It seems fairly obvious to me that the "calories in, calories out" is only one factor in how much a person weighs. I think that carbs - mainly processed food and sugar, as well as a physiological predisposition to super obesity, are the culprits here. Don't get me wrong, I think these people are taking in a lot of calories, but I think that the math here is faulty. Like I do not think that for every pound gained there is an excess of 3500 calories or that there is a reduction of 3500 calories for each pound lost. Clearly, the human body is more complex than that. Even Dr. Now puts them on a low carb diet to shift a lot of weight fast. At the hospital it is grilled chicken and steamed veggies. I do believe that this is one of the reasons that some of his patients are sincerely confused about what their diet should look like. On the one hand, Dr. Now constantly talks about calories, but on the other hand, his method for weight loss is low carb more than low calorie. So when the patients "cut back" on what they normally eat, they think they should be losing weight, but they can't lose any weight because even though they might be eating fewer calories than before, their sugar and carb intake is high enough that their insulin stays constantly elevated. Essentially from we see I do not think that Dr. Now does an effective job of explaining how the body produces and stores fat. He keeps talking about "calories" so that should mean that eliminating one large pizza from your daily diet would result in a one pound weight loss per day, which of course it doesn't. So the calories thing really cannot be the entire story here.