These early surgeries gave weight loss surgery a bad name. Some of the prejudice against weight loss surgery can be traced to these procedures that either failed early on, or had significant morbidity and mortality (our surgical term for complications and death) for their bariatric patients.

There is nothing complicated about obesity. Fat is nothing more than storage, and some people have abundant storage! To get fat you must eat more calories than you use. Calories come in delicious forms, many of which are highly condensed. In weight loss surgery we simply change the way the digestive system works. In all surgeries we limit the amount of food you can take in, and with some surgeries we make the guts a little less efficient at digesting and absorbing calories.

Obesity or smoking—which is worse?

—or if you are a cannibal, don’t eat the smoked ones

With 27 percent of the American population defined as obese (BMI >30) you have to wonder why. There is plenty of blame to go around, and you have no doubt heard it. Of course, the trial lawyers are going to become involved—with a class action suit against fast food places—but they are like vultures, picking off the corpulent carcasses of our citizens.

Smoking is clearly a problem and smoking—ask any addict—is one of the hardest addictions to quit. But America is doing it. The percent of Americans who smoke has gone down over the years. Once, the majority of Americans smoked, now the smokers are in the minority. We mobilized Americans against smoking—why not obesity?

Eating is not an addiction. Eating is necessary for life itself, so reducing the amount of food consumed is possible, but giving up food is not. The latest trend with fast food restaurants is encouraging—they are providing alternative meals that have fewer calories, less fat, and are more nutritious. A few years ago, it was hard to imagine going to Jack in the Box for a good salad, but that is what people are now doing.

Super Size It, Please

When I was growing up in Alaska we didn’t have a McDonald’s—but I loved going to Oregon where my grandparents lived because my brothers and I could walk the six blocks to the McDonald’s on 82nd Street. I thought hamburgers were better than pot roasts back then. Now I wish that my grandmother were alive to make me a roast.

Ten years ago, McDonald’s had a sale on their hamburgers. You could buy the 1964 hamburger for the 1964 price of a quarter, so I did—and I couldn’t believe how small it was. Then, of course, I ordered a proper quarter-pounder, fries, and a coke (for a few cents extra it was super-sized).

The simple lesson here is this—the portions Americans eat have increased over the years, and as our meals have become larger, so have our belt sizes—after all, we do clean up our plates. The burgers are bigger, the bagels are bigger, the pizza is larger, and there are more fries in a serving. And have you seen the size of the soda containers? I had goldfish bowls smaller than those!

The secret is in the packaging. It isn’t too expensive to throw in a few more fries or add some extra soda—and people don’t mind spend a few more dimes for the larger size. Apparently, the founder of McDonald’s thought that if people wanted more French fries they would simply buy more—but they didn’t. People hardly ever go back for seconds. One of his employees, who had been in the movie theater business, suggested the super-size concept, and it worked. It costs just a few cents to put a few more fries in, and customers think they are getting a bargain. This concept has caught on and all of the fast food places are doing it.

As the standard of living in other countries increases, so does their tendency toward obesity. You can find super sized portions all over the world. The concept has gone beyond fast-food places to local restaurants. Even in the middle east I was told I could have a few more slices of swarma for some extra Euros. Most of us have been taught to clean our plates; it is almost un-American, or un-world, if you don’t.