Dr. Marc Bessler is assistant professor of surgery at Columbia University College of Physicians and Surgeons, and director of the Columbia University Center for Metabolic and Weight Loss Surgery. He is also the director of the Minimal Access Surgery Center at New York-Presbyterian Hospital/Columbia University Medical Center. A fellow of the American College of Surgeons, Dr. Bessler's clinical specialties include surgical management of morbid obesity, gastroesophageal reflux disease, laparoscopic surgery of the stomach, esophagus and hernia surgery, and natural orifice surgery. His research interests focus on hormonal, oncologic, and immune responses in laparoscopy.
He earned his medical degree from New York University School of Medicine, and completed his residency in general surgery and his fellowship in surgical endoscopy at the Columbia University College of Physicians and Surgeons and the Presbyterian Hospital in New York City.
Question: What are the biggest misperceptions about weight management?
Marc Bessler: Well that fat is bad for weight loss, certainly fat has more calories per unit volume, so if you eat a gram of fat that’s 9 calories, instead of a gram of protein which is 4 calories. The problem is that some people tend to fill up more on a small amount of fat than they do on a large amount of protein or carbs and especially carbs. So that eating the same number of calories, whether it’s fat or carbohydrates probably is gonna result in the same amount of weight loss or weight gain. What really matters is how full you feel how quickly. If you eat carbs for breakfast, without much protein or any protein, it’s been shown that you get hungry a few hours later because your insulin levels go up from the carbohydrates, but the carbohydrates get metabolized quickly and you’re left with a low sugar rate a few hours later because your insulin’s still around and then you’re hungry and you eat again and if you eat carbs again, you just aggravate that cycle. One of the reasons the Atkins diet works, the concept is that proteins are metabolized more slowly and cause a smaller rise in insulin. So if you have pure protein for breakfast, you stay full longer, you don’t get that hunger a few hours later and ultimately if you manage your protein, carbohydrate and fat intake appropriately you may eat less throughout the day because you’re less hungry from your food choices. That’s how South Beach diet works and Atkins diet etc. those diets work when they work by helping you stay full longer, have less hunger so that ultimately you eat less because the amount of calories you’re taking in will be the same with any diet if it’s 800 calories, it’s 800 calories, what really matters is are you so hungry that you can’t stick with that diet.
Question: Do diets work?
Marc Bessler: Well my wife likes to call 'em live its not diets because if you can’t live it for the rest of your life, the actual short term change in behavior doesn’t have a long term effect for the most part. Diets truly don’t work for the most part because most people don’t make those long term changes. 95% of people who are 100 pounds or more overweight who lose weight, regain it within two years. 85% of people who are just overweight at all and lose weight, regain it within three to five years. So in truth, long term diets don’t work. In the short term diets work for almost anyone who really does it to lose weight. The problem is an overweight person’s body will counteract that by slowing down it’s metabolism and ultimately you’re hungry and therefore you start taking in more calories, your slowed down metabolism allows you to gain that weight back real quick and sometimes even overshoot. A lot of people think that weight loss is simple, just eat less, you’re in control of it, just put less food in your mouth and it’s not that simple. You’re in control of your blinking and I dare you to stop blinking for five minutes, you can’t do it because your body’s screaming you have to blink your eyes are drying out. Same thing in an overweight person, when they take in less calories, their body is screaming “Feed me, I don’t have enough calories around” because the signaling between the fat and stored calories and stored energy and the brain which controls intake of energy isn’t proper, there’s a miscommunication going on there. The brain doesn’t think it has enough stored, so it keeps trying to store and when you hold it back from that it fights ya and ya can’t fight your brain long term.
Question: How can you determine your appropriate weight?
Marc Bessler: There is, the most scientific way of doing it I guess is by the BMI or body mass index and that is a simple calculation fairly, it’s weight in kilograms divided by height in meters squared. So if you’re 70kg, it’s 70 divided by 1.6 meters to the second power or 1.6 squared. A normal BMI is from 18 to 25. There’s also the metropolitan life insurance company tables from 1983, they did a big study looking at longevity, it may be a little bit outdated right now and it’s a little bit skinnier than for more folks. A BMI of 18 to 25 is normal, 23, 22, 21’s a perfect range, over 25’s considered overweight, over 28 is beginning to be considered obese. Obesity goes in several categories from there, a BMI of 30 to 35 is class one obesity, above 35 with medical problems class three obesity. So I think that there’s really a wide range. The big problem with being overweight is that it really shortens lifespan, puts you at risk for a lot of medical problems and so the ideal weight is one that is individualized to a specific person, I can’t give you a number per height for any individual person, but that range is a good one.
Recorded on: 6/16/08