There are a variety of ways that people have found to try to treat obesity, including dietary advice, behavior therapy and pharmacological intervention. There is no doubt that morbidly obese patients can go on a diet and lose weight. You have done this several times. The difficulty is maintaining the weight loss for the rest of your life. Click here to hear Dr. Sharma's views (a good friend of mine).

In a study by Wolf and Colditz (cited below) in 1996, the proportion of patients dropping out of the assigned dietary regimen was over 90% by 52 weeks. In simpler terms, it is very difficult for morbidly obese patients to stay on a permanent diet.

In another study by Garrow, the variation in weight loss of women hospitalized for 3 weeks on a metabolic ward while eating an 800 kcal/day diet varied from 1 kg to more than 10 kg.

Maintaining weight following a successful diet is also problematic. Stunkard demonstrated that the nadir of weight is achieved at the 4 month point on a very low calorie diet, and following this point, weight tended to increase.

This tendency is improved (but not abolished) by the addition of behavior modification therapy. Ultimately each of these conservative strategies is associated with only a very modest degree of temporary weight reduction. Better understanding of the metabolic controls of body fat is likely to result in improved interventions in the future (refer to the article by Farooqi et al, cited below). However, at the present, surgery remains the only effective option for the management of morbid obesity (refer to the article by Brolin, cited below).

The following articles discuss dieting as a means to lose weight:

Brolin RE. "Update: NIH consensus conference. Gastrointestinal surgery for severe obesity." Nutrition 1996; 12: 403 - 404.

Farooqi IS, Jebb SA, Langmack G, Lawrence E, Cheetham CH, Prentice AM, Hughes IA, McCamish MA, O'Rahilly S. "Effects of recombinant leptin therapy in a child with congenital leptin deficiency." N Engl J Med 1999; 341: 879 - 884.

Garrow JS. Obesity and related disorders. Churchill Livingstone, 1988.

Keys A, Bozek J, Henschel A. et al The biology of human starvation. University of Minnesota Press, 1950.

Wolf AM, Colditz GA. "Social and economic effects of body weight in the United States." Am J Clin Nutr 63: 466S-469S, 1996.

Stunkard AJ. "Conservative treatments for obesity." Am J Clin Nutr 1987; 45: 1142 -1154.