Michael Anchors MD PhD, December 30, 2007
Faithtful reader "Joy" asked . . . At times in the last 6 weeks of being on PhenPro the weight loss has stalled for several days to a week. It then continues on. I can assure you I am faithfully following the 5 Lessons. I have heard that weight loss can stall at times if you are not eating enough, that your body goes into 'starvation mode' and holds on to weight regardless of the calorie intake. Not sure if there is any truth to this and wanted your take on it. Thanks again! the difference, and they aren't interested in the difference.
Dr. Anchors answered . . . It is true that the rate of weight loss varies over time. It is not true that the body goes into "starvation mode", a term created in the lay press. An idea btw that violates common sense. Did you see fat prisoners in Auschwitz?
The true reason for the variation is variation in hydration state, physical activity, illness and colon contents. (I don't know about you, but I get constipated when I take phentermine.) And of course the big reason is variation in calorie intake. People, in general, are not saavy about calories, even when they aren't in denial. Evidence for this is that on controlled diets where the patient has no choice, the rate of weight-decline is much more smooth.
THE NOTION OF WASTE
Michael Anchors MD PhD, December 16, 2007
Last week a fat patient told me she had a habit of eating a scone at Starbucks every morning. I showed her in Bowes & Church that the scone has 700 calories. She was distressed. She didn't want to do without; so we agreed that, henceforward, as soon as she receives the scone, she will throw half of it in the trashcan. Immediately. Not make a big deal about it. Just do it. Not caring what other people think.
There may be other ways to handle the problem, but I KNOW my way will work.
She was resistant at first, saying it was wasteful. But that doesn't make sense. Why is it less wasteful for her to eat the whole scone when she doesn't need the calories? It's still waste. The waste occurred when Starbucks made the scone too big and she bought it. After that, nothing she did would make the action less wasteful. At least my way, she will lose weight. With hers, she will stay fat.
This was another example of the amazing fact I have learned about people: 95% of their decisions are made on impulse and the rest of the time is spent finding excuses. Intelligent people say the silliest things to excuse themselves. Men will even fight over it. A little discipline in thinking would help so much.
You've heard it before. Most people, including doctors (especially doctors) in the pit of their soul don't want to know what's true. They only want what they want to be true to be true. They don't know the difference, and they aren't interested in the difference.
AMERICANS ARE OVERGROWN CHILDREN
Michael Anchors MD PhD, December 5, 2007
So often in the office and elsewhere, I hear Americans say, "I couldn't help myself", "I had to have it", "I couldn't resist" and it occurred to me to think, this is NOT how adults talk: this is the way children talk. Such behavior & thinking is universal in the U.S. It is the norm.
It's the way drug addicts talk, but that's a another lecture. Read page 85 ff in "Life Between Meals".
Today my focus is on the downstream effect of the worship of Youth that began in the Sixties. Before then, there was a clear distinction between childhood and adulthood. Adults got the freedoms denied to children, but were tasked with serious responsibilities. Everyone understood the bargain.
But children of the Sixties, disappointed with the racism and cold-warriorism of our parents, determined to create new social values. The chief of these values, the only one that persisted, was the desire to stay young in body & spirit. It lasted because it was the only one of our values that could be used by industry to sell products. The Pepsi generation, etc.
But what does staying young mean? It means craving new toys without taking responsibility. It means malleability in our regard for truth. It means, well, it means George Bush. And the Congress. The people running for President this year. And the voters who would not vote for the better people who don't run because they wouldn't stand a chance. It means not resisting a huge bagel or donut or croissant because, of course, I couldn't help myself, I had to have it, I couldn't resist.
BOTTLED WATER IS NOT GOOD FOR YOU OR THE ENVIRONMENT
Michael Anchors MD PhD, November 20, 2007
Many times when recounting the Five Lessons, arriving at #4 Drink More Water, many of my patients retrieve a bottle of commercial bottled water from their purse and proudly display it. While I am happy they are drinking more water, I am distressed that they are buying bottled water. In 2006 Americans spent $11 billion on bottled water. It's a swindle, guys, and harmful to the environment, too.
Almost everywhere in the U.S. bottled water is no more pure than tap water. The Department of the Interior requires much more rigorous testing of municipal drinking water than the moribund, dysfunctional FDA applies to bottled water. On the news, you heard that Dasani water is nothing more than "filtered" tap water. Did that not make an impression on you? At $2 for a 20 ounce container, bottled water costs thousands of times more than tap water. The capacity of the American people to let themselves be swindled is amazing.
And the poor environment. After millions of barrels of oil are used to produce and ship plastic water bottles, 90% of the bottles land in the garbage instead of the recycle bin.
The remedy is to switch to tap water and purchase a steel container for water or make a one-time purchase of a polycarbonate flask. Other types of plastic contain plasticizers of dubious safety.
FINAL THOUGHTS ABOUT ITALY
Michael Anchors MD PhD, November 3, 2007
So here's how it shakes out. A typical day for the Italians in town. For breakfast a cappucino and pastry. The cappucino is excellent and the same everywhere. In the same size cup. In fact you are given only two choices. You can either have the darn thing, or not. No tall, grande or venti. The pastry is reasonable and flaky. Okay, it's not a great breakfast nutrition-wise, but not too many calories.
At twelve o'clock all the stores, museums and churches close and the Italians go to lunch. In groups. Like pigeons. You don't see Italians alone. I even saw--you won't believe this--groups of MEN having lunch together. They still had the Y chromosome; they talked about sports, politics and technology, didn't listen and tried to dominate the conversation, but hey! at least they were socializing. Any guy without his wife or girlfriend trying to socialize with men in the northern U.S. is perceived as gay. The word itself "gay" has lost its natural meaning.
The Italians ate small plates of attractive comestibles, often sharing. No one dared overeat, because, in public, that would be SEEN, and appearances MATTER in Italy, and overeating is not beautiful--it's "American". America serves the world as the acknowledged, main source of bad examples. The fact that Italians never snack and DO EVERYTHING IN PUBLIC is the chief bulwark against obesity. The American (and English!) penchant for privacy rights has been the chief incubator of our moral decline. I was surprised at this! Like most Americans, I liked the concept of privacy rights. But you know the effect of unintended consequences. Protecting the privacy of individuals is good only in a country where individuals are concerned for the rights of others, in a country where individuals understand that selfishness is ultimately self-defeating. In a nation of selfish individuals only "structure" stands a chance of working. The Puritans understood that. Structure. But I don't want that. I want to love my neighbor for real, and party.
The Italians lunch/talk/sleep/flirt for three hours; then the restaurants close and stores re-open. Everyone goes back to work. They don't work hard, but everything important gets done. At eight, the stores close and everyone goes home to party. And that's on weekdays! They party all day on weekends. No wonder the Italians are so lean and relaxed.
MORE THOUGHTS ABOUT ITALY
Michael Anchors MD PhD, November 3, 2007
The Italians were very lean, as a group. Unstressed and unhurried, Not threatened. Not angry. Warm and respectful. Original art was everywhere and never vandalized. The Italians are well-informed. Even men read there. Newspapers seek to inform, not to persuade.
The personal focus is on being beautiful and leading a beautiful life, and helping others to have a beautiful life, or at least not getting in their way. In the U.S. I can't change lanes without being cut off by selfish, distracted drivers. The Italians drive cars like matchboxes, but have a low accident rate. They respect each other. Not just talk, but do.
The ideal is to have both the appearance of a beautiful life, and the fact; but if they can't afford the fact, it's good enough to have the appearance. Women have only a few dresses and suits in their closet. Each is expensive and well-chosen. To impress. They own less than ten pairs of shoes, and when their shoes wear out, they repair them. No Pay-less. No Walmart. No Target.
There is a big difference between having no money and having some money, but only a small difference between having a little and a lot. Not worth working hard or hurting people to get more. The Italians limit their needs to match their income. They are not crippled by the Barbie syndrome.
As a parent, you swore you wouldn't get into the Barbie cult, but your daughter cried for a Barbie, so you bought one. She was happy for an hour, then declared, "This is Ballerina Barbie. I want Malibu Barbie." So you bought Malibu Barbie. Etc, etc. The U.S. is a nation working too hard and cheating to afford another Barbie. We get old, but never become adults. If you don't see the relationship between what I'm saying and obesity, you have no chance of staying lean or remaining happy.
HEADACHES
Michael Anchors MD PhD, October 25, 2007
Some patients on phen-pro complain of headaches, not severe enough to stop treatment; patients are so glad to be losing weight. I have several comments.
Phen-pro does nothing to change the pattern of migraine if you already get migraines.
The most common cause of headache on phen-pro is caffeine withdrawal. Phen-pro patients must switch to decaff coffee or stop coffee altogether since caffeine increases the potential side-effects and risks. Americans are a hopped-up, overstimulated nation prone to chemical addiction. Portion sizes of coffee are huge. So, not surprisingly, many Americans are blithely addicted to caffeine. The short definition of "addiction" is 'the continued use of a substance despite adverse consequences'. Patience, people. If you are hooked on caffeine, delay starting phen-pro and withdraw yourself from regular coffee first. Drink half-caf for a while. Reduce portion size. Reduce frequency. When you are on total decaff coffee, THEN start the phen-pro.
I don't care about tea or sodas. The caffeine there is much less. Anyone drinking enough soda for soda-caffeine to be a problem isn't serious about dieting anyway.
Ditto dehydration--the other cause of headaches on phen-pro. Some people, when eating less, also drink less, and wind up dehydrated. But Lesson #4 of the Five Lessons is to drink more water all day, and I'm really serious about that.
I WAS IN ITALY
Michael Anchors MD PhD, October 12, 2007
From Sept. 30 to Oct. 10, I compared life in Itay to life in the U.S. The prevalence of obesity was lower. I did not see a single morbidly obese person, though a fourth of Italians had more belly than they should. No big cars. No big apartments. Plates & portions smaller. Prices higher especially paid in toy dollars instead of Euros. People were warm & courteous to each other. They drove fast, but willingly stopped for pedestrians. They weren't in so much hurry. Less stressed. Values other than money. Young people showed respect for older. Respect for authority. People may be born equal, but no European thinks they stay equal.
Newspapers told the truth; photos on A1 were uncensored. Italians were better informed than Americans and more thoughtful. They were secular, or privately religious, but uninterested in religiosity. They were tolerant. Rome, like Washington, is filled with people from other countries.
Every Italian spoke English. Many knew a third language. Italian education works. People, even men, read books. Cobblers fixed shoes, tailors repaired clothing; nothing useful was thrown away. People had less stuff, but each item was well-designed.
Italy has the lowest rate of moving (house) or changing job in Europe. The lowest birth rate in the world. It is hard for young people to move out because Italy has kept their interest rate high to encourage foreign investment. As a result, their economy has flourished. Self-restraint accomplishes wonders. The long-term view. A functional government. Instead of living only for today & borrowing & stealing. Foreigners everywhere are puzzled by the United States. They miss their good image of us. Meso-Americans may bang on our southern border, but Italians have stopped emigrating to the U.S. (see The World Almanac). It's easier to live in (northern) Italy.
THE F WORD
Michael Anchors MD PhD, September 15, 2007
I can tell you the origin of the stigma regarding phentermine. First there is the general stigma against all pills aimed at "psychological" conditions. Ignorant people do not regard such conditions as real. They believe patients could get better through a mere act of will.
Second although English is a polysyllabic language, men lacking the language skills of women have not developed past monosyllables. You see it explicitly in modern Chinese. The word "phentermine" is doomed by its first syllable, which sounds like the "fen" in fenfluramine. Lazy people don't get informed.
When I try to explain the difference between 'p' and 'f', people determined to condemn me charge me with being "defensive". The negative experience has taught me that the majority of people, including doctors, don't want to know what is true--they want what they want to be true, to be true. I might be like them, too, except that I was trained as a scientist.
Read "How We Know What Isn't So" by Thomas Gilovitch, then "Darwin's Dangerous Idea" by Daniel Denett and "Supercapitalism" by Robert Reich and you will understand the world better. If you are really strong, you can even take on "The God Dilemma" by Richard Dawkins and "Dark Age America" by Morris Berman, but that's only if you want the purest truth and no illusions. I'm not sure myself whether it is best to have no illlusions at all. Dawkins and Berman have not made me happier; they only armored me against any future surprises.
HUNGER
Michael Anchors MD PhD, September 4, 2007
A famous endocrinologist once told me that any diabetic who never has low blood sugar is assuredly not in good control. It's true. And it is also true that any dieting overweight person must feel some hunger sometime, or they won't lose weight.
Phen-pro can reduce hunger, but can't eliminate it. But so what? What kind of crazy expectations do we have, to think we shouldn't have hunger some part of the day? You are SUPPOSED to have some hunger. It's normal.
When did we start to think of hunger as pain? We don't talk about thirst "pangs", sleepy pain, not-getting-enough-sex pain. Only hunger is so described. And among well-fed people, ONLY in America.
I suspect the description of hunger as painful is a self-serving excuse to overeat, for if hunger is truly painful, well, then, of course, you have to eat . . . right away . . . the tempting thing you see.
But you could feel the normal hunger in the afternoon before dinner as COMFORTABLE, a reminder that you have not overeaten or snacked during the day. You are losing weight, restoring health. Then the mild feeling of hunger can be experienced as a REWARD.
THE SECOND VISIT
Michael Anchors MD PhD, August 27, 2007
In the beginning with phen-pro, everything works, but by the second visit at six weeks, the weight loss always slows down. So on the second visit I have two-talking points. The first is the need to get food that is very spicy, tasty, expensive, nice-looking, because then people are more satisfied with smaller portions.
The second point is to develop a SYSTEM, on purpose, to avoid temptation. Because in our hedonistic, commercialized society, every American tempted long enough gives in. You should not be in denial about this fact merely because you don't like it. Truth itself has value, whether pleasant or un-, because truth allows people to control their destiny.
If an alcoholic is trying not to drink--call me crazy--but I expect him or her not to have a bottle of vodka in the house. If the alcoholic does, he or she will certainly relapse. Yet many fat people buy cakes, candy, cookies, ice cream, the "C" words, and put them in their house, hoping to resist the urge to eat the stuff. It's bad behavior and saying it's "for the kids" doesn't excuse it. The fact that other people do it doesn't excuse it either.
Phen-pro does not prevent people from filling their pantry with cookies. People who do that will fail, get sick and die young, and no power on earth will prevent it. I just have to remind myself, you can't save everybody. I am on earth to help the willing and achieve the possible.
SNORING
Michael Anchors MD PhD, August 4, 2007
All very overweight people snore while they sleep. The EEG shows that their sleep wave architecture is distorted. This, in large part, is why obese people are so sleepy all the time. Sleeping pills or alcohol taken at night often make snoring worse.
Some overweight people have sleep apnea in addition. When they go into deep sleep, the walls of their throat collapse blocking their breathing. The oxygen in their blood falls and carbon dioxide rises until, finally, it wakes them up, just enough to get their muscle tone back. The patients themselves usually do not know their sleep was abnormal. All they know is that they feel bad in the morning. Patients with sleep apnea snore in a pattern. Louder and louder then a long pause. Repeated over and over. The diagnosis is confirmed with a sleep study and treated with CPAP or other measures.
If the problem is only snoring, the doctor often suggests a "snore ball", a golf ball sewn into a pocket on the back of the pajamas. The ball prevents the sleeper from sleeping on their back. Snorers snore only on their back. Many patients insist they snore on their side, but it's not true as the sleep study always shows.
Both snoring and sleep apnea usually go away with weight loss.
ORDER THE RIGHT BOOK!
Michael Anchors MD PhD, July 19, 2007
Many people tell me on line they are ordering my book, and then I never hear from them again. No letter comes and nothing is purchased on PayPal. You might think they changed their mind, but then many times they write that they received my book ?
What happened is that they bought my old book Safer Than Phen-Fen on E-bay or Amazon, not understanding that the new book Life Between Meals (available ONLY from my website) is much better. They googled Dr. Anchors and of course Safer came up first, not Life.
I wrote Safer Than Phen-Fen in 1996 on the basis of my experience with 500 patients over 2 years.
I wrote Life Between Meals in 2006 on the basis of experience with 3500 patients over 12 years. Life is by far the better book. I did my best to make it the one place you can find everything that is both provably true and important about weight loss, and I have kept it up to date.
I now disagree with several statements in my earlier book.
Be sure to get the right book. Go to members.aol.com/manchors/phen-pro and click on Store.
A SIGN OF HIGH CHOLESTEROL
Michael Anchors MD PhD, July 12, 2007
Several tricks to inspire confidence in new patients. One of them is to look in their eyes and tell them whether they have high cholesterol. Often they have been told they have high cholesterol when they really don't. They may even be on statin drugs they don't need. I'm qualified to know about this because with my Ph.D. in biochemistry and M.D., I was at the N.I.H in the Eighties monitoring patients in the open trial of Mevacor, the first statin drug.
Any patient with dangerous levels of LDL will have a partial ARCUS in both eyes. A small gray crescent, a half-moon shape, at the bottom of the cornea and at the top. Some old people, especially Black people, have a complete circle, the so-called arcus senilis; that is NOT a mark of high cholesterol. And if the complete circle is orange instead of gray, the patient may have Wilson's disease, a rare disorder of copper metabolism.
How can it be that so often doctors tell patients they have high cholesterol when they don't? In two ways. First, some doctors measure only total cholesterol instead of the whole panel. Some patients have high cholesterol only because the HDL fraction of cholesterol is so high. HDL PROTECTS the heart. The best predictor of risk is the cholesterol:HDL ratio, or the LDL:HDL ratio, not the total cholesterol. Everyone is taught this in medical school, but gynecologists especially tend to forget it.
Second, high cholesterol is much less risky when seen in association with high triglycerides. For many reasons. First the test may not be a true fasting test. Second, the patient's problem may be high VLDL or chilomicrons, i.e. Friedrickson class IV or V respectively, not high LDL (class II). VLDL poses no threat. Only LDL does. Class IV and V are common in fat people. They don't need statin. They need to eat intelligently. By merely looking at the eyes, you can tell the difference. Class II people have the arcus.
ONLINE PHARMACIES
Michael Anchors MD PhD, June 28, 2007
Many people buy phentermine and Prozac from online pharmacies, where the meds can be purchased without a prescription. It is not illegal to BUY the meds without a prescription, although it is illegal for the online pharmacies to sell them. The government can't shut them down because they don't know where they are. Indeed, many are offshore.
I have not hitherto given out the URL of online pharmacies because I don't want to be on record condoning their use. It is better for patients to get medicines from real doctors who really see them. But the declining ability of U.S. physicians, their refusal to improve themelves or consider novel approaches, leaves me in a quandary. I don't want to create a legal doctor-patient relationship twixt me and patients whom I don't personally see.
But now there's a real mess brewing. An increasing number of online pharmacies swindle their customers. One person writing to me was given "phentramine", a fake, instead of phentermine. Another was given Paxil instead of Prozac. The customers can't get their money back; they have nowhere to turn. So for the sake of America, again, I will put myself on the line. Here is the URL of two online pharmacies still selling authentic products.
for phentermine . . . www.phentermine.com
for Prozac . . . www.mypharmausa.net
WHY DON'T MORE PEOPLE LOSE WEIGHT? WHY CAN'T DOCTORS HELP?
Michael Anchors MD PhD, June 21, 2007
Here are clues to the answer . . .
(from reputable, recent, published surveys)
87% of Americans can't find Iraq on a map, 11% can't find the U.S.
54% think the Apocalypse will happen in their lifetime.
50% think the biblical creation story is literally true.
45% believe space aliens have visited the Earth.
40% don't know our enemy in World War II.
24% of Americans smoke.
20% of Americans think the sun goes around the earth.
Only 21% of Americans read a newspaper. Most men read nothing at all.
It little matters--most of what's written is distorted to hype sales.
George W. Bush
Hoodia
Alli
WHAT HAPPENED TO US?
Michael Anchors MD PhD, June 16, 2007
I bought CDs of the great speeches of Martin Luther King, Dick Gregory and others so that my children could hear their towering oratory while I am still around to help them appreciate it. My children will join me in wondering what happened to the Sixties generation and the people they fathered and taught? No one sees the danger to the U.S. now.
What happened to Roosevelt's Four Freedoms? We achieved them! and then . . . Freedom from Fear became dullness to news. Freedom from Want became gluttony and ceaseless craving. Freedom of Speech became advertising, soundbites and cynical posturing. Freedom of Worship became superstition and intolerance, while the real U.S. became totally secular.
Any virtue taken to the extreme becomes a vice. The rest of the world tells us this every day in words, economics and roadside bombs. Do you hear?
Recall what the Ugandan rabbis said in my book. They said their children are taught to count their blessings and not their needs. They are taught not to take more than their fair share. Americans, on the other hand, learn to compete, for all they can get, by any means. They learn entitlement, instead of self-reliance. No wonder so many are fat and unhappy.
I want my patients to stop over-consumption because it is the right and moral thing to do. The world is closing in. There is little time left to get it right. Where are the likes of King and Gregory to tell us?
"PHENTRAMINE" IS A FRAUD
Michael Anchors MD PhD, June 10, 2007
Several patients, reaching me online, have purchased "Phentramine" from on-line pharmacies. On noticing that the product caused no appetite suppression or side effects, the patient sent me a photo of the capsule and the bottle. The capsule looks like Eon-brand phentermine, but the content of the capsule is not tiny, hard granules, as in real phentermine. Moreover, the capsule is not stamped "Eon". Red flag #1.
Kids, kids, phentermine is spelled p-h-e-n-t-e-r-m-i-n-e. Spelling matters! Red flag #2.
Below the word "Phentramine" on the bottle, it says "Patent Pending". That means the product doesn't have a patent yet. But real phentermine was patented in 1968. Indeed, the patent has now expired and the medicine cannot be re-patented. Red flag #3.
Moving on, there are no milligrams marked on the bottle. No dose. Red flag #4.
The kicker is that below the next word "Appetite Suppressant" it says (in small print) "dietary supplement". These are magic words. When a company puts dietary supplement on their product, they mean it is not a pharmaceutical, i.e. it is exempt from strict scrutiny by the FDA. Any company can sell anything as a diet supplement as long as they don't make specific health claims for it. Red flag #5.
People who bought this product, almost certainly, got swindled. The patients have no legal recourse against the company, if they could even find it in Cyberspace. The company didn't proimise to provide phentermine; they promised only phentramine. Spelling matters.
MOST PATIENTS LOSE 15% OF THEIR BODY WEIGHT
Michael Anchors MD PhD, May 27, 2007
Although many of my patients lose all their extra weight, most of my patients lose about 15% of their total body weight and then stop losing. They "plateau" (I always thought that was a noun?)
There are six reasons why . . .
1. Patients make more effort at the beginning.
2. Patients get used to the doctor.
3. At the start, patients lose both fat and fluid. Later on, they stop losing fluid.
4. At a new, lower weight, they burn fewer calories in routine activities.
5. Early weight-loss comes from the belly. Later losses come from hips & thighs where fat is less mobile.
6. The phen-pro medicines lose some of their effectiveness in almost everbody, though they continue to work. Patients who focus on the medicines and not on the Five Lessons are bound to be disappointed.
Patients losing only 15% and getting stuck are still much better off. Most improvements in health occur in the first part of the weight loss. Diabetes and back pain go away. Women become fertile, menses shorter. Men stop snoring. Mainly the knees would appreciate a loss over 15%.
WHY AMERICANS ARE FAT AND UNHAPPY
Michael Anchors MD PhD, May 21, 2007
My experience fighting obesity, the news media, pharmacists and other doctors led me to start writing a book to answer the following questions. Why are so many Americans obese and don't seek help? Why are American doctors ill-equipped and lacking curiosity? Why don't newsmedia seek the truth and report honestly? Why are so many Americans who went to school so uninformed? Why do drivers tailgate and block me from changing lanes? Why are so many men's toilets at airports trashed? Why do Americans talk so loud in restaurants, and talk so much on cell phones in public places?
Why are Americans so stressed and unhappy? Why don't Americans save money? Why are managers and CEOs so overpaid? Why does the U.S. have 70% of the world's lawyers? Why do medicines cost so much? Why is the richest developed nation the only one without national health insurance? Why was the voter turnout in the last US election 37% while in the French election 85%? Why aren't there more demonstrations against the war? Whom are we fighting in Iraq? The press doesn't investigate, no one cares, no one asks. What happened to the social ideals of the Sixties generation?
All the answers are related! . . . and related to the subject of obesity, excuse me. It's NOT about politics or religion.
I don't have to finish the book. It's already been written, and written better than I was doing it. The book is called Dark Ages America (2006) by Morris Berman. Everyone should read it. It proves the man's thesis that so few of you will.
BUSY SCHEDULES AND NIGHT SHIFTS
Michael Anchors MD PhD, May 9, 2007
A patient wrote the following: "My downfall appears to be my demanding schedule. My work hours flip/flop between day and night, often running into each other. The phen-pro helps a lot, but I still struggle to make good choices, especially at odd hours and when I am tired. Any ideas?" I often hear things like that. As when patients ask, "Which weighs more, a pound of muscle or a pound of fat?" ???? The actual thing said makes no sense, so I have to parse what the patient really means.
Similarly, no thin person can understand how a busy schedule would make anyone gain weight. If the patient is too busy to eat, wouldn't they eat less? I do. But obese people ALWAYS eat. Recall the Stead Principle from chapter 6 of Life Between Meals: "People always find time to do what is really important to them." They really do. Before anyone argues with me, let them OBSERVE people without theorizing first.
So the patient's complaint is really that the psychological imperative to eat and the lack of time & planning forces them to eat from vending machines and fast food places. I don't have a medical answer to that and never will.
Patients must remember that obese people really die young, cold dead, all the time. Not my rules. Facts. Death isn't interested in your schedule. If weight loss were really important to you (the Stead Principle), you would plan for meals, not snacks.
Even so, there really is something about night shifts that screws things up, the fact that the activity cycle is out of synch with diurnal hormonal cycles. The night shift problem is not just a lack of willpower, opportunity or the action of the Stead Principle. The only sure way to deal with night shifts is to get off them.
SHOULD MEDIA MENTION PEOPLE'S WEIGHT?
Michael Anchors MD PhD, April 24, 2007
Yesterday I heard a disturbing thing on the news--a reporter talking. I wish they wouldn't do that.
The story itself was disturbing, too. In Washington DC a foster mother was sentenced to 12 years in prison for violently shaking a baby left in her care. Near the end, after a hesitation, the reporter mentioned that the offender was 5' tall and weighed 300 pounds. The hesitation indicated that the reporter suspected it was wrong to mention the offender's weight, but being an American reporter, unconstrained by law, ethics, grace or intelligence, he mentioned the weight anyway.
The interesting thing is--not what I just wrote--but speculation on the reporter's motive. Notice, the reporter did not mention the offender's race; thank God we have progressed beyond that. Race had nothing to do with her offense. Race is not something a person can change. Race is not biologically definable; it's a political label. A myth.
You might think morbid obesity is like race, too. But it's not. Obesity is biologically definable, something the person can change. Given the negative social and medical consequences of obesity, the fact that a person does not act to reduce their obesity says something about their character & culture. That's what the reporter believed, isn't it?
But was it relevant? And if not relevant, should it have been said? I am of mixed mind. What do you think?
DIET-FAILING PEOPLE INFLATE LANGUAGE
Michael Anchors MD PhD, March 28, 2007
It is worth studying the characteristics of people who fail on phen-pro, and every other diet. If the failure were due to genetic or biochemical factors, you would expect a random distribution of personality traits among the patients. But in fact failing patients show a narrow range of personality type, suggesting that the most common reason for failure is psychological or cultural. A tool in the analysis is the study of word- choice. Getting people to talk differently is an important step in cognitive therapy, because if people talk a certain way to others, it is likely they talk the same way to themselves.
Notice the way diet-failing people never use the word "hungry"; they use the word "starving" or "ravenous", instead. Never merely "thirsty"; always "dehydrated". Diet-failers don't get "pain", only "excruciating pain". They don't "like" their work; they "love" it . . . or "hate" it and it changes from day to day. In the first guess you might think diet-failing people use stronger words because they are, in fact, more hungry than diet-successful people. But when diet-successful people are diet-restricted before surgery or on vacation, they still use normal language. Diet-failing people, on the other hand, use the word "starving" even when well-fed. They don't "want" chips; they "crave" them.
There is insufficient space to discuss why diet-failers inflate words, but getting them to use language in a measured way is a powerful, underutilized therapeutic tool. Language-therapy should be used only with intelligent patients. Some will get restless at first, not seeing the relevance to obesity; but when (if) the dawn breaks through, the patient's ability to control their life & waist is enhanced and the patient becomes a loyal adherent of the clinician.
SUPER-OBESE PEOPLE DON'T GET DIABETES
Michael Anchors MD PhD, March 11, 2007
It's interesting that battleship-class patients almost never develop diabetes. The patients with type 2 diabetes are never more than heavy cruiser size. You might have thought the risk of diabetes would increase smoothly with increasing BMI, but it doesn't; the risk falls off in the highest BMI range. Why is that?
It's because there is a range of insulin sensitivity (even in lean people as glucose clamp experiments show.) Patients more sensitive to insulin are (A) less likely to develop diabetes and (B) more likely to put on weight with a given carbohydrate intake. Another way to think about it is that patients gaining weight and stumbling into diabetes get sick and aren't able to achieve super-obesity because the disease prevents them.
Doctors artifically create some super-obese diabetics by putting them on insulin. Doctors should almost never do that. The better choice is to counsel diet, use phen-pro and/or do gastric bypass surgery, instead.
The risk of death itself does go up smoothly with increasing BMI. In morbidly obese people, fewer deaths are diabetes-related; more deaths result from arrhythmia, heart attack, respiratory insufficency and falling through the floor.
I choose my tone of speech to deny respect to the condition of obesity. I don't mean to disrespect the people themselves. It's a fine line to walk--to love the people but hate their behavior. Doctors must never allow patients to think of gluttony as a valid lifestyle choice. U.S gluttony is the nation's worst problem, indeed the world's! U.S. gluttony is burdening the entire Earth.
SERVING BOWLS
Michael Anchors MD PhD, February 3, 2007
I have had the opportunity to dine with overweight friends. They know I'm a bariatrician so they are on their best behavior. It is fun to observe on the Q.T. their fat-gaining behaviors that are so ingrained they are unaware of them. It goes without saying that they sit & socialize easily, comfortably and frequently on the sofa. The sofa is dimpled and worn. You expect that.
But here's something you may not have noticed before. My friends serve the dinner plates from the stove and ALSO put out serving dishes. We never do that in my house. For family dinners we serve from the stove, eat our plate of food and then we're done. For dinners with guests we put out empty dishes and serve the food in serving dishes.
For family dinners we don't make enough food to fill both the plates and the serving dishes. And we don't want to wash the serving dishes every night either--they don't fit the dishwasher.
Anyone who serves from the stove AND puts out serving dishes is planning to overeat, even guaranteeing they will overeat. Be aware of what you do, as Socrates said, "The life unexamined is not worth living". (His contemporaries didn't understand because they didn't speak English.) By the way, does anyone alive still know what "on the Q.T." means?
SOUP
Michael Anchors MD PhD, January 21, 2007
It's snowing outside, and cold, the first snow of the year in Maryland and inside I've made a pot of beef vegetable barley soup. It smells so good, it reminds me to tell dieting folk that soup is a good way to diet. If you've noticed, soup bowls in restaurants like Ruby Tuesday and Appleby's are the only item that was never supersized. Fat people don't eat soup, and lean people don't want their soup supersized.
Many successfully-dieting patients, especially men, complain of salad fatigue . . . or they transform their salad into something unnatural, piling on chicken and cheese until the "salad" exceeds 600 calories. Their salad becomes a plate. The answer is to eat more soup.
Campbell's and other canned soups are nasty and high in sodium, but it's so easy to make your own soup. The best soup cookbook is The Cook's Encyclopedia of Soup (SOUP is the title) by Barnes & Noble Books, New York. Everything in this book is easy and wonderful. But you don't need a book, really.
Here's the only three errors you can make. (1) Making too much at a time. Make no more than you can reasonably eat. (2) Adding soup to everything else instead of letting soup be the actual meal. (3) Cream soups have beaucoup calories. Mounds of cheese are not cool either; it's like putting chicken on salad. Let salad be salad and soup be soup.
A NEW DIET PILL! FOR DOGS
Michael Anchors MD PhD, January 7, 2007
Pfizer has just released Slentrol, a diet pill for dogs. A selective microsomal triglyceride transfer protein inhibitor, it blocks the absorption of fat and, Pfizer claims, reduces appetite as well. I wonder how they measured dog-hunger?
It seems to me Slentrol would cause diarrhea. If the fat isn't absorbed, it must go somewhere--on the rug perhaps? Poor Pfizer, having so much trouble, what with paying their departing CEO 30 mil; and now they have another dog on their hands.
But come on, isn't it silly? If your dog is fat, you just feed him less. It's better than free; you save money. Slentrol costs $2 a pill.
A medicine like Slentrol won't work for fat American people, for the same reason Xenical doesn't work. Modern Americans did not get fat eating fat; they got fat eating sugar, and neither Slentrol nor Xenical does anything about that.