If they aren't made whole & happy again, they won't keep weight off. This second objective is accomplished by Lesson #6 and the Four Agreements. Lesson #6 teaches that people must stop slaving for money to buy bigger toys, and instead focus on friends, family & neighbors. Happiness comes from other people. YOU are not the center of the universe, breaking news for most Americans. The Four Agreements come from the book by Don Miguel Ruiz. The Agreements are (my wording): 1. Keep your promises, but promise only what you can do. 2. Don't take things personally. The things other people do are not because of you. 3. Don't make assumptions. You don't know what other people think. 4. Do your best. It will be good enough. OBESITY IN HISTORY Michael Anchors MD PhD, July 24, 2009 The first historical evidence of obesity are the obese clay figurines of fertility goddesses at Mohenjo-Daro. The figurines do not prove that obese people then existed. I mean, Barbie exists, but no current woman has her dimensions. The first known real obese person was Hatshepsut of Egypt (pronounced ha-chep'-sutt) who served as pharaoh from 1473 to 1458 BC. Obese with diabetes, she died from an infected tooth. (National Geographic, April 2009). Obesity didn't really take off until the advent of sugar cane around 1500. Leo X, Henry VIII, Charles V, and Suleiman the Magnificent were huge. Among the U.S. Founding Fathers, only Ben Franklin sticks out. Pickwickian syndrome, the combination of illnesses in morbidly obese people, was named after Joe, a fat boy in Dickens' The Pickwick Papers. Shakespeare penned a fat character, Falstaff. These characters were created not because they were common, but because they were rare, and so, interesting. Women in late 19th century photos, the pioneers, appear overweight, though the puffy clothing style makes it hard to say. In pornography of the time, the sirens and vixens were rubinesque. That all vanished after 1920. Common obesity among commoners did not enter the world until 1973, when Earl Butz ordered American farmers to plant corn "from fencepost to fencepost" and the price of food plummeted. I respect the record of our new surgeon-general Regina Benjamin, but she is obese. A poor choice for the present moment, emblematic of the imminent botch of health care reform. THE AUTOMATIC PILOT DIET Michael Anchors MD PhD, July 17, 2009 The best diet for losing weight, for the long run, in the majority of people, is a diet on automatic pilot consisting of habits and rules the patient thought about once, set in place and forever does. It may be useful initially for some patients to count calories, weigh portions, keep food diaries, etc., but it is a poor strategy in the long run. People don't have time or motivation; they won't keep doing it, and if the bariatrician insists too much, the patients will stop going to the doctor. If the teacher gives too much homework, the students play hooky. After all, the diet that made people fat, to start with, was a pattern of thoughtless, bad habits. The only way out of the box canyon is a pattern of different habits, but ones that the patient thought of, and personalized, with the bariatrician's help. I gave the example of the patient who would snack whenever she cooked; then she sat down and had dinner. Too many calories. With my encouragement, she thought of keeping chewing gum by the stove. Whenever she cooks now, she chews gum. It's a habit now, and it stopped the extra eating. That's the kind of creativity and initiative I demand from my patients. I can't do all the thinking myself. It must be a cooperative effort. TITANIC PLATES, REALLY Michael Anchors MD PhD, July 14, 2009 Over the weekend in New York City, I saw the exposition of materials recovered from the wreck of the Titanic at the Discovery Museum near Times Square. The dinner plates onboard were small, about 9", and another thing . . . The passengers on the ship were separated into three classes based on the price of their ticket. First-class passengers did not eat with, or sleep near, the third-class passengers. It was 1912 and the ship was British. The dinner plates for the first-class passengers were SMALLER than the plates for the second-class passengers, which were in turn smaller than those for the third-class passengers. The first-class passengers were served gourmet food. The lower-classes got what the shipping company thought they were used to--beef, cabbage and potatoes. But why the difference in plate size, and why bigger plates in steerage class? I didn't understand until one of my patients suggested the correct answer. The lower classes did more heavy physical labor back then, and needed more calories. Nowadays the lower classes still eat more, but the eating is usually not matched with labor. A GOAL ATTITUDE, NOT A GOAL WEIGHT Michael Anchors MD PhD, July 8, 2009 "Experts" urge me to set a goal weight for my patients, but I know that is counterproductive. If a patient fails to reach their goal weight, they feel disappointed and give up. If they reach the goal, they get lazy. To ensure they reach the goal, I make the goal too easy. Setting a weight-goal corrupts everybody. Even doctors who recommend the practice can't tell me why. They haven't thought about the issue. I have. I say, set a goal attitude instead! After all, the point of my enterprise is to get patients to think as I do about eating. When that has been achieved, I have won! After 6000 patients and 15 years, I am confident in my advice. My patients lose weight & keep the weight off. But first base is learning the Six Lessons. No one gets home without touching first base first. WHY PUBLIC EATING REDUCES OBESITY Michael Anchors MD PhD, July 3, 2009 Lesson #6 commands you to eat with friends as often as possible. You should (almost) never eat alone. I learned this lesson from the Italians in Italy, who are almost all lean & happy. Public eating is a major cause. There are four reasons. (1) The Italians, eating together, are distracted by conversation. (2) They have the good manners not to talk with food in their mouth or to chew obviously while they listen. Instead they wait for a lull in the conversation to pick up their knife and fork, and they set them down when conversation resumes. This behavior slows down their eating so they have time to absorb the first part of the meal before getting to the second, reducing hunger, eating and dessert-foolishness. (3) Italians don't want to be seen grossly overeating by their friends. Leanness is valued as a health and a cosmetic concern. (4) Besides that, urban Italians like to wear nice clothes. Italian women--I looked into some closets--have a few nice outfits, on hangers with air in between. Clothes made in Europe, not China. All the same size. They wear the same clothes over and over, and if their suits or shoes wear out, they take them to the tailor or the cobbler to be fixed. They dare not gain weight, because if they do, none of their clothes will fit. Italians love to shop, but they buy rarely. A salesclerk told me she talks to obvious non-Italians in the store first before Italians, because the non-Italians are more likely to make a purchase. SYMBOLIC VERSUS REAL BEHAVIOR Michael Anchors MD PhD, June 26, 2009 Although the majority of my patients lose a lot of weight and keep it off forever, I spend a lot of time talking about the few patients who don't succeed, because it is there that I and other doctors can improve our treatment. The chief impediment for patients and doctors is the substitution of symbolic behavior for real behavior and unwillingness to see the difference. Physicians abet the substitution of fakery by over-praising small differences. It is nice that the patient parked farther away from the office or walked up a flight of stairs. Or said they did. Once. Perhaps. But that change alone is not an exercise program, is it? It is nice the patient said they ate half their dinner at Denny's. If they did. But that's not a program of reducing portions or staying out of godawful places like Denny's, is it? It's nice that the patient felt less tired after a shot of B-12, but that's not a weight-loss program, unless the patient really lost weight, is it? It's true that honey catches more flies than vinegar. Doctors should always try to find something to praise in the patient's behavior. But you must not be the patient's co-dependent. The enterprise in which we are engaged, those of us who are successful, is transforming the way people think. Praising failure is not transformative. The better approach is to persistently emphasize the Six Lessons, to persistently notice how much weight the patient lost. In other words YOU, doctor, must stay focused on real things that really matter, without anger, showing that YOU care about the difference between fact and fantasy. So doing, you show you care about the patient. WAS OBESITY NIXON'S FAULT? Michael Anchors MD PhD, June 19, 2009 In 1972 the U.S. shipped 30 million tons of wheat to Russia. As a result by 1973 the price of food in the U.S. had risen to record levels and Nixon worried the public backlash would threaten the Republicans in the next election. He ordered Agriculture Secretary Earl Butz to "fix it". Butz canceled the loans-to-farmers program and the national granary reserve that had been in place since 1933, replacing them with direct payments to large farmers to grow corn. Small farmers were driven out. Corn produces the most food per acre, and Butz famously urged farmers to plant corn "from "fencepost to fencepost". Corn now sells for less than the cost of production, the difference made up by payment of taxpayer dollars to farmers, 40 billion a year. Bumper crops are sustained with fertilizers from oil. After weaning, cattle are moved from farms to feed lots where they are fed corn, an unnatural food for them, getting ready for slaughter in 14 months, down from the 2 years required before when cattle ate grass. Packed together on feed lots, cows live in their own waste, preserved from diseases by antibiotics. Before, on farms, they were fed the waste from the fields, corn stalks and such, and their dung fertilized the fields. That beneficial cycle has been disrupted. Now the production of corn is maintained with petrochemicals and antibiotics, and cattle waste goes to landfills, groundwater and the air. Ditto chickens, ditto pigs. Swine flu came from housing too many animals close together. Antibiotics stop bacteria, but not viruses. Another ingenious device to use excess corn: high-fructose corn syrup. U.S. obesity began in the early seventies. Has obesity been due to the oversupply of food (Nixon's fault) or to unreasonable demand for food by U.S. consumers (your fault)? A chicken and egg problem. I'll give Nixon a break and suggest that the answer is unreasonable demand. Evidence comes from Aug 2002-Aug 2004 when the press was telling the truth about obesity. U.S. restaurants offered salads and vegiburgers. Remember lettuce wraps? Restaurants thought they were giving America what America wanted--healthier food. Universally they found that Americans did not buy the healthier foods. Restaurants & companies won't make that mistake again until someday, some way, the Great Satan is stopped. THE TWO HUMPS Michael Anchors MD PhD, June 12, 2009 Examining the records of thousands of my patients who lost a lot of weight and kept it off, I see two humps, two places where the rate of loss slowed down and picked up again. The unsuccessful patients got stuck on one side of one of those humps. Clinicians should give advice appropriate to the specific hump blocking the patient. Patients lose weight quickly in the beginning, but after a few weeks encounter hump #1 where they must truly stop snacking and soda-drinking. Not everyone will do it. The famous addictionologist Robert L. Dupont talked about the addict's LOVE for his drug-of-choice. The love of snacking is like that. Physicians waste their time talking about calorie-counting while the patients are still gulping down candy and cookies; and patients lose respect for the doctor if he or she is easily deceived. Hump #2 comes later, after snacking has been conquered by avoidance and substitutions. At that point patients may be frustrated that they "can't" get the rest of the way to their ideal weight. The problem is always that they are not appreciating how big packages & portions are in the U.S. You cannot cook the whole package, of whatever; you cannot eat the whole croissant--you must break it and throw away half. Extra food does not become un-wasted merely because you eat it (MOW 12/16/2007). The true waste occurred when the baker made the thing too big and didn't offer you a choice. Blame him or her, but keep yourself pure. PERSONALITY & OVERWEIGHT Michael Anchors MD PhD, June 5, 2009 I'll get a lot of hate mail for saying this, but I find that the more overweight people are, the less variation exists in their personality. There are many types of lean people, but only one type of very obese person. There is a spectrum between the two extremes. The first two reasons are trivial. Obese people spend more time seeking things to eat, less time for hobbies, people or study. And obese people are sleepy (THAT is published). The third reason is more interesting. Obese people tend to be optimistic and unrealistic. They have many friends, often, because people enjoy being with optimistic people. But the property of unrealistic optimism is lethal for the diet and self-image. Leaner patients start the day figuring they have 1200 or 1500 calories to spend on food. If they ate more at breakfast, they'll eat less at lunch, i.e. they budget food. Obese patients swear they will be perfect all day. By mid-morning they discover they have overeaten and snacked on coffee cake and candy, and they say, "Oh darn. I shouldn't have done that. I'll start over and do better." Result? They keep starting over all day! No progress, low-self esteem and no sense of self-control. Obese people don't think this way on purpose. We are all the result of genes and our teenage peer-group (read Pulitzer prize finalist The Blank Slate). Blame and guilt are useless. The only things useful are honesty, intelligence and thinking. The challenges you face are determined for you; the outcome of the struggle is determined by you. EATING WITH THE TV Michael Anchors MD PhD, May 25, 2009 Nutritionists inveigh against eating in front of the TV, but the matter needs more thought. There is nothing wrong with eating a meal while watching TV. Anything that slows down eating helps weight control. Nutritionists say TV distracts attention from what you are eating. Like that is a bad thing. But I say it's a good thing. Think about it. They didn't. No one ever said, and I don't say, to eat snacks or drink sodas watching TV, but that's because you shouldn't eat snacks, or drink sodas at all outside of mealtimes. You may watch TV while eating a meal. But don't watch TV when friends or family are with you. Don't miss the opportunity for conversation and human interaction. The best thing Dr. Anchors ever gave the world was Lesson #6, Happiness comes from people, not from things. Eat with friends! to which you may say, "But that idea isn't special. It's too obvious." Oh yeah? Do you follow lesson #6? COSTA RICA Michael Anchors MD PhD, May 17, 2009 I have returned from a week in Costa Rica. I report that the ticos, on average, are as fat as U.S. people. A few minor differences. I did not see any morbidly obese people--and I looked and asked. I suspect there may be fewer of them, and the few that exist are less visible since it is hard for them to get out of the house, fewer accomodations such as wheelchair ramps and transport vehicles. In the U.S. grocery stores have "golf carts" for the obese to motor around in. Candy is less available only because refrigeration is scarce. Ditto ice cream. But cookies and chips were abundant and people drank too many beers and sodas, even in areas where there was good drinking water. Everyone said ticos are more fat than they used to be. Only pretty, young ticas are skinny, and hard-working, poor, young men. Everyone else is fat. The women are discouraged from labor unless necessary. The ticos do not appear stressed! They eat merely because they are awake. There is no awareness that obesity poses a health risk. People who drive cars the way they do aren't worried about death. The ticos have gotten wealthy by Central American standards by wise management of their resources, eliminating the army, and encouraging tourism. If I can find more data, it's a good laboratory to tease out how much their obesity is due to (1) wealth, (2) Latin culture, (3) U.S. culture. or (4) other causes. First question: is the obesity new? DAVID KESSLER'S BOOK Michael Anchors MD PhD, May 8, 2009 I have read David Kessler's new book The End of Overeating. You shouldn't bother. His thesis is that U.S. obesity is caused by food companies filling our food with sugar, salt and fat to make the food addictive. (Replay of the tobacco company story.) But it's another example of finding someone to blame other than the person(s) at fault--the consumer-- because making Americans feel good, blaming someone else, is a convenient way to sell books. And the food companies can't defend themselves because they lack a common spokesperson. But I remember the 2002-2004 period when the press was on their case, and restaurants offered veggie burgers, salads, anything that might please the public demanding healthier food. The UNIVERSAL experience of the restaurants was that customers did NOT buy these innovations. Bitten once, the restaurants now follow the Stead Principle (in Chapter 6 of Life Between Meals); they look at what you spend on, NOT what you say. Consider this. Are there other places in the world where food is laden with salt, sugar and fat? Sure. Many such places. Take France for example. Are the French fat or lean? They are lean. Why? because they don't eat the whole store. And they don't eat all the time. The stuff in Kessler's book about American food activating opiate receptors is hooey. If it were true, then naltrexone (Orexigen's Contrave) would be a good weight loss drug. If you believe that, let's see you invest in Orexigen. I will judge you, per Stead, by how you invest, not by what you say. PATTERNS Michael Anchors MD PhD, May 3, 2009 Patients who generally do well . . . 1. Those seeing me in the morning 2. Those traveling a long distance to see me 3. Those paying full price 4. Those who spent their childhood outside the U.S. 5. Those who lost weight well before with any method 6. Patients with little weight to lose Patients who generally do poorly . . . 1. Those seeing me in the afternoon 2. My old friends, relatives and old medical patients 3. Anyone getting their care for free 4. Those who never lost weight 5. Patients with a lot of weight to lose 6. Patients who focus on the pills at the first visit Patients who do not learn the Six Lessons by the second visit are hopeless. The following things do not matter: age, "race", social class. I used to get poor results with men and latinas, but I have improved. The trick with men is to (1) never give them more than one idea at a time without eliciting feedback, (2) never talk down to them and (3) see them more often. It is important to see latinas in pairs or groups; they need social support more than anglos. Speak Spanish or at least allow them to speak Spanish. If you don't know Spanish, poor you--it's a bilingual country. UPGRADING LESSON #6 Michael Anchors MD PhD, April 27, 2009 To the Lesson #6 sign on my wall reading,"Real happiness comes from people, not from things", I have added "Eat with friends" to make the connection between real happiness etc. and obesity more obvious. I saw that, in Italy, eating with friends inhibits overeating, for two reasons. First, people are embarrassed to overeat in front of their friends. And second, the Italians like wearing nice clothes. Their clothes are made in Europe, expensive, fit well, and they wear them over and over. If they gained weight, their clothes wouldn't fit, and the Italians don't like shopping and buying so often. But let's talk about what I mean by eating with friends, because I can see that eating with obese friends in a Dunkin Donuts or Haagen-Dasz may not be conducive to losing weight. By eating with friends, I mean eating actual meals, not too big, with friends and having a real conversation. Don't eat with your mouth full (your mother used to tell you that). Generally lean people eat between subjects of conversation, eat slowly and take their time. Do not order too much food. Order soup. Have a salad. Skip dessert. Make the meal itself special, not the dessert. My first choice is for you to eat with your lean friends. Second choice to eat with overweight-friends-trying-to-lose. My last choice is to eat with obese-friends-not-trying, but I still prefer that to your eating alone, because you can still practice the techniques in the previous paragraph. PHTHALATES & OBESITY Michael Anchors MD PhD, April 20, 2009 In a recent New York Times story a study of girls in East Harlem found that the fatter the girls were, the more phthalate was in their urine. The story implied that phthalates cause obesity, but other possibilities were not discussed. I do not believe phthalates play a signficant role. Phthalate is an artificial chemical added to plastic to make it more soft & pliable. It was used in baby pacifiers, sex toys, lotions and nail polish until it was banned just this year. It is absorbed by mouth and through the skin. Most Americans excrete some phthalate in their urine, and they must have been doing so long before the recent rise in obesity. Phthalates have been around for a long time. Europeans have been exposed to phthalate, too, and they aren't nearly so fat. Phthalates are thought to cause insulin resistance, but obesity itself causes insulin resistance. I have seen no evidence that phthalate causes insulin resistance in lean individuals. It is possible that obese people, having become obese by eating too much, excrete more phthalate--I'm not sure why. It may just be that they have more phthalate dissolved in their greater fat stores. In the unlikely event that a phthalate-obesity link is every really proved, there is nothing you can do about it. The stuff has already been banned. The only recourse for you is to eat less, follow my diet pyramid and the rest of the Six Lessons. You had to do that anyway. THE TRUE STANDARD OF LIVING Michael Anchors MD PhD, April 9, 2009 Lesson 6 has been an important, and timely, addition to my teaching program. Lori K wrote as follows: "What a refreshing pleasure to meet you on Monday. The six lessons have been doing great! I'm weighing myself every morning . . . I went grocery shopping with my Mom and spent time talking with our neighbors. What a difference when you focus on people and not grinding away at my business. So far no snacking, no cravings . . . " Two thoughts. It occurred to me, how strange, and typical, that U.S. economists (but not European) express standard of living in dollars/person/year! I noticed that error in my college economic textbook and even then (1968) thought it was bizarre. I got a "C" in the course. Annual per capita income is a component of standard of living, but surely other things are important, too. How about free time? Cultural opportunities? Availability of friends and family? Friendliness of neighbors? Don't those count? I'm proud of my "C" in Eco 101. Second thought. I have a very "Italian" dog. A St. Bernard/bulldog mix, Tucker won't eat unless one of my family eats with him. I saw in Italy that when the Italians got hungry (at mealtimes) they looked for a friend to eat with, THEN they looked for a place to eat. I swear, happiness comes from people and not from stuff you buy. Italians never cheat on their diet, and they are happy, because they are never alone. Seek people. Let the money go. "They" are going to take your money anyway. "They" can't take away your friends. FOOD EATEN LATE DOES NOT "GO TO FAT" Michael Anchors MD PhD, April 2, 2009 Among the many things people-believe-for-no-reason-other-than-hearing-other-people-say-it is that food eaten late at night is more likely to "go to fat" than food eaten earlier. I even included that fallacy in my first book Safer Than Phen-Fen, before looking for the scientific basis of the statement. I looked. There is no scientific basis for it. To remind you, anytime you hear the statement "people say X"--you can rely upon it--X is wrong. That's because people don't bother to comment on what common sense says. And common sense is usually right. In fact a well-done study in 1998 showed that eating late does not make people fat any more than eating at any other time of day. All that matters is total calories eaten by bedtime, NOT when you ate or how the calories were divided. You could have figured that out, because the people in equatorial countries around the world customarily eat late, after the heat of the day lifts. And they are a lot leaner than the people in cold climates, who eat earlier. That's an association, not proof, but it points in the direction that eating late does not make you fat. [Nevertheless, as written in a previous Message, night jobs, i.e staying up most of the night and sleeping during the day, certainly does contribute to obesity.] OF MICE AND MEN Michael Anchors MD PhD, March 24, 2009 A patient asked me an interesting question. "What happens when a group of animals, say mice or dogs, is given constant free access to food? Do they all get fat?" I answered, "After equilirium is established, the bell-shaped curve is shifted to the right. The average mouse or dog is overweight; some are skinny but not as many as before; and a few more than before are obese." "So then obesity is natural?" the patient asked. "What's your point? that anything that's natural is good? Not so. Cancer is natural and it's bad. Do you mean that with excess food, some individuals are destined to be obese? That's true. People don't have completely free will; their choices are restricted by genetics and peer groups. BUT they do have some free will. The individual mouse can choose to be lean by modifying its behavior. The mice, if they got together, could develop a lean culture, with rules promoting leaness. "All this you would believe if it dealt with any subject other than obesity. Don't abandon it just because you want to believe something else about food. Seek what is true, not just what you want to be true." FANTASYLAND Michael Anchors MD PhD, March 23, 2009 Why are Americans, given a permissive environment of wealth, so uniquely prone to obesity? because of the complete, comfortable substitution of wishful thinking for real thinking. Consider the following. "All men are created equal", Disneyland, George Bush (either), the Cold War and its iterations, Superman & superheroes and many repetitions, Barbie, movie stars, baseball, drugs, the NRA, Congress, TV ads, Hummers, subprime loans, supersizing, "more for your money", "no child left behind", 1000 religions passionately believed, bariatricians debating whether a 400 calorie or 800 calorie diet is better. Is it any wonder each American generation, growing up here, is less realistic than the preceding generation? Any wonder so many fat Americans think they don't eat too much? Any wonder bariatricians, in general, have so little effect? "The Wizard of Oz" is our national epic, "Somewhere Over the Rainbow" our national song. Think "There's no place like home. There's no place like home." STOP BUSTROPHEDONIC SHOPPING! Michael Anchors MD PhD, March 20, 2009 You'll know what the word "bustrophedonic" means when I tell you that "bos" in Greek means 'ox' and "strophon" means 'plow'. So bustrophedonic shopping means going up and down every aisle, the way an ox plows a field or a person knits a sweater. Up one row and down the other. Cool word. Egyptian heiroglyphics and some ancient Greek inscriptions were written this way. An efficient way to write, but boy, it takes a mind to write backward and forward with equal facility. Whatever. It's a poor way for dieting people to shop, exposing the overweight person to every c-word (see previous MOW) and piece of advertising in the store. There is no reason to push your cart up the aisle of chips & dips. There's no food in that aisle, nothing for making meals. There's no reason to push your cart down the aisle of sodas. You're not supposed to be drinking sodas, diet or regular. You are DIETING to save your life. Get real. MAKE A SHOPPING LIST of items for making meals. Not snacks. Go around the outside lane of the store, ducking into the center only to grab dog food, detergent and light bulbs. How about this . . . hold your breath when you go into the center of the store. You can breathe again only when you get back to the outside lane. Good dieters are always careful shoppers. You can't eat what you didn't buy, and you WILL eat the snacks you did buy. THE RECESSION Michael Anchors MD PhD, March 16, 2009 Has the recession affected my weight-loss practice? It sure has. In the following ways . . . 1. More local-people make an appointment for follow-up, say they will come when we call to remind them the day before, and then don't show up, 2. And then call us on the phone to ask if I will renew their prescription without a visit. [No] 3. More prosperous-looking people bounce checks. But I still get the same number of new patients, referred by successful patients or from the Internet. More people buy my book Life Between Meals on Kindle or by mail, and try to "do it by themselves". I wish them well. There has been no reduction in the number of patients from out-of-state. I raised my prices a little, once, ten years ago, and never raised them again, so even with the airfare, I'm still cheaper and often more effective than local programs. Has the recession reduced American obesity, profligacy or gluttony? I don't know yet. Too early to say. What do you think? PRIAPISM Michael Anchors MD PhD, March 12, 2009 Some doctors using phentermine add trazadone as a second medicine to (A) make phentermine work better & longer and (B) to help patients sleep. A very rare side-effect of trazadone is priapism (pry'-uh-pizm), i.e. prolonged penile erection. In women, priapism consists of prolonged genital congestion. I have now seen priapism twice. In a woman in January and a different woman yesterday. They had to put cold compresses on their genital area and take Tylenol. If you prescribe trazadone, you should warn patients about priapism. Emphasize that it is rare and reversible. Lay people don't know how to factor in risk. If a medicine would confer great benefit, but has a very rare, severe side-effect, patients won't take the medicine. So, many thoughtful doctors refrain from telling patients about severe side-effects when they are very rare. Less thoughtful doctors (and all lawyers) declare that doctors should tell all patients about all side effects. But if you did that--the thoughtful doctors say--patients would make the wrong choice, not take medicine and suffer needlessly from their disease. Is the doctor in business to help people or solely to avoid risk (to the doctor)? Fortunately, with trazadone the doctor doesn't have to answer the question. Priapism never occurs on the first time taking the medicine, nor the second. It starts later, and increases with subsequent doses, until finally the erection gets stuck or the congestion doesn't go away. If the patient is warned about priapism, they will recognize they are developing it before it becomes a problem. If they are not warned, they won't know to look for it. FRENCH FRIES Michael Anchors MD PhD, March 5, 2009 At least one quarter of Americans get a meal at a fast food restaurant every day, based on self-reporting, so I'm sure the real percentage is higher. The worst thing about it is french fries. In my office I have a small sign regarding french fries. It says, "What's wrong with french fries? High starch, high calories, high fat, saturated fat, trans fat, high sodium, no protein and no vitamins. French fries aren't French by the way. The best guess is, they're Belgian. The idea for them was brought back from Europe by the American soldiers. Modern French call french fries "pommes frites". The English call them "chips". 70% of potatoes eaten in the U.S. are consumed as french fries. Economists use "% potatoes consumed as french fries" as a measure of the Americanization of culture in foreign countries. Potato chips have the same deficiencies as french fries, but being smaller in mass, they do less damage. Still, if you are hooked on potato chips, try Terra Chips instead. ARE ALL DIETS EQUAL? Michael Anchors MD PhD, February 25, 2009 Tonight the ABC Nightly News (mis)reported a scientific study, showing (they said) that "all diets are equal". What the study really showed was that in subjects on different low-calorie diets in which the calorie intake was VERIFIED to be equal, the weight-loss was equal. ABC said the study showed that "all diets are equal", and "it doesn't matter which diet you follow" as long as you really follow the diet. ABC edited what the researchers SAID to make it sound that way. But I am sure the researchers did NOT state their conclusion in such terms. I have more respect for the scientists. I have no respect for the journalists. I had little doubt that such a study would show such a result, but it is nice someone took the time to do the actual study. It might have turned out differently. You never know with Nature. You have to check. Butbeallthatasitmay, there is ample evidence that low-carb diets are BETTER-TOLERATED than low-fat diets. Compliance is higher. Moreover, the low ambient insulin level on low-carb diets confers health benefits beyond mere weight loss. Oh, ABC News didn't tell you that? That's because they don't believe their purpose is to inform. Their purpose is to tittilate and make money on advertising. Or because they believe that they, under-educated and uninformed souls, know the real truth. Because as it says in the DOI, "all men are created equal". So experts aren't special, are they? No wonder education in the U.S., for all we spend on it, is so ineffective. Why would anyone bother to become a true expert, if you are "equal", i.e. already know everything, just by being born here? REFERRING PATIENTS TO DR. ANCHORS Michael Anchors MD PhD, February 14, 2009 Many of my successful patients refer patients to me. Such referrals are my single best source of new patients. Thank you. A couple of words of advice however. Don't nag or badger friends or family members to go see me. People who require badgering won't perform, because they come only to get you to stop nagging them. Besides, nagging friends loses friends. Your fat friends are still your friends. You must realize, as I did, we can't save everybody. Second, don't send me morbidly-obese, huge people. I won't be successful with them. There are reasons why such people get so big--I'll write a MOW on it soon. Those people need gastric bypass surgery. I explain the surgery and refer them to Barry Greene, the famous surgeon near my office. Send me middle-weight people. Those are donts. Here's a do. Do tell them the medicines Dr. Anchors uses are not the same as phen-fen. And what makes my office special is NOT the medicines; it is the Six Lessons and I spend 30 minutes personally with each patient and I am honest. I have treated 5288 people, coming up on fifteen years, with great success. Send prospective patients to my websites www.michaelanchors.com or www.phenpro.com or share my books and pamphlets. If talking like that doesn't move them, they're not ready to lose weight. HOW TO COOK VEGETABLES Michael Anchors MD PhD, February 4, 2009 According to my food pyramid, dieting people, and most others too, should eat more fruits (other than bananas) and vegetables (other than potatoes). It is amazingly difficult to get people to do it. Patients give three reasons for disobeying me. First, they say fruits and vegetables are too expensive. When I ask the price of some specific vegetables, none of the patients ever has any idea, proving that this "reason" is really an excuse. Second, they admit they don't know anything about vegetables. I can respect this answer, but I still expect the patients to correct the deficiency. There are vegetable cookbooks. You hardly need them as I will explain below. Third, they say they don't like vegetables. I guarantee that everyone who says that drops frozen vegetables in boiling water until they're soft & mushy. Yuck! A better way to make good-tasting veggies with intact vitamins is to peel, chop and saute them briefly in a pan with a little olive oil, so that they are soft & sweet on the outside but crunchy on the inside. This works great for onions, squash, turnips, peppers, carrots, green beans, cauliflower, broccoli, okra and mushrooms. Don't saute peas. You can reduce spinach in a pot with a little oil and garlic. Ditto kale. Collard, mustard and turnip greens must be boiled or they come out tough. "Greens" taste best with a little vinegar, according to my southern palate. WHY BUS BOYS CANCELED MY TALK Michael Anchors MD PhD, January 27, 2009 I was supposed to talk at Bus Boys and Poets Bookstore on Thursday, Jan. 29 in their Educator series, but as soon as they found out my talk would include "diet pills", I was canceled. Why? In 2003 People magazine interviewed me and one of my patients for the first in (what has turned out to be) a series on "Losing Half Their Weight" about Americans who lost half their weight, without bariatric surgery. When the story was published, it did not mention that my patient had taken diet pills. The reporter said the editor changed her story. They couldn't find enough patients who had lost half their weight without diet pills (my guess), so they "edited" the story. Why? Why the aversion to diet pills? The same reason there is aversion to pain medicines for pain, anti-anxiety medicines for anxiety, and anti-depressants for depression. Americans believe the brain is not an organ like others. It's the seat of the soul. We are deep in the Dark Ages in America. We'll be saying the sun goes around the earth next (actually in a poll 15% of Americans believed that!) There is no aversion to talking about blood pressure pills or gout medicines. Those have nothing to do with the brain/soul. But as soon as you believe cholesterol can be controlled by correct eating, then cholesterol-lowering medications, too, become taboo. Medicines are held to be moral (?) only for things you can't willfully control. It would be funny if so many people didn't suffer and die from such superstitious ignorance. VEGETARIANS WITHOUT VEGETABLES Michael Anchors MD PhD, January 18, 2009 I have met several persistently obese vegetarians. Without exception they have not lost weight in the phen-pro program. (I have never met an overweight vegan.) It is easy to figure out why. The overweight vegetarians are eating some vegetables and lots of cakes, candy, cheese and cookies. They are "vegetarian" only in the sense that they don't eat meat. They don't lose weight in the phen-pro program because (1) phentermine reduces hunger but does nothing about candy and (2) anyone so deluded about the point of vegetarianism is likely to mess up the Six Lessons, too. The whole issue underscores my point that Americans recently have gotten fat on sugar and starch, not fat. With all that said, vegetarianism is a good way to lose weight, keep weight off and be healthy PROVIDED the vegetarian truly eats vegetables, grains and fruits, and some eggs and cheese, but NOT the C-words.