Living Large: It’s complicated

“1 of my common jokes is that everybody out there is a weight loss expert. It's difficult for people who have really never been very overweight to wrap their heads around somebody who needs to lose 100 pounds (45kg) or more,” says Dr. Charles Procter, the bariatric surgeon and star of the new TLC series Too Large. “Even many doctors will treat the patient who needs to lose 5 or 10 pounds (2kg or 4,5kg) the same way they would treat their patient who needs to lose 100 pounds (45kg) or more. 1 of my ongoing jobs is to educate the medical community that while this is perhaps the same disease, their physiology has changed to the point where it does require a completely different treatment point.”

Intrigued? We asked Dr. Procter to explain a bit about what has made weight loss so slippery for the patients we see in his show.

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Inside Too Large

What might healthy weight viewers not really realise about weight loss for morbidly obese patients?

“I feel like a lot of healthy people out there look at people who are very, very overweight and feel that it's a disease that the patient brought on themselves, and that they should be able to just find that right diet and exercise plan and work it off, and if they don't, they're just too lazy. That couldn't be further from the truth.

The reality is, our fat tissue is there in large part to be a backup energy source for us. Primitive humans had to forage for food, and if they ran out of energy from their last meal, they had some fat they could metabolise for a while to keep them alive. Our bodies are very efficient at adding fat if we ever come across excess calories – which most of us do on a daily basis. Our bodies see the accumulation of excess fat as protective for us, because it'll keep us from starving to death. The problem is, every time we've added fat throughout our lives, that fat becomes reset, or recalibrated as our baseline normal. And our bodies are particularly good at keeping us at “normal”.

“Going on a diet, you're not taking in as many calories as your body needs. You must burn some fat to make up the difference. But what happens over time is your body will slow your resting metabolism to the point where you will not lose any more weight. At the same time, our bodies will increase our hunger hormone levels, and they will remain elevated for weeks to months. Eventually, we (unconsciously) increase our calorie intake until we have put back that fat that we've “borrowed.”

“We always have this idea that we should be able to dial our weight up or down if we just stick to a diet or so forth. But the reality is, if you need to adjust your weight over 100 pounds (45kg), our bodies typically are not going to let us do that and maintain it for very long. In fact, the National Institutes of Health here in the United States in 1990 did a study on that and showed that only less than 5% of the time are we able to do that for more than a two-year period.”

“Then we used to think for decades that weight loss surgery was about reducing intake by reducing the size of the stomach. We've now discovered that what metabolic surgery does is reset that baseline weight in patients. So, that's been a really interesting discovery we've had over the last ten years.”

What mental effects have you seen morbid obesity have on your patients in Too Large?

“1 of the ongoing themes for Too Large has been that we want to re-instil hope in our patients. I have not run across a morbidly obese patient yet who hasn't done everything they possibly can to try to lose weight. They've never been taught that their body’s physiology just isn't going to let them lose weight and keep it off. So, they've failed over and over and over again, and the mental damage that does! They're being told that they're not trying hard enough. Oftentimes, their biggest worry going into surgery is that they're going to fail again, which is why I think that psychological support after surgery is one of the key aspects of this whole thing.”

How do you actually go about lifestyle change sustained over time?

“We got to these bad habits incrementally over the years, by making the wrong turn by a single degree over and over and over again. Oftentimes we – especially in a half hour TV segment – expect to see a patient make a complete turnaround suddenly. But when your lifestyle has gotten you to the point where you are 500 (226,8kg), 600 (272kg), 700 (317,5kg) pounds, that is not going to change in the other direction overnight. We have to help coach these patients through changing incrementally because they're going to have much more success with that than if they tried to change everything, they're doing wrong all at once.”

“You need to believe in the process. Every single day you wake up and you do something to move yourself forward, and for the first time in their lives, they see this change and they understand they can do this, and they start seeing these little victories come along. I think over time, they believe that they can live a normal life again. That's one of the really rewarding things that we get to see with this journey.”

n our other interview Dr. Procter talks about making Too Large, and gives his thoughts on Dr. Now.

Watch Too Large Season 1, Mondays at 21:00 on TLC (DStv Channel 135)

 

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