Overweight people are constantly bombarded with fitness information and advice from some really questionable "experts." You only have to turn to some of the channels on cable television, especially on weekend mornings, to hear of the latest "miracle cure" for losing weight. For me, as a physician, I watch them for comic effect. But I also watch them because, sadly, I know that some of my patients are watching them as well. That for me, is the most frightening part.

In fact, the main reason I started focusing my practice, way back in 1993, on the treatment of obesity (not "cosmetic" weight loss; treatment of truly obese patients with significant health risks) was because my patients were paying their hard-earned money on some of these outrageous "miracle" treatments. From "fat blockers" to "starch blockers," from "cabbage diets" to green tea and herbs, from BioLean™ to Metabolite™ to Hydroxycut™. Crushed up oyster shells, chitan, useless doses of megavitamins, herbs that even a starving elephant wouldn't eat - anything a carnival huckster could put in a capsule and sell on cable was going into the mouths and bodies of my desperate patients.

And, with all due respect to the North American Association of Fat Acceptance (NAAFA), they weren't desperate because I frightened them into worrying, unnecessarily, about their weight. They were desperate because they had health problems clearly as a result of their excess body fat. They were, however, desperate enough to go to local "alternative doctors" - everyone from chiropractors to acupuncturists to hypnotists to the owner of the local health food store were unmercifully bilking my patients with some "secret" or "magic" answer to weight control. And this doesn't even start to go into the weird, bizarre, possibly harmful things there were hearing from their "thoughtful" neighbor whose "cousin's wife lost 50 pounds having coffee enemas twice a week."

Clearly, my medical patients were putting their finances at risk with this out and out quackery. But, that was their right and their "choice." However, as their physician, some of these "cures" were putting my patients at risk of adversely effecting their health. Now that was my business. You have to understand, in the early 1990s, ephedrine (ephedra or as the Chinese herbalist called it Ma Huang) and phenylpropanolamine (PPA) were still over the counter and not FDA regulated. Get rich quick scam artists were able to put these potentially deadly "herbs" in their miracle cures with impunity. By the time the FDA would start getting reports of adverse reactions from emergency rooms and private physicians, these fly-by-night scams would disappear back into the cable television from which they came. They would magically pop up again, 6 months or so later, with the same pill, packaged under a different name, "new and improved and still only $39.95 with a money-back guarantee". Their damage would be done to countless, unsuspecting overweight people but they will have made their quick money. Same song, second verse.

I decided enough was enough. I was tired of working for weeks to try and control a patient's high blood pressure with increasing doses of prescriptions medicines, which have their own side effects, only to be asked on the sixth visit and the third dosage increase "Hey, Doc. I am taking [insert your favorite herbal product here]. Could this have anything to do with my blood pressure?" Or, after the patient had had a cardiology evaluation with a Holter monitor and echocardiogram to evaluate their daily "heart fluttering" to be asked the same question. Or, after a colonoscopy for constipation and rectal bleeding to have the patient admit, sheepishly, that they were taking "something my wife bought from a friend which was supposed to 'block fat' and help me lose weight."

It was time to start addressing the problem that was, quite obviously, bothering my patients enough to put their health in harm's way. Now, I have to admit that, in retrospect, I was the biggest contributing factors to my own problem. Having trained for Internal Medicine in the late 1970s and early 1980s, I had heard countless stories from my mentors about the evils of the "pill mills" that treated obesity with amphetamines a few years earlier. How doctors started prescribing these drugs to patients for weight loss only to have patients, at best, get addicted to "speed" or, at worse, die from complications. It was a huge scandal for the medical profession that, previously, had been held in high regard by the public. In the history of medicine, it was a true black eye for the profession. There were calamities associated with medical treatment of obesity before amphetamines (thyroid extract in the early 20th century for one) and there have been some since (collagen-based very low calories diets (VLCD), and "fen-phen" most recently), but the "rainbow pills" of my generation really shook the medical profession to its core.

As a result, the pendulum of medical doctrine swung far and fast in the other direction. No self-respecting medical doctor would treat a patient for the purposes of losing weight. Ever! In a chorus sung by the multitude of M.D.'s across the country, we chanted "NO!" in unison to the millions of patients who asked: "Doctor, is there anything you can do to help me lose weight?" The mantra was concluded with: "All you have to do to lose weight is to push yourself away from the table and walk some." End of medical advice.

With no small degree of guilt, I must admit that I took up the "party line" for the first 15 years or so of my practice. My poor patients, reluctant to even ask the question to begging with, were answered with a resounding "Just get off your sofa and get some exercise!" or "show some self control!" or "just eat less; here's a diet sheet to follow." No wonder these people were seeking out someone - anyone - who would help them. During this time, when doctors turned their backs on the obesity problem, the 40 billion dollar weight loss industry grew and prospered.

When I did decide to go against my previous indoctrination and actually look into what could be done for patients whose excessive body fat was affecting their health, it was quite an eye-opening time in my professional life. There actually was a legitimate role for medical doctors in assisting patients with achieving a healthier lifestyle and, if necessary, weight loss. The early calls to action were raised, as they often were, from the ivory towers of academic institutions. Harvard Medical School, Johns Hopkins Hospital, Vanderbilt University. Then, the government started to take notice with the U.S. Department of Health and the Center for Disease Control. It was, at that time (the early 1990s), just starting to trickle out to the practicing doctors.

As I started the process of examining the research out there about the medical treatment of obesity and obesity-related conditions, it became stunningly clear that there was a significant body of evidence that medical intervention can make a differences in this condition. Further, physicians have an obligation to counsel and advise their patients - of all weights - about healthy lifestyles. We need to specifically ask about exercise and eating habits. Doctors can guide, without being judgmental, patients toward healthier habits. Doctors still are a trusted source, for most patients, about health information and we need to start helping our patients understand what things are available to them for living a healthier, long life.

The medical community had started to change. The information was there and the attitudes were, ever so slowly, being enlightened. And I was glad I could not start helping patients without being called that most horrible and demeaning of all medical names: a "diet doctor." I found there was even a society of doctors who were banding together to share information and experience about working with patients dealing with obesity. The American Society of Bariatric Physicians (ASBP) was a wonderful source of information and, more practically, experience with treatments of obesity.

After gathering all the information I could, I decided it was time to tackle the problem head-on. Instead of waiting for them to get the courage to ask me about losing weight, I started asking them about their eating and exercise habits. We developed questionnaires and screened new patients for the "lifeless lifestyle" syndrome, as we came to call it. We asked new patients, up front, if they felt their excess body fat was a health problem for them. And when our current patients asked about what they could do to lose weight, we stopped saying "push away from the table," and talked about lifestyle and eating changes that could help them in a practical way.

We have never advertised, recruited, or solicited referrals. Our yellow pages ad says nothing about "weight loss" and we have never done radio or television advertising. We didn't have to. It seemed we had struck a chord with our patients. They were starving (pun intended) for sound, well-founded information about living healthier lifestyles. They were all too ready to abandon their desperate search for voodoo, witchcraft and expensive over-the-counter "miracle in a pill" solutions to their obesity. Medically-sound, reasonable dietary guidance and exercise "prescriptions" were just what my patients were craving and hoping for. And, when they started feeling more energetic and slept better and, maybe, lost some weight along the way, they were thrilled. It was a revelation for my patients and for me.

Over the past decade we have come a long way. The journey was pot-holed with the "fen-phen" debacle (which, fortunately, we never used) and the insurance industry's continued stone-walling of coverage for obesity as a medical diagnosis, but it has been fascinating journey, nonetheless. I am happy to report that both my patients and myself are getting better all the time. Our three-pronged approach - activity, smarter eating habits and, when indicated, medication - has brought some significant improvements in the quality and, hopefully, the length of my patients' lives.

There's is no magic bullet or quick fix out there anywhere - but science is getting better every day identifying just what works for what people. Moreover, there is no "quick fix." New mixtures of the same old herbs, roots and vitamins are being put into capsules and "power drinks" and marketed every day with deceptive, misleading or fraudulent advertising. Don't believe the hype! The answer is not in a capsule: it is within you. When you make the decision to change your life for the better, we will help guide you where to start. The best starting point is a well-balanced diet coupled with regular exercise. This is still the safest and most effective way to achieve a healthier lifestyle and live a longer life.

Copyright © 2005

Albright Bariatric Clinic