​My wife has pancreatic cancer diagnosed Mar. 3, 2012. By January 15, 2013 it had spread to her lungs and she is on heavy chemotherapy now. I have cut back to the point that I am in the office only three hours a day. Barry Mennen MD, my able student, is renting space in the office to see patients when I'm not here. In a pinch, he could cover me. He knows what I know and uses my methods.

​When I get very obese patients, I focus on getting them to stop drinking sodas (diet or plain), sports drinks, energy drinks, Vitamin Water, Crystal Lite or any other American swindle to sell sweetened water. People in the battleship class are doing everything wrong, but if you try to get them to change everything at once, they won't come back. The problem must be approached in easy stages.

​Overconsumption of alcohol is a significant factor in U.S obesity. Bariatricians should learn to ask their patients about the topic, with appropriate seriousness & politeness, in a way likely to garner an honest answer.  I can explain how to do this--I may do so in the future--but honestly, the ability to talk to people should be the doctor's chief skill. If it isn't, they are in the wrong business.

​Fat people drink a lot of soda. It is an amazing madness to want everything sweet. And cold, no less, in the middle of winter! On Christmas Eve I stood in a long line at the grocery store just before closing time. In front of me in the line stood a morbidly obese man and his morbidly obese child, in the store for the sole purpose of buying two liters of diet soda. Stupid.

​Only two kinds of people ever say they are starving: starving people and fat people. Lean people say only that they are hungry. I offer this as an example of the way fat people sabotage their effort to lose weight by using the wrong words.

Patients arriving at my office expect to sit in the waiting room. They pick up a magazine or fire up their cell phone. It annoys me. Why don’t they look at the educational material on the walls? Why don’t they talk to other people? The old patients don’t know each other, but I know all of them and I know that many of them would become friends if they just talked to each other. Americans are some of the most unfriendly people in the world. Overworked, self-centered, distracted, impatient, isolated and lonely. And fat. There is a connection.

I took steps. I threw out the magazines in the office and put up a sign telling patients to turn off their cell phones because they interfere with equipment next door. A lie, but how else could I get them to do it? I put up a sign saying, "This is not the waiting room! This is the room for talking to each other and reading the stuff on the walls."

​I was interviewed by VOGUE magazine a year ago. The article by Elizabeth Weil has finally appeared in the January issue on page 112. It is marginally better than the March 2011 article in MORE magazine, but not much. It still retains an unsupported negative view of diet pills. Consider that the title of the article is "A Quick Fix". Moreover, the article is so out-of-date, it doesn’t even mention Qsymia, the FDA-approved combination diet pill.

​When patients first come to the office, they are focused on pills, pounds and money. It is important to show them that I am not focused on pills, pounds or money. Those are all things, and truly, listen, things never make you happy, never satisfy very long. True, lasting happiness comes only from people and ideas. When people grasp this idea, they can lose weight.

​In the past I have described groups of people with little success losing weight. Morbidly obese people, Latinos, and people who talk too much in the office. In this Message I will describe another group—people with attention deficit disorder or ADD. They comprise only 5% of the population, but they number among your best friends. They are attractive shakers and movers; they make life interesting, but they finish few of the projects and relationships they start.

Since so many people follow my Mesages of the Week now, I have kicked up the length of the messages. But every now and then I like to toss in a short, practical message for the folks trying to lose weight. 

Here is one. Eat snacks on plates.

​You hear, "Eat your fruits and vegetables." Everyone thinks they know what that means, but I am sure you don’t. What do potatoes, peas, broccoli, squash and avocados have in common? Answer: nothing, other than being derived from plants. What is a fruit? Most answer that fruits come from trees. Well, but avocados come from a tree, too. Is corn a vegetable? No, it is a grain.

Dictionaries stumble over the definitions and resort to lists of examples. The only definition of vegetable that makes sense is ‘the edible part of a plant’. What else would it be? My definition fits with the Latin root "vege" meaning ‘to grow’. So fruits are vegetables, and the saying "eat your fruits and vegetables" can be reduced to "eat your vegetables".

​A sign in my waiting room says, "This is not the waiting room". It goes on to say, "This is the room for making friends, talking to neighbors, reading and looking at the information posters on the wall. Put away your cell phones and live a little."

​Many years ago when I was beginning to treat obesity, I gave advice that sounded reasonable but had not been tested. For example, I told patients to "eat when hungry and stop when full". Seems reasonable, right? but the advice was wrong. Following it, my patients gained weight. And I told patients not to follow the clock; if it’s lunch time and you’re not hungry, don’t eat lunch, I said. I thought that was a good idea, too, but it was a disaster. I should have known better–the idea is un-French. People reading this blog know the lifestyle of French women is ideal. I have given plenty of evidence. In particular, they don’t skip meals.

The old idea that is still true...

Patients underestimate portion sizes and don’t count their snacks and beverages.

BUT even when I fixed that problem in 2008 by teaching classes on calorie-counting to gifted students, still, no one lost weight. There must be other reasons for the failure.

​As an experiment, I have asked middle-age and younger people to tell me what the word "duty" means. The majority of American young people believe it means ‘tax’, thinking of duty-free shops at airports. They are hard-pressed to come up with any other meaning. Isn’t that a pickle?

​Order #2 of the Eight Doctor’s Orders, i.e. "use smaller, dark-colored plates", is particularly effective since it requires little effort and no willpower. I got the idea from a study I read in March. A message on my cell phone led me to an article in the Huffington Post, and from there I found the actual study. Unfortunately I have now lost the reference. If anyone knows it, I’d like to have it.

​I am somewhat certain I will be on TV cable channel 10 at 4:00 PM on Tuesday October 30. The show airs only in the Washington DC area, but hey, Washington is a big, important city. The show was supposed to be about my new book Medical Myths Doctors Believe about the fact that a huge part of what medical doctors know is false. OMG the practice of medicine has little to do with science. Commerce rules.

​I will share with you an e-mail from my patient P.T., but first I want to make a comment. I have been doing bariatrics for 17 years, but I have only gotten this good in the last year, after picking up lessons #2 and #4, i.e. use dark plates and don’t balance meals. The other lessons are important, too, but the addition of #2 and #4 completed the set. I just don’t fail anymore with young women, soldiers and kids. Other groups are a challenge, but I am doing better there too. And having lost weight, my patients don’t gain weight back.

​On top of everything else people have to worry about, the confusion in the media has got people worrying about their metabolism, as though the word meant their destiny, character or value. I hear over and over again, "My husband can eat anything he wants because he has a fast metabolism." Implication: life is unfair so I can be forgiven for getting fat. There is so much wrong with that. Obesity is a health issue, not a moral one. It is a matter of mistaken ideas and self-injury. It’s not about wrong ideas or bad behavior. Please see the difference.

​People are confused about the meaning of words such as "carbs" and "metabolism". The confusion is exploited by advertisers, so let me explain. The word "carbs" was originally a shorthand for "carbohydrates", i.e. molecules containing only carbon (C), hydrogen (H) and oxygen (O). A pretty useless term since the definition included molecules that had nothing in common. What biochemists meant, in practice, by the term was sugars or chains of sugar as opposed to protein or fat.

​I do not want my patients on phentermine to drink large cups of regular coffee. It is too much stimulation. A small cup would be okay, but since most Americans have no idea what "small" means–a major reason for their obesity–it is safest to tell them to avoid regular coffee, i.e. coffee with caffeine.

Recently, in my office, I changed the Eight Lessons to the Eight Doctor’s Orders, because I was bothered by the number of people treating my lessons as guidelines or recommendations, instead of as express orders. Patients such as Katelyn whom I saw a month ago, losing over 40 lb in two months, ALL learned the Eight Lessons by heart, word for word, in order–not that the order matters. Such people take life seriously and get real results. Everyone else is just fooling around.

​Anyone who asks me this question after hearing or reading The First Visit Speech has missed the point. A major point of the speech is that I don’t want you snacking. Keep your insulin LOW between meals–in mid-morning, mid-afternoon and during sleep. Insulin is allowed to be high–not too high–only in the hour or two after each of the regular meals of the day.

​Here are my planned concluding remarks for "Forward Motion" with Karen Allyn, being taped September 11. I will post dates, times and channels as soon as I know them. If you miss the show, don't worry--MCTV re-runs everything many times . . .

​My long experience with teaching people how to lose weight has given me some insight into people. I have identified the one thing most important to men. They will sacrifice everything for it. Independence. They will say stupid things in public, OVEREAT in front of everyone, make bad jokes and be (quietly) sorry for it later. Men turn down good offers, refuse good advice and fail to read instructions, ALL to show they are independent.

The Vivus Company, maker of Qsymia, offered me a plane ticket, hotel room and $2500 cash to attend their "Speaker Training Program" in Dallas. I won't go. It is a bribe to get me and other doctors to prescribe Qsymia. I can't be bought.

Years ago I attended the kick-off of Meridia in Phoenix to take advantage of the free ticket to Phoenix where my daughter lives. I spent the time with her. I went to only one meeting, the evening Q&A session. We had to write our questions down on index cards. The cards were screened by company reps before being given to the expert panel. Having no patience with fools, I stood up and asked my questions aloud regarding some misleading data. You know that Meridia was withdrawn a few years later for its ineffectiveness and substantial risk.

​This Saturday, Aug 25, 2012, I will be giving a talk about my new book Medical Myths Doctors Believe at Books-A-Million in Bethesda, but I will not be allowed to sell the book in the store and the store will not carry the book for sale. Why? because Medical Myths is a print-on-demand book published by Amazon. The parent company of Books-A-Million has decided that their stores, as a policy, will not carry print-on-demand books.

Many of you, if you were watching the wrong channel, which was most channels, saw a story in the last two days with the headline "Egg yolks almost as dangerous as smoking". Anyone who has heard me talk, or traveled to foreign countries such as France where people eat a lot of eggs but outlive us by 4 years and have a lower risk of heart attack, or anyone who has read my new book Medical Myths Doctors Believe which teaches in plain terms how to evaluate evidence, or anyone with common sense, will know there is something wrong with the egg study.

​The main effect of phentermine is to reduce hunger, but there is a second way in which the med helps dieters. It causes them to feel more awake at night after dinner, so they are less likely to cheat on their diet. If you read The (Honest) Truth About Dishonesty by Dan Ariely, you know that stress and fatigue are the enemies of conscience and good sense.

​Please read the following blog:

http://tomfoodery.blogspot.com/2012/06/goddam-noisy-restaurants.html

I endorse everything Tom wrote. I have carried a sound meter into American and European restaurants and notice a big difference. American restaurants with entrees under $30 are all, extremely (illegally) NOISY.

​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.

​I would have thought that by now there would be better diet medicines than phen-pro. Well. Not only are there no better medicines, but phen-pro is almost the only man left standing. They took ephedra and Meridia off the market. The FDA blocked Qnexa and Contrave. Hoodia withered. Public Citizen is even complaining about Alli. Alli! which does no harm and no good.

A good friend of mine who worked at Goddard Space Center suggested I give a lecture there. 

I eagerly wrote a speech about many of the themes you have read about here. 

After I wrote the speech, I found out that the colloquia at the Center are not just lectures by leaders-in-their-field, but are about leadership itself. 

The tone of the speech was to be like a college commencement address. 

I didn’t fit in.

Michael Anchors, MD, PhD is a practicing physician in Gaithersburg, Maryland.

Dr. Anchors was awarded a Ph.D. in biochemistry from Harvard University in 1974 and performed postdoctoral research in neurochemistry at UCLA from 1974 to 1978.

Then from 1978 to 1980 he earned his M.D. from the University of Miami medical school.

Although 1/3 of patients lose weight well with simple phen-pro, 2/3 of them lose only some of their excess weight and then get "stuck". When one asks them about it, many of them say that although the basic phen-pro suppressed their appetite well in the beginning, after a few weeks or months, their excess appetite spartially returned. If one adds 5-HTP to the mix at that point, the extra hunger goes away again and the patients resume their weight loss.

"Phen-Pro" is the combination of phentermine and a low dose of one of the following: Prozac, Zoloft, Celexa, Luvox , trazadone or Effexor.