Flashback Friday: Can Morbid Obesity Be Reversed Through Diet?

Dr. Walter Kempner introduced the first comprehensive dietary program to treat chronic kidney disease, and in doing so, also revolutionized the treatment of other disorders, including obesity. Kempner was Professor Emeritus of Medicine at Duke, where he came up with the so-called “rice diet,” which basically consisted of rice, sugar, fruit, and fruit juices. Extremely low-sodium, low-fat, no animal fat, no cholesterol, no animal protein. The sugar was added as a source of calories so people wouldn’t lose too much weight. But some people need to lose weight; so, he started treating obese patients with a lower calorie version of the diet.

He published this analysis of 106 patients who lost at least 100 pounds—not because there were only 106. He was just picking the last 100 people who lost over 100 pounds, and by the time he finished looking through their charts, six more had joined the so-called century club. Average weight loss among them was 141 pounds. This study demonstrates that massively obese persons can achieve marked weight reduction—even normalization of weight—without hospitalization, surgery, or pharmacologic intervention. Here’s a weight chart of someone who lost, in a year, nearly 300 pounds: from 430 pounds down to 130 pounds.

One important fact to be gained from this study is that, despite the misconception to the contrary, massive obesity is not an uncorrectable malady. Weight loss can be achieved, massive obesity can be corrected, and it can be done without drastic intervention.

Well, the rice diet is pretty drastic. Definitely don’t try this at home. The rice diet is dangerous. It’s so restrictive that it “may cause serious electrolyte imbalances, unless the patient is carefully medically supervised with frequent blood and urine lab testing.” Dangerous, says who? Said the world’s #1 advocate for the rice diet—Dr. Kempner himself.

The best safe approximation of the diet, so, low in sodium, and also no animal fat, protein, and cholesterol, would be a vitamin B12-fortified diet centered around whole, unprocessed plant foods. But even a medically-supervised rice diet could be considered un-drastic compared to, like, getting one’s internal organs stapled or rearranged, wiring someone’s jaws shut, or even brain surgery.

Attempts have been made to destroy the parts of the brain associated with the sensation of hunger, by irradiation, or by going in through the skull and burning them out. It shows how ineffective most simpler forms of treatment are that anyone should think it reasonable to produce irreversible intracranial brain lesions in very obese patients.

The surgeons defended these procedures, explaining that their justification in attempting the operation is, of course, the very poor results of conventional therapy in gross obesity, and the dark prognosis, mental and physical, of the uncorrected condition. To which a critic replied, “Such strong feelings [about how dark the prognosis is] run the risk of being conveyed to the patient, to the effect of masking the operative dangers [of experimental surgery] and steam-rolling the patient’s approval.” To which the surgeon replied, “If any ‘steamrolling’ is taking place, it comes rather from obese patients who sometimes threaten suicide unless they are accepted for experimental surgical treatment.”

As of 2013, the American Medical Association officially declared obesity a disease, by identifying the enormous “humanitarian…impact of obesity as requiring the medical care and attention of other…diseases.” But the way we treat diseases these days involves drugs and surgery. Anti-obesity drugs have been pulled from the market again and again, after they started killing people: this “unrelenting fall of the pharmacological treatment of obesity.”

The same has happened with obesity surgeries. The procedure Kempner wrote about was discontinued because of the complication of causing irreversible cirrhosis of the liver. Here are the current procedures, including various reconfigurations of the digestive tract. Complications of surgery occur in almost about 20% of patients, nearly one in ten of which may be death. In one of the largest studies, 1.9% of patients died within a month of the surgery. “Even if surgery proves sustainably effective, the need to rely on the rearrangement of our…anatomy as an alternative to better use of feet and forks [diet and exercise] seems a societal travesty.”

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

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