Obesity: Problem, Solution, or Both?

Since 1982, the Southern California Permanente Medical Group's Positive Choice Weight Loss Program in San Diego has treated more than 30,000 adults, predominantly middle-aged, for obesity—some successfully, some not. This has been an extraordinary experience and provided us with numerous counterintuitive observations. We now are convinced that obesity is widely misunderstood, and we realize that the unusual program we have operated safely and effectively for more than a quarter century is often misunderstood as well. There is growing interest in our program and in using our approach as a model for other Kaiser Permanente (KP) Regions. We therefore share an overview here of our experience with this specific program. Consequently, most referenced works in this report are publications emanating from our program, sometimes contrasting those findings with conventional views on the subject. The Positive Choice Weight Loss Program has two integrated components: Prolonged absolute fasting, with the use of a supplement to support health and to prevent death from such fasting. A lengthy and complex group program to explore the basis of each participant's unconscious compulsive use of food, as well as to explore the hidden benefits of obesity for that individual. Given that the average weight loss of someone completing our 20-week program is 62 lb (28 kg) and that approximately 5000 patients each have lost more than 100 lb (45 kg), we realize we have challenged the belief systems of some who assume either that such weight loss cannot commonly be achieved or that the process of supplemented absolute fasting must be dangerous. In fact, the process has been notably safe, and major improvements in biomedical outcomes have been the norm. This article addresses four basic issues: The safety of properly supplemented prolonged absolute fasting in obesity The observed origins of obesity, and their implications The components of a relevant treatment program Outcomes of the Program.