Dr. Younan Nowzaradan: Saviour or Surgeon?

[Meredith Quill]

Your Dr. Younan Nowzaradan Topic!

[AdorkableWitch]

I adore when Dr. N reads his patients the riot act. "Pizza is not part of your diet if you weigh 700 pounds."

[Red Bridey]

Maybe they edit it out, but I would love for the good doctor to stress to all his patients that they need THERAPY and COUNSELLING to deal with their issues around food. 

[PityFree]

I have always gotten the impression (who knows how accurate it is) that he is sort of shady. My impression comes from the fact that his office looks like it's in a strip mall, the office looks trashy, and the is a big neon OPEN sign over the door. 

 

I'd like to see if the doctor has any sort of nutrition classes before or after the surgery to prepare people for the changes they will be doing. I've seen almost all of the episodes, but I can't remember if they ever showed this.

[AdorkableWitch]

My sleep doctor is in a strip mall and he is affiliated with a major hospital. I don't see that as a bad sign. His website has some information, including they offer "comprehensive weight management" and "non-surgical weight loss." I did see some support group information on his Facebook page (and we saw those with Henry's surgery, though as far as I can see, Henry was the only patient in Houston.)

 

He's also widely published in many different journals and has given professional lectures. 

 

[BostonBlonde]

I have always gotten the impression (who knows how accurate it is) that he is sort of shady. My impression comes from the fact that his office looks like it's in a strip mall, the office looks trashy, and the is a big neon OPEN sign over the door. 

 

I'd like to see if the doctor has any sort of nutrition classes before or after the surgery to prepare people for the changes they will be doing. I've seen almost all of the episodes, but I can't remember if they ever showed this.

 

 

My sleep doctor is in a strip mall and he is affiliated with a major hospital. I don't see that as a bad sign. His website has some information, including they offer "comprehensive weight management" and "non-surgical weight loss." I did see some support group information on his Facebook page (and we saw those with Henry's surgery, though as far as I can see, Henry was the only patient in Houston.)

 

He's also widely published in many different journals and has given professional lectures. 

 

Yes...My world famous cardiologist has an office in a strip mall as well. He is highly regarded so I don't think location says much...

 

In all fairness, we are only seeing what is interesting enough to be on tv. The more menial stuff is probably left on the cutting room floor. 

[Oldernowiser]

I admire the guy. He's taking on patients knowing there's an extremely high rate of failure and that they often have significant mental and emotional dysfunction and addiction problems. The fact that he seems to stay calm with even the bitchiest of them is impressive.

The trailer says there's only a 5% likelihood of long-term success. There aren't many people, let alone surgeons, who are generally pretty arrogant by necessity, who could handle that stress.

Edited January 8, 2015 by Oldernowiser

[CarolMK]

I really like Dr. Now. He's from Iran, I think (hence the accent) and he's been in Texas for quite a long time now and will operate on the severely obese than probably many other

doctors will not. I think I heard that the limit for most gastric patients is about 500 lbs. When he was talking about having to tie off 400-500 blood vessels through some of these surgeries, my respect for him increased tremendously. It also appears from what we've seen that he doesn't turn too many patients away, he will operate if at all possible.

[mrsjoe]

It does take courage to do his work. I'm sure there are doctors out there who won't take on risky patients because they are afraid of damaging their stats. I would be curious how his complication numbers compare to doctors who won't take on the super morbidly obese...

[gunderda]

And he makes them work for it before he will say "OK" to their surgery.  Most (if not all) have to prove that they can lose a small amount of weight on their own before their surgeries. 

And i don't see anything shady about his location.  He doesn't do surgeries there.  For the people he sees it's the ideal location.  Easy to get to, what appears to be ample parking close to the building (although i guess people could argue that his patients need a good walk from the parking garage), and obviously the office was custom modeled because the front door is bigger than your normal door so I would imagine other doors inside the office are similar. 

[silverspoons]

I think he is gifted as a vascular surgeon. It takes a great work ethic to stand on your feet for 4-6-8-12 hours tying off blood vessels.

 

I do think some of what we see is insurance driven and I do think Dr. Now knows those insurance rules well and makes sure he going to get paid before he operates or takes on a case. While I think he cares about his patients in a way , he cares about money as well. I think when he mentions lose 25lbs before surgery to some and 50lbs to others or different amounts to lose before skin surgery it has to do with insurnace paying more then his personal opinion.

 

I think Im torn because he is still  hard working at 70 years old and could easily retire. So is he in it for the money/fame or for the people? I have read conflicting stories from he tries to recruit certain patients that have the high paying imsurnace to stories that he saved someone life. He certainly is not as transparent as other TLC stars.

[CarolMK]

I'm guessing that to be a surgeon willing to take on the risks involved, he's not doing it strictly for the money. He really seems to genuinely care about his patients. He knows that some of these people have a high risk of dying either during surgery or shortly thereafter (one show on either TLC or Discovery channel showed a 900 lb mom who had

weight loss surgery but died of complications a month later). Insurance aside, he is being paid by the show to complete these surgeries. Some of his patients appear to 

be low income and likely on Medicaid. The Medicaid reimbursement rates aren't very high. 

[KarmaG]

I'm guessing that to be a surgeon willing to take on the risks involved, he's not doing it strictly for the money. He really seems to genuinely care about his patients. He knows that some of these people have a high risk of dying either during surgery or shortly thereafter (one show on either TLC or Discovery channel showed a 900 lb mom who had

weight loss surgery but died of complications a month later). Insurance aside, he is being paid by the show to complete these surgeries. Some of his patients appear to 

be low income and likely on Medicaid. The Medicaid reimbursement rates aren't very high. 

 

 

I think he gets an appearance fee, much like Jen Arnold of The Little Couple, and his clinic gets exposure in a different way than it did previously, like Texas Children's Hospital gets on The Little Couple. I don't think he's paid to complete the surgeries. I do wonder, though, how a man his age keeps up with his hours. We know the gastric bypass surgeries take many hours, the skin removal surgeries take many hours. I don't think I could do it, bravo to him.

 

I did notice this season another name on the front door that they've blurred out. Didn't see it there last season.

[poeticlicensed]

I do think some of what we see is insurance driven and I do think Dr. Now knows those insurance rules well and makes sure he going to get paid before he operates or takes on a case. While I think he cares about his patients in a way , he cares about money as well. I think when he mentions lose 25lbs before surgery to some and 50lbs to others or different amounts to lose before skin surgery it has to do with insurnace paying more then his personal opinion.

 

Absolutely. Medicine is a business and he needs to make sure his patient (or their insurance) can pay the bill.  Anytime you walk in a doctor's office, they run your insurance. My guess is that each insurance companies have benchmarks that kick in regarding how obese a patient has to be to do surgery. I know my insurance doesn't pay unless there is another health issue present, such as HBP or diabetes. As for the skin surgery, I think it's about insurance, but it's also about safety and standards of care. It's far easier to remove saggy skin than it is to remove skin with fat attached.

[Betweenyouandme]

And to make sure all the loose skin there probably will be ...at least that would appear in a long time or disable walking...can be removed in one surgery.

It doesn't bother me if Dr. Now makes more money from the show. It seems like he's really competent at the surgeries, someone has to do it, and it's TLC paying rather than him racking up patient costs.

[Miss Chevious]

I think it's great that he tells his patients like it is. If someone in their family is being an enabler, he tells them. He doesn't accept any excuses. Invariably patients come up with a bunch of excuses when they come in for checkups and they either gained weight or didn't lose any and he doesn't put up with that. It may seem hurtful, but sometimes a dose of reality is what the patient needs to either get motivated or stay motivated. He does it for their own good.

[gunderda]

I like him but during this episode both people gained weight and was due to stress - which is normal.  So he asked them why they gained weight and instead of giving them ways to cope with the stress he just said "quit making excuses"  which I guess is what they need.  But if they need more emotional help I think he should be able to give them suggestions for that instead of saying "too bad, suck it up"

[KarmaG]

I like him but during this episode both people gained weight and was due to stress - which is normal.  So he asked them why they gained weight and instead of giving them ways to cope with the stress he just said "quit making excuses"  which I guess is what they need.  But if they need more emotional help I think he should be able to give them suggestions for that instead of saying "too bad, suck it up"

 

I would agree if maybe they were a month, 5 months out from surgery. They were almost two years out from surgery. They know at that point how to deal with stress and it's not by turning to food. Also, Paula basically admitted Dr Now was right when near the end she said, I HAVE to make my health a priority (the very thing Dr Now told her during her first visit of the episode).

[gunderda]

I would agree if maybe they were a month, 5 months out from surgery. They were almost two years out from surgery. They know at that point how to deal with stress and it's not by turning to food. Also, Paula basically admitted Dr Now was right when near the end she said, I HAVE to make my health a priority (the very thing Dr Now told her during her first visit of the episode).

Yea I know.... I get it but it would still irk me if he asked me "why" when really it's a trick question because no matter what you say he's going to be like "stop making excuses"   I don't think it was that harsh for Paula because she was obviously not making the progress the entire year but Chuck seemed to do amazing and he had a slight setback. 

[Oldernowiser]

Well, and turning to food when under stress isn't a mandate. Personally, I feel sick and lose my appetite.

He may be calling them out on returning to a coping mechanism that obviously backfired terribly on the past. After all, this isn't about bathing suit season. This is about whether they live or die.

[curlytoes79]

I don't know why Dr. Now doesn't require a psychological evaluation for all his patients. He emphasizes that the surgery won't solve the emotional/psychological issues that are leading his patients to overeat, and so it would seem counseling would be a necessary part of the process. I've never even seen him recommend it upfront...it sometimes becomes part of the conversation later, but only after the patient has been struggling. I've even wondered if he withholds this kind of advice until later so that TLC can get some good footage of the patient trying (and failing) to deal with stuff on their own. I certainly hope that's not the case, but...

[Oldernowiser]

I doubt very much that Medicaid is going to come across with potentially hundreds of thousands of dollars without some kind of psych eval first. They're not including it in the show, probably because any real therapist would consider this an ethics problem.

[hottesthw]

I don't know why Dr. Now doesn't require a psychological evaluation for all his patients. He emphasizes that the surgery won't solve the emotional/psychological issues that are leading his patients to overeat, and so it would seem counseling would be a necessary part of the process. I've never even seen him recommend it upfront...it sometimes becomes part of the conversation later, but only after the patient has been struggling. I've even wondered if he withholds this kind of advice until later so that TLC can get some good footage of the patient trying (and failing) to deal with stuff on their own. I certainly hope that's not the case, but...

When a family member had this surgery years ago we went to many, many drs ahead of time for consults before deciding on one. Every single one required a session with a psychologist and every single one of them required at least a 25lb weight loss on her own before agreeing to do the surgery. So all of that is pretty standard stuff. Due to privacy and all I'm guessing the psych part of things is left out of the show. Plus it's probably not all that interesting. And in our case, it was one appointment with the shrink who then gave a yay or nay on the surgery. They strongly suggest continuing care but it's up to the person to follow up, not the surgeon. The only show participant I think probably should have been denied was Penny. I saw through her BS from day one, not sure how a mental dr let her slip through the cracks.

[Oldernowiser]

Penny spins a great line of bullshit and she's smart enough to figure out the right things to say. It's served her well and I can see her bullshitting an overworked mental health professional...or maybe they just signed off to get her the hell out of the place.

[Betweenyouandme]

I'd think the psyc eval would cover making sure the patient can make decisions for themselves rather than are they depressed.

[Betweenyouandme]

I'm not an expert, but I don't think these two are mutually exclusive. Depression often interferes with self-care, so a patient struggling with depression might not always be able to make good decisions on the daily.

What I mean is that the psyc professional would need to sign off that the patient is able to make and is making their own decision about surgery. They may recommend further counseling or think meds may help, but that wouldn't be their role to provide, and their advice isn't required to be adhered to by the patient.

The decision to have surgery is the patient's and surgeons/ medical doctors as long as it is clear or checked that the patient is able to make decisions. People who are depressed can still make their own decisions about surgery unless, for example, they were planning to somehow use the surgery or meds to harm themselves or others....or at that time had a plan and desire to kill themselves some other way. And, for patients with severe schizophrenia who are not medicated....then, yes, it's likely they may not. Making good decisions or bad decisions isn't what the psyc doctor is there to ascertain.

[mrsjoe]

I had the same surgery as Penny, with the big difference being I was sort of entry-level obese, weighing no where near what she is. The psych eval was required of everyone. They made it very clear from the get go that even if your insurance did not cover the appointment, you would not have the surgery without it. There were two parts to it.  The first was to fill in a questionnaire.  Most of the questions were clear why they were included. For example, there were questions like "Weight-loss is going to be super easy after the surgery" to test for realistic expectations. There were questions looking for depression and/or lack of self-esteem.  And I know it's a serious thing, but there were also questions clearly trying to determine if you were completely delusional that were actually sort of funny. The one that sticks in my mind is "I have crossed the Atlantic Ocean 50 times in the last month - yes or no". So you'd be going through reading all these serious questions and then get "I can alter gravity with my mind - yes or no" thrown in.

 

Anyway, part two was the actual appointment where she went over your answers, asked about your expectations, had you talk about what you thought was going to be most difficult, etc. I was low risk all around, mentally and physically, so my appointment was pretty much just chatting. I know from some of the Gastric Sleeve message boards though that others get referred for further evaluation/treatment before they can have the surgery.

 

I'm sure TLC and the doctor both require some sort of screening.  I doubt TLC wants to risk a patient committing suicide or something while on the show (or maybe they would want that).  All that being said though, I could see that with TLC involved, wanting to speed things along, the show participants may get an eval more like mine and just be sorta waved through, when let's face it - you don't get to 600 lbs without some really big issue going on that needs work.

[Bellalisa]

Penny was great with the platitudes. I am sure she said everything she was supposed to say at the psych eval! I'm doing this because my only choice is to live, I have a son, I know it will be hard but i'm determined..yadda yadda. She said all those things on both of her episodes. She spouted all the right sentences! I don't know how they would determine she was never going to even try to lose the weight from the questions they asked or that she was happy lying in bed getting served. It even took awhile for Dr. Now to realize that. She is clever that way this bitch.

[Hana Chan]

What I appreciate about how Dr. Now handles patients is his blunt honesty about their circumstances. Let's be honest - for some of these patients, this is what may stand between them and a premature death. Many of them come in with multiple health issues related to their morbid obesity, which makes an already risky surgery even more dangerous. And then you have the myriad of psychological pathologies that these patients suffer from. None of them came out of psychologically healthy environments. Most of them are surrounded by either enablers or those who actively sabotage their efforts to help themselves. He can't afford to coddle them because for so many of these patients, it is a case of life and death.

[Cherrio]

I don't know why Dr. Now doesn't require a psychological evaluation for all his patients. He emphasizes that the surgery won't solve the emotional/psychological issues that are leading his patients to overeat, and so it would seem counseling would be a necessary part of the process. I've never even seen him recommend it upfront...it sometimes becomes part of the conversation later, but only after the patient has been struggling. I've even wondered if he withholds this kind of advice until later so that TLC can get some good footage of the patient trying (and failing) to deal with stuff on their own. I certainly hope that's not the case, but...

Sadly, I think that ratings (money) is all that TLC cares about.    There would be no show, no drama if they were to film showing the proper and healthy way.

[Cherrio]

If therapy isn't working or the patient isn't giving it a sincere try, then they should not be cleared for surgery. The real problems are not solved by surgery. Dealing and healing the emotional problems are at the root of it.

 Penny and some others are perfect examples.

  Whether or not the surgeon is "good", the statistics are really poor for a successful outcome.

    In this particular doctors defense, I think he makes these people go through a lot more than we see before being considered.

[notyrmomma]

If therapy isn't working or the patient isn't giving it a sincere try, then they should not be cleared for surgery. The real problems are not solved by surgery. Dealing and healing the emotional problems are at the root of it.

 Penny and some others are perfect examples.

  Whether or not the surgeon is "good", the statistics are really poor for a successful outcome.

    In this particular doctors defense, I think he makes these people go through a lot more than we see before being considered.

 

I believe there is a lot of testing going on behind the scenes.  Every Dr is different, but all require a different battery of medical tests to make sure you will survive the operation in an of itself.  So when Dr. Now says that he will schedule surgery for "tomorrow," he is probably just doing it for the camera since a lot of prep and testing goes into the pre-op process (and the test results are only good for like 2 weeks or so).

 

And about the emotional aspect of eating - I had the sleeve operation (VSG) in Sept and I will tell you for sure, the only thing the surgery does is limit the amount you can eat at one time.  It does nothing to take away the compulsive eating behaviour...however, a binge for me was eating a lot of food at one time, and the VSG basically killed that ability (a couple weeks ago I got lazy and tried to eat two of the chicken nuggets that I cooked for the kids' lunch, and afterward, I felt like I did one of those eating challenges from Man vs Food, I was so sick and uncomfortable).  Because of my experience, I still struggle to understand how Penny managed to not lose any weight...especially in the first month where you eat nothing at all for three days, then slowly move to liquids, then mushy foods.  To my original point though, I guess she could have been drinking a chocolate milkshake every two hours, for example, and fought through the pain (Why God why???).  When I was still in the hospital, one of the nurses told me that they had a bariatric patient on the day after his surgery had a tray of food delivered from the cafeteria (he lied and said it was for a visitor)-only he ate the tray of food and threw it all up.  That is one mad food addiction.  Five months out and eating is still a tedious process for me.

[rue721]

To my original point though, I guess she could have been drinking a chocolate milkshake every two hours, for example, and fought through the pain (Why God why???).

 

I think Penny likes being taken care of because that makes her feel loved, and was/is afraid that that would stop if she "became" able to take care of herself.

 

I don't think it's the surgeon's job to get into the nitty gritty of someone's psychological issues, his job is to make sure that the surgery itself won't harm the patient. The patients need to take some responsibility for themselves and for their own aftercare.

[AdorkableWitch]

I have done some research into what I would have to do be accepted into a bariactric surgery program. Patients at our local center have to attend weekly group therapy sessions, and meet with a nutritionist twice before surgery. You also have to be evaluated by a psychologists.

These surgeons have the same accreditation as Dr. Now, and I was told this is the standard for almost all clinics. I struggle to think Dr. Now doesn't have the same requirements.

[Peanutbuttercup]

I checked out Dr. Now's reviews on obesityhelp and bariatricpal and his patients all seem to love him, even though they comment on his being a little abrupt! And it does look like he has a complete aftercare program and rigorous requirements leading up to surgery -- TLC probably doesn't choose to show that kind of thing because they figure it wouldn't be as interesting to people as seeing someone have their husband wash between their fat folds with a squegee stick.

[deedee2]

 And it does look like he has a complete aftercare program and rigorous requirements leading up to surgery -- TLC probably doesn't choose to show that kind of thing because they figure it wouldn't be as interesting to people as seeing someone have their husband wash between their fat folds with a squegee stick.

 

Still not sure how Pauline met those rigorous requirements to have her surgery approved.

[4forme]

Did you mean "savior" or the Latin "savoir"?

[gunderda]

Still not sure how Pauline met those rigorous requirements to have her surgery approved.

Because some people are real good at telling you what you want to hear. 

 

I know I had high hopes for Pauline at the beginning of her episode. I'm sure a lot of people did.  Because she's a big delusional liar. 

[Bellalisa]

Yup, she was full  of platitudes like her twin in sloth, Penny. 

[Oldernowiser]

Did you mean "savior" or the Latin "savoir"?

I wonder about this every time I look at this thread title. Think it's a typo?

[4forme]

Since I'm not getting the play on words if it was meant to be the Latin definition, I'm going w/typo...which means I'm annoyed every time I see it! :)

[Oldernowiser]

C'mon over here...you can sit by me on the Compulsive Proofreaders' Bench.

[cheatincheetos]

Maybe they edit it out, but I would love for the good doctor to stress to all his patients that they need THERAPY and COUNSELLING to deal with their issues around food. 

They tend to get therapy toward the end of the formulaic episodes. The mental game and motivation are so central that it seems like that should be up front, in the initial trial weight loss before he agrees to operate.

[brandyelf]

C'mon over here...you can sit by me on the Compulsive Proofreaders' Bench.

Me too, please! It drives me crazy.

[dinkysquid]

This guy has the patience of a saint!! I would lose it with these people, who are supposed to be losing to even have the surgery and come in fatter because they or their fellow unemployed and usually severely overweight as well "enablers" have been through the drive-through obviously on a daily basis. Now, with the Internet, it doesn't take a genius to find out about healthy eating and I don't accept the defense that it's "cheaper" because it isn't. You can eat healthy and not go bankrupt. People do it every day. 

 

He must count to ten a helluva lot.

[Guest dutronc]

He doesn't address the cost of food--he talks about food behavior, which is what really matters.

[greekmom]

Would TLC producers please tell Dr. Now to stop colouring his hair.  The reddish brown shade didn't do anything for him.

[BostonBlonde]

Anyone notice in the credits that it's a family project? The producer is Dr. Now's son & even more Nowzaradan's are throughout the rolling credits. Interesting. 

[Guest dutronc]

Yes. I think that's one of the reasons the first series was actually fairly decent. Jonathan Nowzaradan is less involved with the second and third series.

[Miss Chevious]

Dr. Now must get so frustrated with those manipulative patients with bad attitudes that refuse to follow his directives. Don't know how he does it.