Reflections by an early adopter Endocrinologist with 34 years of experience about weight

Such a problem, obesity, affects 75% of the population. About 42% of the population is obese with a BMI of over 30 (body mass index). A normal BMI is less than 25, obese is over 30, malignant obesity is over 40. About 9% (one of every 11 persons) is massively overweight with a BMI over 40. When I started practice 34 years ago, I thought I had a method to help my patients lose weight. I supplied a powdered diet of 600 calories per day, we had a psychology group session weekly, I would see the patient or a psychiatrist would see the patient weekly, weekly labs and we would have a 2-year follow-up when the patient reached their goal. We really tried. It cost $180 per month, not bad. Each person lost an average of 10-14 pounds per month. Guess how many of the 1000 persons who were in the program kept their weight off. Not one. 

This made me conclude that external persons or programs are worthless. Matter of fact the average weight loss for weight watchers is 6 pounds in 2 years. The people who have lost weight, which is 3% of the population have always found a way on their own. No one helps them. I certainly haven't helped. I find it not valuable to press the patients. It just makes them feel bad and with a 97% failure rate my day would be one of combativeness and frustration. I find kindness and understanding are the best way to help. If that helps I really don't know, but at least the patients feel better not being harassed. I consider them trying to lose weight like fighting a genetic propensity by force of will. 

Moderation does not work. Only extreme measures work. So cutting down here and there and walking a mile a day is great and certainly encouraged but will not help someone lose significant weight. Only extreme measures work. 

Suggestions which only rarely followed:

1. No carb diet.

2. Breakfast with 2 eggs and coffee, tea or water, lunch is a 300 calorie frozen meal, dinner is a 300 calorie frozen meal. The moment one cracks is the moment one looks at himself or herself and sees the problem. It is just hard to be on such an extreme course. One will lose 10-14 pounds per month doing this. 

4. No carb vegetarian diet with 1 protein per day such as a chicken leg. All the green vegetables you want. 

4. Gastric bypass. This is really the best, not a sleeve. Especially for diabetics. A bypass is longer-lasting, has a higher success rate, and 20 pounds extra weight loss. About 85% of patients lost at least half their needed weight loss. If you do it, go bypass. I have had many patients have a bypass and 75% of the time, diabetes becomes controlled. There are naturally some that sabotage their surgery. I had one patient drink 4 six-packs of Pepsi every day. In the future, a gastric bypass will be offered to patients who are not massively obese. Cardiac disease is virtually stopped. The patients feel so much better. It is like giving CPR to watch the patients return to life.

A funny story. In 1993 I was called by Johnson and Johnson and they just wanted to discuss with me my thoughts on the future. Remember this was 27 years ago prior to when the gastric bypass was not considered acceptable. I told them that they had the cure for diabetes or at least a major treatment. They make Ethicon which is the surgical instrument company known for intestinal stapling. Thus they are used extensively in gastric bypass surgery. As you probably have figured out, I have little confidence that patients can strictly follow a diet since there is a 97% failure rate in losing weight. I was very passionate about how a gastric bypass helps diabetes. I told them we need studies but in my experience which was vast, that diabetes many times disappears. He was startled and amazed. I had a surgeon I had known do his first gastric bypass surgeries for me and since I introduced him to this, he since has done over 5000 of them before he retired. Other surgeons saw how busy my surgeon was with this gastric bypass, and the others joined in and now Fresno County is where many of the patients come from around the world to get their bypass. 

Another funny story. I gave a diabetes speech in San Francisco in the 1990s. I showed them a case of gastric bypass where diabetes disappeared. I was condemned by the older endocrinologists. I told them it was coming. That it works and they better help the patients because they will lose confidence in them if they did not support the patient. They probably are seeing now how farsighted I was at the time. 

Paul Norwood, M.D., F.A.C.E. 

Associate Clinical Professor of Medicine

UCSF in Private practice