KEEPING FIT : Surprise! Weight Loss Is No Simple Matter : Costa Mesa Doctor, Confirming What Dieters Have Known All Along, Pioneers New Approach to Slimming Down

Weight loss used to be such a simple matter.

Twenty years ago, all doctors needed to do was tell their obese but otherwise healthy patients to eat less and exercise more, recalls Dr. Marshall B. Stamper of Costa Mesa.

There was just one problem: It didn’t always work.

And when patients would come in after weeks or months of following their doctors’ orders with little or no improvement, Stamper says, doctors just assumed that the patients were lying--to them and maybe even to themselves.

“But doctor, I really don’t eat that much!” was seen as pretty much the equivalent of “The dog ate my homework.”

Stamper heard that line so many times from his patients, however, that he began to wonder: They couldn’t all be lying, could they?

“I learned from my patients,” he says. “Something was going on in their bodies that was different. They were not like their friends. Eventually, I learned that the medical profession was wrong and the patients were right.”

Eating less and exercising more are still important components of a good weight-loss program, Stamper says. But there are plenty of other factors, and what works for one patient may not work for another.

Next month, Stamper is celebrating the 20th anniversary of the day he made the switch from family practice to a specialty hardly anyone had heard of: bariatrics, the treatment of obesity.

Although he was never shy about offering his patients dietary advice--daughter Cynthia Graff remembers his spotting patients in a local restaurant and walking over to comment on what was on their plates--Stamper didn’t seriously focus on weight loss until his mother died of complications of obesity. After that, he started a weight-loss clinic to help others avoid the same fate.

“My first patient was the only patient, so I had plenty of time to ask questions and try to figure out what the problem was,” he recalls.

Since then, his 29 Lindora Medical Clinics in Orange County and elsewhere have treated more than 75,000 people, with more than 2,000 patients coming in every day.

By observing the experiences of that first patient and others, including a couple of his wife’s relatives who came to live in his home for a few months of closely supervised weight loss, Stamper learned that every individual has what he and other doctors now call a “set point” that controls their metabolism.

“In overweight people, the set point is too high,” Stamper says. “In some cases, this is familial. But habitual overeaters also over-stress the set point so that it no longer regulates the body properly. The larger they become, the easier it is for them to continue gaining weight. So fat breeds more fat.”

Meanwhile, a behavioral cycle compounds the problem.

“All overweight people use food as a tranquilizer,” Stamper says. “They go through cycles where they have an overwhelming need to overeat. Then they feel guilty, so they cut way back. They expect to lose weight, but they don’t, so they feel bad, and then they make themselves feel better by eating.”

After some experimentation and research, Stamper settled on a diet based on the work of Italian endocrinologist A.T.W. Simeons. The diet is consistent with current medical wisdom, emphasizing complex carbohydrates, fiber and protein over fats and simple sugars.

Stamper also uses vitamin, mineral and protein supplements to ensure his patients’ health during periods of rapid weight loss.

“We used to say that a calorie is a calorie is a calorie,” he says. “But now we know better. It makes a difference where those calories come from. Fat calories are more likely to make you fat.”

But physical changes aren’t enough to bring about permanent weight loss, Stamper says: “The self-image must be changed. Now when I went to medical school, I was taught that the self-image was fixed. Then the behaviorists came along and showed us how it could be reprogrammed, just like a computer.”

Until people can visualize themselves as thin, he says, they won’t be able to become thin. So he has special fun-house-type mirrors in all his offices that use optical illusion to allow overweight patients to see themselves as thinner.

He also employs affirmations, teaching his patients to repeat aloud such phrases as “I am too pretty to be fat.”

And he teaches them to plan ahead, taking a few minutes at night to visualize the day ahead and decide what to order for that business lunch or dinner date.

Not everyone needs medical supervision to lose weight, Stamper says.

“If you’re 15% to 20% or more overweight, you very definitely should be supervised by a physician,” he says. “If you’re taking regular medication, you should definitely be followed. If you have problems such as heart disease, high cholesterol or high blood pressure or diabetes, you should see a doctor.

“If you’ve tried and tried without success, or if you’ve lost weight only to gain it back, you probably should work with a doctor. But if you’re one of those who can notice you’ve put on a couple of pounds and then take it off without too much trouble, you probably don’t need any help.”

And for some people, Stamper notes, “just the simple commitment to spend money to lose weight is enough incentive to make it work.”