​My patients seldom gain weight back. I know, because every July I get my secretaries to randomly pull 100 charts of patients who were in my office for at least three visits and had not returned in over a year. We call the patients and have long conversations with them. We find that with few exceptions the patients kept the weight off or continued losing. When we do see an exception, it is almost always because of (1) a new major life-stress or (2) the patients never learned or forgot the Six Lessons. [As readers of this blog know, there are now Eight Lessons.]

Eleanor Roosevelt said, "The besetting sin of America is wishful thinking," and boy, isn't that the truth? We think of wishful thinking as bad, and it certainly is. We think of positive thinking as good, but what's the difference? The most important difference is that positive thinking is about what we want to do ourselves, and wishful thinking is about what we want other people to do.

I suspect that a big part of the increasing obesity of Americans is due to ethnic diversity. It's a paradox, right? Think of Hispanic families having a picnic or Asian families taking an after-dinner walk. You would think the inclusion of such family-oriented cultures into America would increase socialization and reduce obesity?

Several authors recently have misconstrued the meaning of Sacks FM et al: Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009;360:859--. The authors said that the NEJM study shows there is no difference in weight loss between a high-protein diet and a high carbohydrate diet, implying that Atkins and the rest of us got it wrong.

​When I meet new patients, I can't tell who will be a weight-losing star and who a flop... except with men. I can always tell with them. The men who come in talking and don't stop will be flops. The silent ones, if they aren't angry, will be stars. You can tell if men are angry--they broadcast it with their body language. The only reason men can enjoy playing poker is that they can't read body language. Any woman, if she deigned to play such a trite game, would beat the men, because women can read body language.

​The male species :-) evolved from stone age hunters practicing persistence hunting in midday in hot Africa. Working as a team, shouting, the men would flush a large animal. The animal would easily run away, a distance and stop. The men would catch up and flush the animal again, persisting until the animal, unable to lose heat except by panting, developed heat exhaustion and stopped trying to escape. The men did not overheat because they, unlike every other animal on earth, lacked body hair and sweated on their whole body surface. Persistence hunting is the reason human beings lack body hair and sweat.

One hundred years ago the Dutch were 2" shorter than the Americans. Now they are 2" taller. Indeed, west Europeans in general are taller than Americans. The NPR story today correctly identified our crappy health care system as one of the causes, and the fact that a few American children don’t get enough to eat, but the story completely missed the most important cause–the new American emphasis on carbs.

My daughter Rachel, a competition-dancer and motion-picture-animator, taught me that in good dancing and good animation, there is an illusion of continuous motion, but what we really see and remember is a series of poses. The brain does not easily remember smooth motion itself.

I re-read Eugen Herrigel's wonderful 1953 book Zen and the Art of Archery, an 80-page gem about learning Zen through the process of learning to shoot arrows accurately in a relaxed, mindless manner. At one point Eugen asked the Master why he watched him as he shot, but the Master did not look where the arrow went. The Master gave two answers.

You are constantly seeing articles about studies showing that if you do X, then Y happens. Last week the Press made too much of an epidemiologic study in BMJ Open "showing" that...

1. Cutting TV viewing to less than 2 hours per day extends life by 1.4 years.
2. Sitting 3 hours less each day adds 2 years to lifespan.

It may be true or it may not, but the study did not SHOW it. Epidemiological or population studies cannot prove such a thing; only prospective randomized controlled trials can. Read my book Medical Myths Doctors Believe, available on amazon.com or Kindle, to learn the difference.

When you talk to very old people who are doing very well, ninety years old, ninety-five, a hundred, you discover they have three things in common. They are not obese. Obese people die young, but the body can handle a moderate degree of overweight pretty well. We are not as delicate as false experts claim.

​Scene. A call-in radio talk show in which an interviewer questions a thoughtful, qualified guest. People speaking fifth grade English call in. "Uh, I believe that… " yak yak. The interviewer asks the caller to formulate an actual question for the guest. They never do. Their opinion is baseless, usually irrelevant and always unoriginal. You'd rather listen to the guest.

Thomas Jefferson wrote, "All men are created equal."  He surely did not mean the statement literally. He meant "equal before the law", or maybe "entitled to equal opportunity". But even if he meant it literally, he would have conceded that men don't remain equal.

My approach has continued to evolve. At this point I'm not as focused on weight-loss as I used to be. I want my patients to lose some weight, but more than that, I want them to stop thinking like Americans. If they continue to be materialistic and distracted, there is no way they will keep weight off, no way they'll be happy.

​The obese people I examine tend to have more dental caries and gum disease than the lean people I see. No surprise--fat people eat more sugar and more often. So how about the Dental Diet! Get compulsive about brushing and flossing after every time you eat. You would be less likely to snack then. And even if the "diet" didn't lead to weight loss, it would sure lead to healthier teeth.

The small number of my patients who don't lose much weight are almost all incapacitated by stress. There is no point talking to them about the Six Lessons until the stress is reduced. One technique is to read from a children's book, Ming Lo Moves The Mountain. Like all good children's books, Ming Lo is entertaining to children, but contains an important message for adults.

Here are my 8 Weight Loss Lessons that I give to all of my patients.

1. ​Eat less food.
2. Use small dark plates.
3. Follow Dr. Anchors' Food Pyramid.
4. Don't balance meals.
5. Drink lots of water all day.
6. Weigh yourself every morning.
7. Stop snacking completely.
8. Eat with friends & family.

​I have added a new lesson to my list of six. Call it lesson 2 1/2. It is this: Don't balance meals. Americans are taught that the dinner plate isn't healthful unless it has (1) a high protein food, which will, of course, have some fat as all natural high-protein foods do, (2) a vegetable and (3) a starch. Uh, that is wrong; no other country teaches such foolishness. 

On UPI.com July 10 "Sweeteners help some lose weight", we read that "Using sweeteners instead of sugars may help the overweight reach and maintain a healthy body weight if they don't eat more to compensate . . . a statement from the American Heart Association and the American Diabetes Association published in the journals Circulation and Diabetes Care." The statement is followed by no research data whatever, only the credentials of the authorities making the statement.

​Most people gaining weight notice when their pants or, I guess, dress gets too tight. I urge you NOT to simply buy new pants when that happens. Fight the good fight. Eventually, as you age or have children, you may make a few, grudging strategic withdrawals to larger pants sizes, but don't give ground willingly.

​Fat women carry food with them and make sure their children carry food, too. The women are surprised that I know about their food-hiding. I challenge them to open their purse, and voila! I am never wrong.I do this trick with lean women, too, for a control--the few lean women I see--and I have never caught them with food.

​After 16 years 6 months of bariatrics, I finally reached ten thousand patients. That's an actual count. I kept it on my blackboard. And I saw all those patients, individually, myself. 

​Nothing in medical school prepares you for the range of bizarre (or wonderful) ideas and behaviors people have, that you learn about by talking to them for more than five minutes. Most doctors never have this pleasure because they don’t spend time listening to patients. The doctors aren’t edified, educated or improved. And the patients aren’t benefited as much as they could be; if the medicine doesn’t fix the problem, the problem doesn't get fixed.

A couple of messages ago I talked about a group of patients that uniformly fails to lose weight--men who don't stop talking. Now I'll give you another group that uniformly fails--baked-chicken-people. Baked-chicken-people are a subset of the people who say, "Doctor, I don't understand how I could be so heavy. I eat right." Most of these people still go on to do well in my program, but the baked-chicken people INSIST I listen to the full list of what (they say) they eat each day. The list always has yogurt in the morning and baked chicken without skin for dinner. Baked-chicken people never lose weight.