Let me say one thing, right from the start: I’d love nothing more than to put myself out of business. On most days, I can be found in a chilly, dimly lit operating room. I stare at a pair of flat-screen monitors positioned to float above the head of my anesthetized patient. The image I view is captured from a scope that I have passed all the way through the patient’s abdominal wall. I am constantly manipulating staplers, graspers, burning devices, and scissors at the end of very long instruments that enable me to perform surgeries. I attach adjustable, restrictive, gastric bands or bypass lengths of small bowel to stomachs that I have dramatically reduced in size. I do these routine procedures 14 to 20 times per week, totaling more than 3,500 times to date. And, as you might imagine, there is no shortage of work for me. By the time you read this, the combined weight lost will have totaled more than 200,000 pounds.

Through weight loss surgeries, I help people acquire a tool to keep the weight off. But the real magic in their transformations occurs when they use it.

I spend most of my energy making sure that my patients know how to use their tool. Surgery is about an hour long, and it's usually pretty easy for the patient: They sleep through the whole thing! But what they get in surgery is forever. That's the hard part. The patient is responsible from that point forward—they have to do the work for the next 20, 30, 40, 50 years.

How do people who have had many, many years of failed weight loss succeed after the surgery? Here's a hint: It's not the surgery. Rather, their ability to succeed stems from the fact that they feel satisfied with a small meal. The power of the fullness is what is most important in their lives. But they must learn to eat the right foods at the right times to be full.

My patients have been to a world that most of you have only visited in your nightmares. A BMI of 35-plus is very hard to live with. It severely impacts a person's health and quality of life. Such a person is willing to make an ironclad commitment to never go there again. They have perspective and realize the gift of the tool. They actively court fullness at every turn.

Trust me: They know that they could drink those rich, caramel, calorie-laden drinks at their local coffee shop, but such food would not make them full and would result in too many non-nutritious calories. They know it is all about being full. That's what keeps them away from the rich drinks. When they are satiated, it is no longer about control. It is about truly not desiring the junk.

After an all-you-can-eat extravaganza, no one goes to the parking lot and thinks, I wonder where we can go for dessert? When you are full, the idea of more food holds no power over you. The trick is not to go on some fad diet (which rarely works) but to find healthy, reasonable ways to achieve the feeling of fullness.