My early career in medicine was dedicated to metabolism -- diabetes particularly. After medical school I spent three extra training years working in biochemistry laboratories including the famous Max Planck Institute in Munich where I studied under Prof. Feodor Lynen who won the Nobel Prize in Medicine. When we returned from the glorious year in Bavaria 1962- 1963, I was a hot property, having co-authored two critical papers with the recent laureate. Accordingly, on reentry to life in America I sought and quickly received two large research grants from the NIH, one involving cholesterol metabolism and the other called "The Effect of Diet on The Metabolism of Fat in Man." This multimillion dollar award equipped my group with beds in the metabolic ward of the Lankenau Hospital in Philadelphia where dad and I were affiliated. Coincidently, I became chief of the diabetes service at the Philadelphia General Hospital.
The large grant gave full support to elaborate research efforts with volunteer patients in which we altered diet constituency, amount, and timing, and injected radioactive foodstuffs to monitor their metabolic patterns. This generated an avalanche of high quality research papers. We had four to six research subjects at the time who lived on the metabolic ward and were paid $10 a day for their participation. The subjects varied in gender and age, but particularly in weight. Without formal publicity we found ourselves deluged by potential research subjects who had been referred to us as a last gasp potential.
Perhaps a year after our project was instituted I interviewed an amazing man who had failed every conceivable prior weight loss program, including Mickey Stunkard's, professor of psychiatry at my alma mater, the University of Pennsylvania. This was in 1966. My new aspirant was huge. My office furniture was not yet fully paid for, and when he sat on the chair it cracked under his huge dimensions. We had to take him down to the food department to get an accurate weight, 691, barely able to walk, yet bright and full of hope. I gently introduced him to our metabolic ward staff where he was to spend the next two years of his life. Our initial assessments indicated that he was eating 5000 calories per day merely to sustain his huge bulk. He quickly adapted to our new routine that consisted of 800 calories of a liquid diet, specifically concocted out of different proportions of protein, carbohydrate, and fat in three equal meals plus supplemental vitamins and minerals. While with us he sought and received his high school diploma, and generally volunteered in minor support tasks. He was single, and otherwise unaffiliated. We weighed him weekly.
His final weight with us was 179. He had lost 512 pounds under our protocol. His weight-loss featured the development of large aprons of redundant skin that required four plastic surgeries, the largest single donation of skin ever to the skin bank.
We celebrated his huge loss and began preparation for his eventual return to the real world. He is Jewish and hurried directly to a kibbutz in Israel to begin his new slim life.
I wrote up his medical case in the prestigious American Journal of Medicine in August of 1969, volume 47, pages 325-331, complete with before and after pictures and graphs of his weight loss and other metabolic parameters. The title of my article was "a 500 pound weight loss."
That was in the 1960s when my research interest was fat metabolism. My aging focus came only later when Dad died and I moved to Stanford.
Now 60 years later, I age 86, he age 82 had had no interim contact until last week when I found via white pages.com, his phone number and address in Philadelphia. "Hello, this is Dr. Bortz." He exclaimed shock and delight. He is married with two sons. He allowed that his wife was suffering from Alzheimer's disease from which my wife had also painfully died. For most of the intervening years he had worked for the Board of Social Services in Camden, New Jersey from which he retired to care for his wife (I know this drill). Our conversation drifted, but I was still overcome by the fact that he was still alive, and had sustained the loss, now 180 pounds. Most men our age are dead. He thanked me for saving his life, which undoubtedly was accurate.
But the big story that emerges from him is that nothing is impossible. "You can't change human behavior", "weight loss is easy, I've done it a 1000 times," etc. all of these idioms are made false by his experience.
The popular television show Biggest Loser features dozens of cases of lesser weight losses. But every record is made to be broken. I had presumed that my case was a record. However, a recent internet search reveals the instance of a young man in Saudi Arabia who had weighed 1345 pounds, and had already lost 700 pounds under some unspecified medical procedure. The Fox News website on February 9, 2016 shows pictures of him walking with a walker. He had to be transported earlier by a mechanical crane.
The amazing personal experience with my patient continues to exalt me, in showing what can be accomplished despite seemingly impossible odds. As John Gardner used to say "he who would effect real change can not be of short wind.