Michael Anchors MD PhD, Dec. 28, 2008
Sit-ups are a useful way to flatten the abdomen. As a doctor interested in health, I am concerned only about excessive fat in the liver and around the intestine. Most patients, on the other hand, especially women, are concerned about the cosmetic appearance of the round belly. Many patients, starting a weight-loss program, focus on sit-ups. They believe, incorrectly, that sit-ups flatten the belly by reducing fat. It's not true. The rectus abdominis muscle is small; you don't burn many calories using it. The largest muscles of the body are in the legs, so the fastest way to reduce fat is to use the legs.
YOU KNOW I don't recommend exercise to obese people, for three reasons. First they are averse to exercise & embarrassed about being seen. If the weight-loss experience is unpleasant, they may give up the whole thing, diet and all. Second, obese people risk injury when they exercise. Third--come on now--obese people get plenty of exercise just living. They burn calories just breathing, standing up, walking, pumping a double blood volume. Why oh why do I have to keep explaining this?
Nevertheless, it is true that many overweight people have a weak rectus abdominis muscle. If they did sit-ups, it would reduce the size of the protruding belly, even though the intrabdominal fat remains the same. If changing appearance makes people happy, why not? SO DO SIT-UPS. But please do them safely. Do NOT put the feet under a sofa or sit all the way up. Think of the exercise as a stomach crunch, not a sit-up. Come a third of the way up only. At that point the rectus muscle has shortened as much as it can. Coming up further does nothing to improve the exercise.
AMERICANS ARE OVERGROWN CHILDREN
Michael Anchors MD PhD, Dec. 17, 2008
Often 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 real adults talk; this is the way children talk. Such childish thinking is universal in the U.S. I’m talking about 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 responsibilities. Everyone understood the trade-off.
But the children of the Sixties, disappointed with the racism and cold-warriorism of their parents, set out to create a new social regime. They succeeded, but not in the way they intended. Their chief value was the desire to stay young in body & spirit. That value persisted, because it was the only one that could be used to sell products, e.g. the Pepsi generation.
What does “staying young” mean? It means craving new toys without taking responsibility. Egocentrism. Carelessness with the truth. Examples, shall we? George Bush, Ken Lay, Oliver North, Bernard Madoff and every recent American president except Carter & Obama. 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.
ONCE A YEAR MONITORING--I CAN'T DO IT
Michael Anchors MD PhD, Dec. 4, 2008
Some out-of-state patients have noted that Congress just passed a law requiring patients to be really seen by the physician once a year to receive prescriptions from the physician. The patients ask if I will see them once a year instead of more often. I tell them that the once-a-year national standard is a minimum. States are allowed to require more frequent visits, and my state, Maryland, does.
In fact, almost all other bariatricians see patients more frequently than I do. I spend more time with each patient, but see patients less often. I can make some allowance for long travel, but I still need to see people more often than once a year. Besides--as I say over and over--the weight loss program is NOT the Two Pills--it is the Six Lessons. People who focus on the pills always fail. Those focusing on the Lessons always succeed.
I often travel to visit family in other states, and patients in other states have asked to meet me in their state. I can't do that, legally, without a license to practice medicine in their state.
Many people come to me from out-of-state since the on-line pharmacies collapsed and the good old bariatricians are retiring and not being replaced with good young bariatricians. Besides, many bariatricians overcharge or require patients to pay for things they don't need; so, many patients find it CHEAPER to fly to Washington to see me. I wish I could make it easier for them. I could franchise myself. I'd be happy to discuss that idea with any doctor.
THANKSGIVING DINNER
Michael Anchors MD PhD, Nov. 24, 2008
Although every bariatric patient has the capacity to figure out how to handle Thanksgiving dinner, it is important for the physician to give specific advice, because, otherwise, the it's-okay-to-do-what-everyone-else-does error takes over. The idea of Thanksgiving gives people warm, fuzzy feelings, leading directly to fuzzy thinking. No, you may not overeat on Thanksgiving to any great degree. Gluttony is gluttony on the last Thursday in November as much as any other day.
My first & best suggestion is to drink a lot of water before sitting down to dinner. Have a high protein lunch--don't skip lunch to "make room for dinner". You don't want to be too hungry at the start of turkey dinner. Focus on the turkey and vegetables, NOT on the carby dishes such as mashed potatoes or yams (I wish they weren't even on the table!) or "stuffing". which is of course a mass of bread and gravy. Rice is marginally better. Don't drink too much alcohol. (A) It's fattening. And (B) it impairs your judgment about food.
Focus on conversation and friendship and family. Eat slowly. And talk & listen. Dessert for you is fruit or thin slice of pie.
BACK TO THE MEDIA
Michael Anchors MD PhD, Nov. 20, 2008
I will be speaking at Bus Boys and Poets bookstore 2021 14th St., N.W. from 3-6 on December 18. Other book stores too, and I'm going back to radio. I have a press agent. Are you reading this, Sheryl? My successful patients are eager to go on, with me. It's time. There are fewer effective weight-loss doctors in the U.S. The generation of doctors that got into the biz with phen-fen is retiring or dying (gulp), and not being replaced. But more, I need to get back to the media to remind people that U.S. obesity is cultural in origin. The intersection of junk food and American sollopsism. No other explanation makes sense.
When I was a young man, what did I own? Nothing. I had an apartment. My furniture was boxes and my bed a mattress on the floor. But I had books and ideas, and friends. But the generation after mine grew up with real furniture; they mistake material comfort for happiness. Food is just another material thing. Seek ye comfort-people, not comfort-food.
CONFUSING SIZE WITH QUALITY
Michael Anchors MD PhD, Nov. 18, 2008
Americans have terribly confused size with quality. They think anything is better if it's bigger. Food certainly. But also cars, TVs, houses, breasts, theaters, stadiums. Europeans, on the other hand, appreciate quality, the best they can get, but as for size--things should be only big enough and no more.
Fat Americans, mistaking size for quality, will never be happy dieting or keep weight off. The physician must help them see, really see, the error in their thinking, and correct it. You'll notice, when the dawn breaks, successful patient-thinkers fix the mental error across the board, not only in the area of food. Fat Americans, fixing their food portions, who still buy an SUV will not long remain on the wagon. Successful patients learn principles. Good doctors teach them.
REPORT ON GROUP LESSONS
Michael Anchors MD PhD, Nov. 12, 2008
My first session of group lessons is now finished. I began with six intelligent, overweight women who had nevertheless not learned the Six Lessons or read my book or lost weight. My initial idea was that (1) they were visual, not verbal learners (2) motivated to make changes and lose weight; and (3) they were victims of oversized meals, plates, pots, pans & packages, and (4) NOT significantly snacking on cakes, cookies & ice cream.
Of the six women, one was hospitalized for cardiac surgery before the first meeting, and one never attended, though she had said she would. One of the attendees at the first meeting was in an auto accident on the way home and suffered a neck strain that (apparently) prevented her from attending more meetings. Only three carried through.
By the third meeting, from listening to the patients talk to each other, I realized that the time spent on calorie-counting was a waste. The problem was not oversized meals, as I supposed, but instead the C words--cakes, candies, cookies, etc. in other words, adults eating and thinking about food as small children do. WHAT do you do about that? What can you ever do about that? Phentermine won't stop it.
No one lost weight. So my initial impression is that the group-approach adds nothing worthwhile to the one-patient-at-a-time approach.
C WORDS REDUX
Michael Anchors MD PhD, Oct. 30, 2008
It's amazing how much of the bad stuff starts with the letter "C".
Cakes
Candy
Cookies
Chocolate
ice Cream
Cane Columbus
Childishness
I had assumed the women in my group lesson, since they were not so overweight, were merely overeating at mealtimes, but I was wrong. It turned out the problem WAS snacking, on cake and cookies. They just didn't do it as much as larger people, or they had not had enough time to gain more weight. For overweight adults to eat excess cake, candy & cookies is childish, and denying it won't make it untrue.
"Cane Columbus" is on the list to remind us that before Columbus, the world had no cheap sweetener. They had honey, sure, but it was expensive and hard to get. The Spanish transplanted sugar cane to the Caribbean, where it grows better than in its original home in Indonesia. After that, the world had a cheap sweetener, and tooth decay, heart disease and obesity followed in its wake.
TWO LESSONS LEARNED
Michael Anchors MD PhD, Oct. 19, 2008
As said before, the majority of my patients listen to my speech and read my book and do well, losing weight, but I have a small group that do not. I am developing programs for them. For the women I have introduced group sessions; for the men, the e-mail-every-day club. In each case I have learned an important lesson.
The e-mail club began with four men. After five weeks I am down to one, my dance teacher. All four men were honest in describing what they ate, but three of them didn't follow my advice. I didn't understand why until psychologist Uzi Ben-Ami explained. Years of evolution, he said, have conditioned men to resist being in a subordinate position. My dance teacher stuck with the weight-loss program because half the time, I am in a subordinate position to HIM--he teaches me to dance. There is a tit for tat. With the other three men, there was no tat. Armed with new understanding, I will revise my approach to men.
The women's group is doing better. Next week is our field trip to the grocery store. For the group I chose six women of similar weight & personality hoping to get positive interactions. Indeed, the ladies, in forming friendships, shared secrets they never told me! I had assumed that women in the overweight-not-obese category ate oversize meals, not cake & candy. But now I have learned that the pattern of sweet-eating is the same for the overweight women (in my group) as for obese women. Differing in degree, not in kind. I'll be more focused on sweets in the future and dispense with calorie counting.
ATYPICAL PATIENTS
Michael Anchors MD PhD, Oct. 10, 2008
Most of my patients are obese adults (BMI>30) but not all. Some patients are merely overweight (BMI 25-30), and I know some doctors don't treat such people. Back when phen-FEN was in the news, I didn't treat them either. But I found that merely overweight patients denied anorexiant medicine usually went on to become obese. Remind yourself that patients paying full price in cash usually KNOW they have a real medical problem. For the clinician to substitute their judgment for the patient's in all cases is arrogant. Should the doctor give anorexiants to everyone requesting them? Obviously not. But the doctor should look for reasons NOT to give the meds instead of trying so hard to withhold them.
I gladly prescribe phentermine or phen-pro to patients with bulimia. It is very effective. Prozac was originally developed for bulimia, not for depression. None of my bulimics reduce to unhealthy levels, but they do stop binging and purging. Another group to treat is patients exercising excessively to maintain low weight, risking hip, knee and foot injuries.
The final atypical group is children and teenagers. I don't make a big deal about treating them--I don't want trouble--but I have to say, kids and teens have been my only perfect group. Every one reached ideal body weight if I got several chances with them. It's good, because fat cells make the enzyme aromatase which converts progesterone, testosterone and adrenal steroids into estrogen, screwing up peripubertal development. Moreover, obesity-related negative experiences within the peer group can scar the personality forever.
THE FIRST GROUP SESSION
Michael Anchors MD PhD, Oct. 4, 2008
Last Wednesday was my first group sesson. I meant to have six medium-overweight ladies, but one student was unable to attend because of emergency cardiac bypass surgery, underscoring the fact that overweight is a serious health problem. I opened with a review of the Six Lessons, which by now are posted on every wall of my office. It is a sad comment on human nature that half my patients still haven't learned them.
I observed that very obese people ignore every one of the Six Lessons, but modestly overweight people simply eat too much, because their food portions are too large. I ordered my students to measure their portions and gave them a handy tool. Literally. The thumb is 1 ounce, the palm 2 ounces, and the fist 6 ounces. (Actually it's 8 oz, but pretend it's 6.) The foods in the top two layers of the Anchors' pyramid are 100 cal per ounce. The lower layer, fruits and vegetables, is free. So on a 1200 calorie diet, they can have two fist-size portions of food a day and any amount of fruits and vegetables. A moderate beverage with meals, but only water in between.
Purists say my system is too simple. I should say it is! But you get about the same calorie count with the fist-system or any calorie book, provided you eat normal food. If you eat only chocolate and ice cream, then of course the fist system will be off, but the people in my first group don't eat that way. When I take on larger patients, I'll have to devise different tools. Still, to hedge my bets, I gave each student in this first group a copy of Allan Borushek's Calorie King, the best calorie pocket book.
OBESITY AND THE BAIL-OUT
Michael Anchors MD PhD, Sept. 24, 2008
There is a relationship between obesity, the Wall Street collapse and the Federal bail-out. Follow me. Why are investment banks collapsing? The ultimate cause, not the proximate cause. Answer: Many Americans can't make their mortgage payments. Why can't they make their payments? Again ULTIMATE cause, not proximate. Yes, they took out adjustable-rate mortgages and their payments went up, some, but not much--the prime is still low. Yes, their real wages are down and house prices up. Yes, gas costs more. But all these are proximate causes, and they're all BS. Americans' annual per capita income is over $40,000. Even allowing for unequal income distribution, it's still more income than anyone else. Americans can afford a house. But they don't want any house; they want the dream house. The ultimate cause of our demise is gluttony, the same unique sense of personal entitlement, and irresponsibility, that drives Americans to overeat.
What is the answer contemplated? (A) Bail out Wall Street so they don't suffer for their mistakes using money which (B) we borrow, instead of raising taxes. (C) Restructure loans so people who bought houses too big can stay in their home. No fault. No responsibility. No one suffers. How like the yearning for a pill or diet to take away fat without suffering, exercise or expense? American obesity is a deep cultural malaise of arrested personal development. There's just no biology to it.
Many Meals versus a Few Sept. 20, 2008 Many patients have said they heard you can lose weight by eating five small meals a day instead of two or three larger ones. An obese patient even said her personal trainer told her she didn't lose weight because she didn't eat enough. Anyone will lie to you for money. These bizarre ideas are all over the Internet. Check out www.goaskalice.columbia.edu/4463.html or blog.ultimatefatburner.com/wordpress/is-5-small-meals-a-day-useless-for-weight-loss/. I assure you, the main thing determining how much weight you gain is total calories per day, regardless of how it is divided up, with two minor exceptions. (A) You gain some weight if you eat more carbs. (B) You gain some weight if you don't eat breakfast. That's the truth; abundant evidence proves it. Other "theories" are not worth reading. Only observation ever counts. How did the myth of many small meals get started? It is NOT published in any peer-reviewed journal. Some people heard about the metabolic contribution of food (MCF) and got confused. The MCF is the calories used to digest food. The intestines move and enzymes are secreted; all that takes energy. So the mere fact of eating increases the metabolism a little, but there are always many more calories in food than the MCF. Hence, you can never lose weight by eating. Do yourself a favor. In the future when you hear, "People say X", assume X is wrong, or use the fabled Yankee common sense Americans used to have. Crying in My Office Sept. 19, 2008 I have now seen 5000 people in my office, since March 1995, for the treatment of obesity. Three times I have had a patient cry in my office. Once the patient was depressed. Another time I misread the patient's body language and pushed too far; she started crying and abruptly left. I hated that. But you MUST push people to some degree or you don't get results. It happened only once, out of 5000 people. Expecting to open phen-pro clinics in other cities (more about that later), I have been assembling a complete manual for physicians to teach exactly how to do what I do so successfully. A key issue is to teach doctors to read body language to judge patient response WHILE a speech is being delivered. The physician's talk must be skillfully adjusted to the target audience. The third time a patient cried in my office was especially affecting. She cried because she felt relief. She had finally arrived on a safe shore, a place where she could hear what is really true, without struggle, instead of sorting through the lies so many other Americans tell. I recognized that sense of relief. I felt the same way when I read The Blank Slate by Steven Pinker. That book is the best book ever written on any subject. In fact, I would say that the purpose of learning English and going to college and gaining life-experience is to be able to read and appreciate The Blank Slate. You will know what I mean only when you read the book for yourself. Phentermine tablets stamped 'K 25' are authentic Sept. 15, 2008 I am now convinced that the phentermine 37.5 mg tablet from KVK Tech, Pennsylvania, is genuine. It is stamped "K 25". I have attached a photo. In a previous mailing I affirmed the genuiness of the tablet from Qualitest stamped "K" on one side and " 50 30" on the other, and the tablet from Actavis stamped "A159". All are football shaped and either light blue or white with dark blue speckles. I'm doing this because I can't be sure of the origin of the fake pills the patient showed me. Even Some of the Phentermine Tablets are Fake Now Sept. 12, 2008 Doggone it, it's getting hard. Now some of the generic tablets sold at CVS are bogus, i.e. contain no phentermine. Most of the phentermine sold without prescription on the internet is bogus. Some of the capsules sold in pharmacies are fake, too. But this is the first time I have seen fake tablets. The patient who sent them to me complained that they did not work like per previous pills did, and indeed they look different. No little flecks of color. I added some of the pills to a sample of serum and sent it to the lab for phentermine level. Sure enough. No phentermine. A control sample using Adipex-P did show phentermine. So I have amended my prescriptions to read as follows. Phentermine 37.5 mg generic tablets from Qualitest or Actavis only stamped with "V" or "A159" on one side 1 tab po qAM It's too much to write, so I print my prescriptions with the above information on the script. Alternatively the physician can specify brandname Adipex-P, but it costs more. What does 'Serving Size' mean? Sept. 6, 2008 A patient asked me an interesting question. He asked, "What does the 'serving size' mean in the Nutrition tables on packages? Shouldn't they have different sizes for different people." Well duh. Yes. I'm embarrassed I never thought to wonder about it. I can't find any published original definition for the term. I believe it meant, to the nutritionists collecting information back in the seventies, the amount of the specific food eaten by the average person at one sitting. The median person then was a middle age 5' 2" 130 lb woman. I can't imagine how they knew how much the average person ate. The "serving size" is NOT saying how much a person should eat. That would depend on the rest of the diet. So, any ideas, people? We may find that the serving size is arbitrary, and then I'd like to know who sets it. New Diet Books Sept. 2, 2008 Now that I'm doing full-time bariatrics, I'd like to do more TV and radio. Trouble is, they usually want you to have a new book for sale. They don't count a self-published book like "Life". Here are some recent new books. I heard the authors talk on NPR radio. The Get Sick Diet by Mark Garner MD. Eat all you want and you don't have to exercise. Each chapter devoted to a different non-fatal, wasting disease with tips on how to contract it. The Surgery Diet by Ellen Shaffer MD lists the internal organs you can probably do without in order of weight and offers advice on finding a surgeon to remove them. The Idiot's Guide to Home Liposuction. Not even by a real doctor. I have doubts about the methods. I wouldn't want to use the kitchen after someone tries this. The Auschwitz Diet by Sophie Warner. I thought this book was in poor taste. Shows how desperate some people are (talking about authors, not fat people.) Short book. No recipes. Abbot & Costello Diet "Dieting is when you can eat all you want of everything you don't like." -- Lou Costello Daily Monitoring by E-mail Aug. 22, 2008 Most patients do fine with my first-visit speech adjusted for the age, gender and ethnicity of the patient, the phen-pro meds, the Manual and the book Life Between Meals. But for patients who persistently don't "get it", I am developing alternate methods. I mentioned the group lessons in a previous MOW. Another new idea is Daily Monitoring by E-Mail. The patient e-mails me every day to tell me their weight & what they are doing and eating. I have been doing this, as a trial, with two male patients, and I am very pleased with the results. Compliance has not been an issue; the patients enjoy talking to me on-line. I was worried the patients wouldn't be honest, but they have been amazingly honest. Patients may put up a false front on a monthly visit, but when required to write every day, it's too hard to lie. The truth is quick & easy. Daily e-mail contact promotes a habit of truth-telling. One patient had on his list three slices of pear gorgonzola pizza. Jeepers, that's 1800 calories! He didn't know? People think anything exotic is low cal. As if a piece of gorgonzola or arugula on a pizza--pardon my French--would subtract calories. Alcohol Aug. 11, 2008 I haven't discussed alcohol in these messages before. Unlike other doctors and writers, I don't find alcohol to be a major contributor to obesity in women. For them, alcohol and food abuse seem to be alternative tracks. Alcohol is a major factor in some men. The facts. A 4 oz glass of wine has about 100 calories, a 12 oz glass of beer about 150. Mixed drinks range from 65 calories for a vodka tonic to 320 calories for a white russian. 1 jigger = 1 1/2 oz = about 100 calories. 1 lb fat = 3800 calories. Rough "metabolism" estimate = weight in pounds x 10. With exercise, fat people burn about 10 cal/min. From the foregoing, you can appreciate that anyone for whom alcohol-calories are a large portion of daily calorie-intake is drinking too much. Here is why it matters. U.S. death & disability from non-alcoholic, obesity-driven hepatic cirrhosis, i.e. scarring of the liver, now exceeds that from alcoholic cirrhosis. But the real truth is that the most common cause of liver failure is combined alcoholic and non-alcoholic cirrhosis. With practice you can look at a "fat" man and guess whether the obesity is from abdominal adiposis (too much fat around the intestine) or ascites (fluid in the belly from cirrhosis). The abdomen with ascites is tense and spherical. The obese abdomen is soft and egg-shaped with the long axis front to back. Many internists miss this clue. Not that it matters. If the patient is in denial about alcohol, there's little the clinician can do about it. Setting Goals Aug. 2, 2008 Several self-described experts have criticized me for not setting goal weights for my patients. I do set goals--I set goal attitudes. Goal weights are counterproductive. Patients who don't reach goal weight feel bad and may give up, even though they had lost an important amount of weight. On the other hand if the patient reaches goal weight, they tend to stop trying and either gain weight back or plateau. The latter is not necessarily bad, but if they could have lost more, why not? Moreover, goal weights have a corrupting influence on the clinician. Eager to avoid disappointment--theirs or the patient's--clinicians make weight goals too easy. Obvious, isn't it? But you would be amazed how firmly doctors are attached to goal weights . . . on the basis of no good literature. It is religion, not science. Instead, during my thirty minute personal interview with the patients, I look to see that they have absorbed my teaching. Do they know the Six Lessons? Are they eager and persistent and creative in applying them? If so, my job is done. Most patients "graduate", losing enough weight that they are not so hungry and mastering the Six Lessons. I congratulate them and urge them to teach and spread joy. I only wish more of my fellow doctors were as teach-able as my patients are. Why are they not? Dark Ages America again? I am afraid so. Rice July 24, 2009 Several astute patients have remarked on my inclusion of rice in the top, to-be-avoided "carb" section of the Anchors' pyramid. Patients say two things. First, they say, "That can't be right because the Chinese a lot of rice and they are lean." I answer, "The average Chinese doesn't eat a lot of anything. If you eat so little, you can have some rice." The second thing they say is, "Isn't rice a whole grain? Shouldn't it be in the middle, high-protein section?" The answer is, "Yes, it should be, if only people ate rice as they eat other whole grains. BUT when Americans eat rice, they eat a LOT of rice, on top of everything else. So for practical purposes, I put rice in the avoid-it, top section of the pyramid to put a damper on people's behavior. I'm a practical man." Let's look more closely. The serving size of rice is 1/4 cup dry or 1/2 cup cooked. The portion contains 160 calories, 37 grams of carbohydrate and from 2 (jasmine rice) to 4 grams (Bhutan red) of protein. A single portion of oatmeal w/o milk or sugar contains 150 calories, 27 grams of carbohydrate and 5 grams of protein, but everyone adds milk & sugar so oatmeal winds up being similar to rice, with perhaps a little more protein. But no one eats heaping plates of oatmeal, the way they eat rice. The Last Two Points July 17, 2008 Now regularly on visits #1 and #2, as my final two points, I say the following: What is the source of happiness in life? (Don't let the patients answer. You are going to tell them.) The source of deep, lasting joy in life is people. Yourself, family, friends, neighbors and good strangers. NOT what you buy. NOT what you eat. If you don't believe what I say, trying living without people. You'll see. Final point. As Aristotle said (in an earlier MOW) a good life is always a balanced life, where five things are in balance: sleep, meals (and notice I say meals, not eating), working to make money, physical exercise and leisure. By "leisure" I mean active enjoyable thinking, reading, debating with friends, doing puzzles, games . . . not just watching TV, or doing crazy stuff to "have fun". But look--most Americans get no physical exercise, no real leisure, not enough sleep, they eat plenty but don't have meals. So that leaves only working to make money. You can't stay healthy that way. You can't even stay alive. You, the bariatric doctor, cannot get people to lose weight and keep it off by focusing on food. It was by focusing on food that your patients GOT FAT. You must focus on other things yourself, and get your patients to focus on other things. Otherwise, they won't lose weight, or if they do, they will gain it back. Obesity is a cultural problem, and it has only a cultural answer. We Will Do DVD's and Group Sessions June 27, 2008 While I wind down my medical practice, I am thinking about how to improve my bariatric pratice. I will make some DVDs and introduce group sessions. I will start with a group of women, once a week. The first meeting will be organizational, assigning homework assignments. In the second session, we will go over homework results. On the third meeting, I will take the group on a field trip through four restaurants near my office, working on strategies to handle ordering and eating. On the fourth meeting, I will take the patients grocery shopping. After several monthly groups, I will see if the newsmedia wants to watch a field trip. After doing a few groups of women, I will try a men's group. Then I will do a latino group. I HOPE I can keep up. I am listening to Spanish radio and soap operas to get ready. Do you think this will go well? I got a little worried when I presented the idea to another doctor and he said disdainfully, "So all you're going to talk about is eating less?" Well YES, what the heck else would we talk about? But it's not so simple for these people. Many people are visual learners--I heard on NPR. I know most Americans don't learn from written text. That's obvious. Then I noticed many don't learn from spoken words either. Witness the number with no memory of the Six Lessons on the second visit . . . or even thirty minutes after the first visit! Hopefully I will find they can learn when I SHOW them things. I'll let you know. I am aware, always, that I do what I do, and publish, not only for myself and my patients, but for the whole country. Someone must look for better methods. Having the group pore over charts and brochures with a nutritionist won't work. While the nutritionist teaches about calories & exchanges, the patients are eating candy at home. Letting the patients exchange salad recipes doesn't work either. Get real. I am still the leader--it's what people pay me for--and leaders must lead. I will try to do so more visually. Look for my DVDs in the Fall when I'm convinced I've got something worth distributing. Why Mass Media Won't Do The Phen-pro Story June 22, 2008 The period of 1997-1998 when I was on TV and radio shows was one of the most bizarre of my life. I could not figure out why the newsmedia would not report the phen-pro story as it actually was. I kept thinking I was not being persuasive enough, or my credentials/evidence weren't strong enough. I kept hoping the reporters would tell me why they were distorting the story. (They never said.) It would have been comfortable to think they were all stupid, or that there was a conspiracy of the editors, but no rational person could credit such a hypothesis. The article in Health magazine last year, and the one in Fitness magazine this year if it ever comes out, are contemporary examples of bending the story to fit the pre-set mold assigned by the editor before any actual research. Editors seem to believe the purpose of news-reporting is to "prove" what everyone already "knows". If that's so, why is it "news"? But now I understand it! It took Drew Curtis, founder of Fark.com, to explain it to me. I encourage you to read his book It's Not News, It's FARK: How Mass Media Tries to Pass Off Crap as News. Despite the scatological language, this is a concise on-target critique of Mass Media. Curtis documents that news, real news, never was interesting to the public at large anyway. Real news and analysis appealed only to a small subset. The majority of people were interested only in "naughty bits", to use a word from Monty Python. The reporters who talked to me, and their editors, were looking only for the "naughty bits" in the phen-pro story. The fact that phen-pro coupled with the right counseling is superbly effective in getting people to lose weight & keep it off is not naughty. The fact that the newsmedia confused all meds sounding like "fen" leading to foolish lawsuits and countries banning phentermine, while naughty, is not a "bit", i.e. it's too big a story. Thus, any effort to get phen-pro into Mass Media is doomed, and useless anyway. The Internet, which I have used all along, is the news source of the future, I mean, of the present. The Four Phases of My Doctor-life June 11, 2008 I have been shutting down my general practice. After August 15, I will practice bariatrics only. Thinking back on my 25 years as a general internist, I recognize four phases. Phase 1. As a young doctor I was often not confident of the patient's diagnosis and did unnecessary tests to find the correct diagnosis. I was lucky to make so few mistakes. I had few patients then and no medical students. Phase 2. Many patients. I almost always got the right diagnosis from the history and a little exam. I did tests only to prove the diagnosis, in case I was questioned later by lawyers or doctors. I had many medical students. Phase 3. I always got the right diagnosis from the history because, gee, I had seen the same things over and over. I stopped bothering to back up the diagnosis with unnecessary tests because my experience would overcome any challenge. I stopped teaching medical students because I didn't want them to acquire my arrogance without my experience. Phase 4. I realized how much of my patients' disease-burden was self-inflicted through eating too much, drinking, smoking, and did I mention eating too much? I spent more time trying to change my patient's culture. There was less opportunity to see cool stuff like tularemia and hairy cell leukemia. Instead, it was just diabetes and more diabetes. How To Read Health Claims June 1, 2008 People often ask me about dietary supplements & treatments claiming to cause weight loss. 99% of the time the claims are bunko and the people ought to know it. But they don't. Why don't they? The fundamental reason is the turn, over recent years, of Americans toward antirationalism. (Read "The Age of American Unreason" by Susan Jacoby) The claims of mystics and theologians are accorded respect; conclusions of scientists from evidence are suspect. The old canard about MMR vaccine and autism, long laid to rest, resurfaced as the cover story of "Time" magazine. The "conflict" between evolution and intelligent design got its own radio show ("Speaking of Faith" on NPR). The rest of the advanced world has moved on, into the sunlight, while the U.S. has receded into the dark. Americans have lost their skepticism. They believe anything negative said by a non-scientist, any irrational thing written. Americans think, "they" wouldn't say it if it wasn't true! Right? They wouldn't be allowed to write something that wasn't true? Right? Well no, you can write anything you want, and a publisher will publish it if it might make money. You KNOW that fact in the back of your brain, but you forget it in the front. Like children, Americans don't want to know what is true. They want what they want to be true, to be true. (Read "The Death of the Grownup" by Diana West). Let's look at a phony claim for one dietary supplement, chromium. This is an easy one, guys. "Chromium, which occurs naturally in the body, helps regulate blood sugar and utilize carbohydrate, and although few studies have shown any correlation between chromium supplements and fat loss, chromium may still aid weight loss. That's because chromium helps keep insulin levels down. High levels of insulin, after all, make fat burning almost impossible. Although chromium may not cause weight loss, by lowering insulin, it may remove an obstacle to taking off weight." by Karen Asp on AOL "Best Supplements To Drop Pounds" At least here the author wrote "few studies have shown any correlation between chromium supplements and fat loss." Indeed! You would think that would lay the matter to rest, but the author goes on "chromium MAY still aid weight loss . . . because chromium HELPS keep insulin levels down [no proof for that!] and high levels of insulin make fat burning almost impossible [that's true]." You should ALWAYS ignore claims with words like "may" and "helps". Here is what the writer did--made a weak connection between A and B, then a strong connection between B and C, leaving you with the impression of a strong connection between A and C. Don't be a sucker! The only firm basis for truth is verifiable evidence, honestly collected & openly published. Truth is never based on conjecture. Never. You Don't Need A Gym May 25, 2008 My family bought me a membership to Fitness First, but I feel silly there. Almost all the muscle- building I do there, I could have done at home for free. I can do the chest press on the Nautilus there, or I could do push-ups at home. I can build up my biceps on three machines there, or I could do pull-ups on the bar in the garage. I can go on the stationary bike or the elliptical, or I could run around my neighborhood. Do you get the point? In the Army, the recruits do calesthenics in the fresh air; they don't work out on the Nautilus and relax in the sauna. I have not seen obese people at Fitness First. Maybe they are embarrassed to be seen, or maybe they don't like gym-exercise, or maybe they read previous Messages of the Week explaining that obese people don't lose weight with exercise. It's still true. Amazing how I have to fight for something so obvious. Look, a three-hundred fifty pound man burns as many calories lying in bed as I do running, from the work of breathing and pumping a double blood volume. Such large people don't have to go to a gym; they can't NOT exercise. If such a man gets up, goes to work, goes home and goes to bed, everyone says, "See, he's fat because he doesn't exercise." If I picked up a 180 lb barbell and carried it all day--not that I could do such a thing--everyone says, "The doctor is lean because he does so much exercise." But it's the SAME EXERCISE, children! A publisher turned down my book because I said exercise doesn't help people lose weight in any published study (look at the data, not the conclusion). I protested, "But it's true". And the publisher said, "It doesn't matter that it's true. You shouldn't say it." OMG. Welcome to the stupidest country in the world! where the citizens can't do math without a computer or make music without an MP3 player, and the only thinking going on is wishful thinking. It's no home for a scholar. Dr. Anchors Will Do Bariatrics Only May 16, 2008 After 25 years of practice, I have decided to close down my practice of internal medicine and continue practicing bariatrics exclusively. I will continue to help people lose weight, but I will not be anyone's primary care doctor. This way I can focus on improving my repertoire of weight- losing techniques that really work. I would like to visit other bariatric doctors, my friends, to see what they do that really works. And I would be happy to teach. I thought of arranging group sessions with patients, going grocery-shopping with them or going to lunch. Who knows what I will do? but I want to do only things that really help. Not fake waving the hands like B-12 shots and Optifast. Real stuff. I will see patients on Monday and Tuesday and Thursday and Friday, but I want Wednesdays off to think creatively and to visit local primary doctors to teach and advertise my services. When I and other doctors thought of phen-pro back in 1995, who would have thought that 13 years later, the pharmaceutical companies would not have come up with anything better? or they would have stopped trying and focused on better advertising instead of better medicine? or that there would be fewer doctors giving effective anorexiant medications, not more? or the country would continue to get so obese, and sick, with so little insight and will to reverse the trend? Wiser people than I might have foreseen the trends, but not I. I continue to be amazed and disgusted. I soldier on, for a little while longer. And my wonderful flock of patients does well. Mr. P.M yesterday lost 45 lb in 6 weeks, Alexis lost 32. I saw patients from North Carolina and California this week. A Balanced Life April 30, 2008 Aristotle, the great ancient Greek philosopher, wrote that the "good life" results from balancing five activities: 1. sleep, 2. eating (meals with friends!), 3. working for money, 4. physical exercise, 5. leisure, by which Ari meant reading, contemplation, doing puzzles, etc. Active use of the brain, to improve and sustain the organ, just as physical exercise sustains muscles. The five point program is a very healthy prescription for life. In the U.S. the great majority of people get no exercise and no leisure. Sleep is short-changed, and while people eat plenty, they don't have convivial meals. They don't even know what 'convivial' means. They get only a little time to eat and sleep and the rest is spent working, so they can spend more money than they have (average U.S. personal savings = - 3.1%) , so they can work even harder to pay their credit card debt. They die young, and what else can the philosopher say but they deserve it. You choose your life. Not choosing is still choosing. High Blood Pressure In Obese People April 16, 2008 It is difficult to measure blood pressure in obese people. Hence a lot of fat people are prescribed BP medicine they don't need. Blood pressure is usually measured by compressing the upper arm with a cuff. As the pressure in the cuff is slowly released, the sound of the heartbeat returns and the doctor marks the systolic BP. With further release the sound goes away again and the doctor marks the systolic BP. Simply put. Problem #1. It's hard to compress the large upper arm of fat people. The usual 5" cuff (#11) can't do it. When such cuffs are used, the BP is always falsely elevated. Even the 7" (#12) cuff has trouble. The #13 "thigh" cuff may work, but in short women the distance from the shoulder to the elbow isn't long enough to use a cuff so wide. Often so much of the cuff is used to gird the arm, there is not enough overlap for the Velcro to hold. Some doctors resort to wrapping the cuff with a band to keep it on. Problem #2. The doctor listening in the bend of the elbow is in the ideal position to hear the heart beat/turbulence downstream from the narrowed artery, BUT automatic monitors such as Sunbeam and Omron work by a microphone under the cuff over the biceps muscle. The microphone has trouble hearing soft sounds through thick skin fat and muscle. To beat this problem, some patients and doctors use wrist cuffs and even finger cuffs, but these fail because so much of the wrist and finger is bone, and the arteries are smaller in diameter and emit softer sounds.Sometimes the fat pad at the elbow is so thick, the doctor can't hear the beat even there. BP can be measured with an indwelling arterial catheter, but catheters are impractical for routine measurements. What's a doctor to do? What the nurses do, often, is to write down a number, any number, and the doctor accepts it without checking. What the doctor SHOULD DO is to find the pulse in the wrist (thumb-side between two tendons) and pump up the cuff until the pulse disappears. Then gradually let the air out and note the point at which the pulse reappaears. THAT is the most accurate way to measure the systolic BP. If the systolic is below 140 (or 120 for diabetics), the doctor can stop there. If the systolic is much higher, it's nice to know the diastolic, but often the only way to get it is with an expensive, risky arterial catheter. In practice, it's good enough to base treatment on the systolic alone. The best initial medicine for high BP is a diuretic, since it's cheap, works well and counters ankle swelling. My patients don't need extra potassium because they listen to me and eat more vegetables. There is potassium in all fruits and veggies, not just bananas. Indeed, bananas are only medium in their potassium content, and they have more calories and cause constipation. So. Please. Other fruits & veggies. Beta blockers usually fail in fat people, I don't know why. ACE aren't good because they tend to cause cough, and fat people have cough from acid reflux--it's confusing. ARBs are better. Calcium channel blockers are okay, too. Minoxidil is good but causes hair growth. Even if people get adequate results from a single medicine at the outset, almost everyone needs two or three meds later, to block the body's compensatory mechanisms. As the patient loses weight, the BP meds can usually be peeled off, discarding the diuretic last. Obesity & The Collapse Of Empires April 8, 2008 There are many parallels between the final years of the Roman Empire and these final years of the American Empire. Most Romans were unaware their empire had collapsed. To the end the Byzantines called themselves romani. The Holy Roman Empire, lasting until ca.1800, believed they were the true descendents of Caesar's people. (Most Americans today, even readers of this website, are unaware of the collapse of the U.S.) The Roman Empire didn't end suddenly. It faded away. (So will the U.S.) To the end, the empty shell of the Roman republic was preserved. The consuls (our President) were annually elected; the Senate (our Congress) met, but none had power. True power was in the hands of the Emperor (global corporations). Rampant bribery & corruption prevailed. The public, uneducated & uninvolved in politics, was distracted by bread (subsidized food) and circuses (violent entertainments) and oriental religions. The old religion of the Republic was publically honored and privately ignored. The rich were very rich, while the great majority of people were very poor. The middle class disappeared. Art, literature and the theater died before the Circus did. Oratory was no longer studied or respected; the Latin language declined. Sumptuary laws tried to restrain the gluttony and conspicuous consumption of the Roman aristocracy, to no avail. For the first, and for long the last time, there was a significant number of obese people--we know this from paintings, statuary and Roman literature. Prisoners were tortured, and the death penalty was routine. Many "criminals" were sentenced to slavery (jail). The Tiber was polluted. Lead in the drinking water. Smoke & filth in the air. Many Mediterranean animal species became extinct, overhunted & killed in the Circus. The currency was debased. Stagflation set in. Trade was disrupted. After allowing small farmers to be driven out by big estates in Italy (decline of domestic U.S. production), Rome was dependent on grain shipments from Egypt. In the end pirates and resurgent enemies in the East cut off the grain supply (Mid-East Oil). The army of Roman citizens was replaced with a mercenary army (our volunteer army) because the government did not trust ordinary citizens (remember Vietnam?). Roman military technology dominated, but the Romans preferred to use proxies to fight in the provinces. It was cheaper. Barbarian tribes, envious of the material wealth of Rome but contemptuous of its culture, streamed across the borders. Stone walls were erected across England and along the Rhine river to keep out foreigners (our wall along the Mexican border). Continual wars with Parthia = Persia = Iran Things the Romans did better . . . The quality of Roman engineering held up. (U.S. infrastructure crumbled early.) The high quality of the Roman bureaucracy was maintained. (Distrusting government, the U.S. never had a good bureaucracy, and what we had is now dysfunctional--IRS, INS, FEMA, EPA, FDA.) Romans were not racist. They oppressed everybody equally. Roman soldiers had cool helmets. Things the U.S. does better . . . No slaves. Less abuse of women and children. Our army kills fewer of our own citizens. We have a better space program. More Techniques For Talking To Patients April 4, 2008 I continue to be amazed by the eagerness with which Americans believe transparent garbage. Patients paying for my advice often object to Lesson #1 because "they heard" the MORE you eat the more you lose (!) or to Lesson #5 because "they heard" you shouldn't weigh yourself every day. Imagine the dim state of mind, the nerve of arguing with me, a fifteen-year veteran author/expert... arguing is okay... but on the basis of a mere rumor contradicting common sense? The people who say such things usually don't do well, but I still have to do my best. For those minutes they are paying me--I work for them. The best approach, as in the last MOW, is to put the ball back in the patient's court. The patients are testing you--god knows why--and you must pass the test. So say, "When you heard that people lose weight by eating more, did it fit with your common sense? Did you actually see anyone lose weight by eating more? Did you ever lose weight that way?" Ask sincerely as though the patient really had answers. With this positive approach the patient usually confesses to doubts about the "information" from a friend or the Internet, and they feel complimented that you took them seriously. DO NOT DO any of the following. (1) Ignore them or (2) impugn their intelligence in words, tone or body-posture, or (3) impugn the intelligence of the friend or sadly, other doctor who told them the garbage. Americans tend to believe anything negative, but they do NOT like people who say negative things--the dilemma faced by American politicians. And wonder how the dickens the U.S. got so messed up! People go to school. They get grades. But few remember anything they learned. Employers import foreign workers on H1B visas, train them and send them back to their country WITH THE JOB, not because, or not only because the foreigners work for less, but because it is hard to find Americans qualified to do the jobs. If all that matters in the U.S. is money . . . then all that matters is money. Not truth. Not art. Not logic. Not people. The U.S. has ceased to be a nation and become a shopping mall. Everyone here has a hyphen: Irish-American, Spanish-American, Jewish-American, Native-American. People do that because the word "American" itself has no content. When politicians talk about the American dream, ask anyone, "What is the American dream?" or when they talk about values, ask people "Give me an example of an American value". No one knows or they give wildly discordant answers. Some melting pot! Cracking Through Denial March 22, 2008 I'm going to get off the soapboax for now and give useful tips to doctors on talking to bariatric patients. I spend 30 minutes with each patient; you spend 10-15 (you also make more money than I do) (Don't tell my wife) You don't have as much time to be creative and experimental. So I offer some, short techniques that have often worked well in my patients. You seldom face the problem of denial in patients who come to you specifically for weight loss. You face denial with general medical patients who need weight loss but don't seriously consider it. When they say "But doctor, I don't eat much", you must be sensitive enough to know when they are saying (A) "Back off" or saying (B) "It seems to me I don't eat more than other people". In case A you should drop the subject. In case B there is an opportunity to help. You should say that, however much the patient eats, it is still enough to keep them at their present weight. If they ate less, they would lose weight. The most avid denier can't find an argument, fast enough, to counter that! They must agree with you. And the more you lead them down the "yes" trail, the more teach-able they become. Don't let them get into telling you what they eat. Stop them gently and say, "That sounds good, but that's one of your best days, isn't it? I'm sure you do many things right, so let's talk instead about foods you have trouble with." If they return and didn't lose, or gained, jump right into talking as though you know they ignored your advice. Speak matter-of-fact-ly. Don't show anger or disappointment. If they really did follow the diet, believe me they will stop you and correct you. But usually they let you talk on, confirming that they were non-compliant. A good technique then is to ask them, "What do YOU want to do?" They usually repeat the good ideas you told them AS THOUGH they were their own ideas. When your idea becomes THEIR idea, you have won. Americans Hope Not To Make Choices March 13, 2008 Let me connect some dots for you. Dot #1. Hillary Clinton mooted that if people voted for her, she might get Barack Obama as a running mate, i.e. voters would not have to choose between Barack and Hillary--they could get both. Dot #2. New York's governor & former prosecutor Elliot Spitzer was caught spending $$$ repeatedly for a high-class prostitute. Dot #3. Diet foods, diets, pills and programs promising you can eat a lot and still lose weight. I sat on the sofa listening to my wife & daughters discussing the Spitzer case. They had seen Spitzer's wife and daughters on TV and could not imagine why Spitzer would risk so much for a hooker. I said nothing. I had seen a photo of the hooker, Ms. Dupre, on AOL. As a male with an ounce of testosterone left, I knew why Spitzer WANTED to do it, but NO WAY could explain it to my family. Even so, to actually do what he did was stupid. That's not relevant to obesity. What is relevant is the amazing tendency of Americans, high and low, to believe they never have to choose. To think they can always have everything. Take risks and never lose. Give or take a teaser mortgage and never have to pay. (Yesterday the Fed baled them out, did you notice?) Americans hope they can eat a dessert and not gain weight, buy a phony diet book or med and not have to pay for their sins? Who else engages in magical thinking? Who else eschews responsibility? Oh that's right. Children. But adults, real adults, are supposed to know better. There are no adults left in America. I am deeply weary of struggling against the winds of infantilism. The only pleasure left are the exceptions--god bless them--who come to my office. I love my successful patients. Morris Berman Says . . . Mar. 4, 2008 Sociologist Morris Berman says the moron index in the U.S. has passed 43%. A society becomes unstable, he says, when the moron index exceeds 33%. Driving to work today I struggled to change lanes-no one let me in. On the radio I heard Virginia passed a law banning drugs to enhance the fighting ability of dogs and another law to ban text- messaging while driving! At a gas station, a red-faced fat man bought cigarettes and lit up while filling his car with gas. Am I bad for wishing he had blown up? Did he have health insurance? If so, his behavior drives up the cost for the rest of us. If not, we pay for his ER visits. 43%of my patients, ignoring signs in my office, have their cell phones buzz during their visit. 43% can't find the bathroom initially, then walk out with their urine cup inhand ignoring6" high letters telling them to put the sample in the box. AsaCivil Surgeondoing immigration physicalssince 1985, I just haven't seenforeigners with good English make similar mistakes. Some morons get elected to Congress. Some run for President. Some run companies. You could say too many are born every day in the U.S., but looking into the face of a baby, can you really say that? Babies are born smart. Something inthe U.S. ruins them later. And makes them fat. I don't know what it is. I'm not sure Morris fully knows. DISCLAIMER. I am NOT saying fat people are morons, but there must be some reason why Italians got rich and didn't get fat... and the U.S.did. THERE IS something bad going on here. Patients Always Know What They Do Wrong Mar. 2, 2008 The great majority of my patients lose weight from visit to visit, but for those who don't... I used to spend time going over their recollection of what they ate, in an effort to understand why they did not lose since the last visit. But it's a total waste of time. Patients always KNOW what they did wrong. They won't say, contemporaneously. If they ever say, it is only months after the fact. When patients come to the office for the first time, all they want to tell is the things they do right. I assume they do some things right. But what I want to hear is what they do wrong. That's what really matters. Actually…… I don't even want to hear that much…… because the mistakes are always the same. There is much less variety in behavior among obese people as observed from a spy-helicopter than there is in what they claim. Remember the Stead Principle from Chapter 6. On the first visit I want the patients only to listen and learn from me. On the second visit they get to talk. Phen-Pro Treats Bulimia Feb. 20, 2008 I have had enough experience to say confidently that phen-pro is a very effective treatment of bulimia. Recall that Prozac was originally developed as a treatment of bulimia. When Eli Lilly discovered that Prozac also worked for depression, they shifted their focus to a depression--it's a bigger market. Moreover, bulimics usually avoid treatment. Definition of bulimia-->"an illness defined by food binges, or recurrent episodes of significant overeating, accompanied by a sense of loss of control. The affected person uses various methods -- such as vomiting or laxative abuse -- to prevent weight gain." I like this definition because it reflects why bulimics induce vomiting or use laxatives. It's a rational effort to avoid weight gain. The irrational part is the eating pattern. Phen-pro helps both aspects. Why is bulimia a disease? Because the vomiting can lead to dental problems and osteoporosis. Laxatives can lead to dependency. And because of the psychological toll of the behavior. Bulimia is easy to distinguish from anorexia nervosa. I don't think the two conditions really coexist. Anorexics never really overeat--they just say they do. Bulimics really overeat. If the clinician can't distinguish, he or she didn't get the right history. Although some bulimics are overweight, all the bulimics who sought help from me have been normal weight. To be Quiet Frank, all of them looked like models. All the more to make me uncomfortable giving them a prescription to present to a nosy pharmacist. Can I get into trouble for this? I don't think so, because I can show my good results and the absence of any harm. My bulimics sustain a normal pattern of eating and cease purging. The only way for a clinician to mess up is to give phen-pro to a patient with anorexia nervosa. Anorexia nervosa is much more rare than bulimia, and should always be treated by a team with a qualified psychiatrist. Putting Me First Feb. 13, 2008 Nothing in medical school prepares you for the number of times patients, in all seriousness, say things that make no sense, then sit looking as though they had said something profound. The ball's in your court, doctor. I commented previously on the times overweight patients told me they ate too much because their parents taught them to "clean their plates". You just don't know how to respond. I stutter things like, "It's thirty years later now. Do you still do only things your parents taught you?" Or I ask them to name something else their parents taught them. They never remember anything. My pet peeve today is the patients who tell me they can't lose weight until they have the chance to "put me first". They say they spend so much time taking care of other people, they don't have time to take care of themselves. Breathtaking, isn't it? Maybe the Renaissance was a mistake. I have drifted back to the medieval view that individual human beings are not equipped to manage their own lives. "Well," I stutter. "Uh . . . you seem to have time to snack, eat fast food, and do extra grocery shopping. Seems to me you're putting yourself first. After all your eating doesn't help anyone else." In fact I rarely talk like that, because it doesn't help. Any patient who says something so irrational won't be influenced by immediate rational discussion. The proper groundwork has to be laid first. I'm reminded of the Stead Principle set forth in my book Life Between Meals, "You can always find time to do what you really want to do." Interpretation: judge people by what they do, not what they say. An important principle in this election year, wouldn't you say? The Biggest Loser Jan. 30, 2008 At Fitness First when I walk on the elliptical, I'm usually facing the TV screen showing the "Biggest Loser" program. Have you seen this beast? I have strong objections to it. First, the show implies that the main route to losing weight is exercise. Anyone who has read my book or messages or just observed life in an unbiased way knows it's not so. No American loses weight focusing on exercise. Every published study in a peer-reviewed journal has confirmed this fact, even when the authors didn't notice! Second, the show makes exercise appear difficult and painful. Assuming that TV companies are interested solely in profit, why would they make exercise appear unappealing? Because it is what they think fat people believe about exercise, and TV is all about telling people what they already believe. Third, the show makes fun of fat people. In the episode last night, the mostly male Blue team tried to do yoga. The camera made the most of the fact that round bodies can't bend. But what does yoga have to do with losing weight? It was just gratuitous making-fun-of people. All I can figure is that the mavens of TV believed the segment would appeal to the self-loathing of fat people. Having studied the issue, the TV wizards know what sells, and they must know that most of their audience is overweight. Who else watches much TV? Interesting to compare the cruelty & mean-ness of the current show "Just For Laughs" with the old, kinder humanistic "Candid Camera". Many readers recognized that the word "grok" in a previous MOW came from Heinlein's novel Stranger In A Strange Land. I often feel like a stranger in a strange land. Anyone wanting to lose weight and be moral & healthy must feel like a stranger in the U.S. If you are comfortable and settled in, here, you are lost. Making Diabetes Go Away Jan. 23, 2008 Using phen-pro and treating my patients like respected fellow adults, teaching them, I regularly make type 2 diabetes go away. 35% of the U.S. population is obese. Another 30% are overweight. 12% have type 2 diabetes. Most type 2 diabetics make lots of insulin; they make more even than non-diabetics do. They just can't make enough to overcome their overeating and predilection for candy. In the current issue of JAMA Vol. 299 No. 3 Dixon and colleagues report that after gastric banding or bypass surgery, type 2 diabetes went away in 87% of patients losing 10% or more of their weight. Over 90%, in fact, lost >10% of their weight. Control patients "on" low-cal diet & exercise, instead of surgery, did not lose significant weight and their diabetes did not go away. From other studies we know that surgical patients rarely gain much weight back. There is no published data to say the diabetes stays away, but any bariatrician dealing with surgical patients knows it does. My medical, i.e. phen-pro, patients regularly lose at least 10% of their body weight, and they seldom gain weight back. I see diabetes go away, too. The fasting blood glucose is under 120 and the A1c is under 7%, often below 6%. It's disheartening that I, we, can't get more doctors interested in phen-pro and can't get the press to do the story. Moreover, I don't understand why so many colleagues keep experimenting with new combinations. Fifteen more minutes spent talking to the patient is worth more than the amino acids, hormones and B-12 shots. It is bad habits and inadequate thinking that gets Americans into this mess. It is better habits and thinking that can get them out. I do little experimenting now. Don't see the need. I just deliver the service. Malignant Optimism Jan. 12, 2008 Our favorite description of ourselves, from foreigners, has always been that Americans are optimists. It's true, but it may not be a compliment. Optimism means seeing more the good side of life, than the bad. Confidence, even baseless confidence, in the face of obstacles. It means eating a big piece of cake and not being ashamed, hoping not to gain weight tomorrow. Both optimism and pessimism entail selecting facts that fit our view and ignoring facts that don't. It's what children do, not adults. It's what Americans do, not smart Europeans. (Go there and see!) I wish Americans were more rational. I wish American school-education had a lasting effect. Instead Americans muck about in religion and optimism, cf. the cover story of the US News & World Report. Americans are so deeply mired, they don't see the Middle Way, cf. The Argument Culture by Deborah Tannen. They don't know the value of patience, compromise and wisdom. Yesterday on NPR Madeleine Allbright said "the purpose of foreign policy is to get other nations to do what we want". Really? Why do they call her "all bright"? John McCain said New Hampshire voters would be electing the "next leader of the world"? The rest of the world no longer sees such hubris as funny. Congress is dead-locked with partisan politics because it reflects the American public. What do you know, democracy works. What do you know, democracy is not always good. (But per Churchill, still the best choice.) Name one other developed nation with a two party system. News and government reports here have degenerated into propaganda, i.e. efforts to persuade rather than to find and spread the actual truth. If you say the sun revolves around the earth, maybe it does. If you say Iran is a threat, maybe it is. I grok the spirit of the Middle Ages now; the Dark Ages that seemed so strange to me before have arrived in America. I know it first-hand. Who remembers the word "grok" or the enlightened spirit of the book from which it came? How U.S. Obesity Will End (Soon) Jan. 9, 2008 All bad things come to an end. I always say that when you hear a saying such as "people say X", X is always untrue. Consider the proverb "all good things come to an end". Actually good things can last a long time. Only bad things end quickly, by generating opposition. I know now how U.S. obesity will end! Not by government action or wisdom on the part of Americans, but by the simple fact, happening now, that food prices are climbing rapidly. There are two reasons for it. (From the Economist magazine supplement, the World Almanac and my own trips to the grocery store.) First the price of oil was over $100 a barrel last week, jumping the price of fertilizer and transport. Moreover, the high cost of oil has led the U.S. to divert a large part of its harvest to the production of gasohol, so that the infantile public can continue to enjoy big car-toys. To fill an SUV with gasohol one time consumes enough grain to feed a person well for a year! U.S. gasohol production now consumes enough grain to meet half the annual world grain deficit, i.e. feed half the hungry people in the world. So much for the morality of the "world's last super- power". I'm glad we're the last. Brazilian gasohol production is more moral & efficient; it uses sugar cane, fermenting a pure carbohydrate to make gasohol. The U.S. wastes protein to do it. The U.S. diversion of grain to gasohol raises the price of food here (we deserve it) and around the world. Enjoy your SUV! Second by shifting our manufacturing to China, Malaysia and India, we have generated a wealthy middle class in those countries. (Not everything we do is bad!) But it's still bad for us. Middle- class Asians are shifting their diet to meat. It takes 7 calories of grain to generate 1 calorie of beef. Hence, the world demand for grain has shot up. The price of food in the U.S. is beginning to rocket skywards. THAT is how obesity will end here. The U.S., they will say in the future, was the first, only and last nation to have fat poor people. But soon. NO MORE. All bad things come to an end.