Weight loss is – literally – a hefty industry. With 66.7 percent of Americans overweight or obese, “Obesity truly is an epidemic,” said Dr. Theresa Piotrowski. As head of the Mount Auburn Weight Management Center, Piotrowski is one of two licensed weight loss bariatricians in the state, and sees patients who have anywhere from 20 to 200 pounds to lose. They come to her to receive a medical weight-loss program that includes diet and nutrition plan, exercise, lifestyle changes and if needed, prescription medications. As a bariatrician – an MD who specializes in the treatment of obesity – Piotrowski’s patients aren’t thinking, “I have to lost ten pounds before I get to the beach this summer,” but rather, “I have to lose 100 pounds before I can just get out of the house.”

Piotrowski’s typical patient has been through a litany of “big box” commercial weight loss programs and even bypass surgery, but gained the weight back. “I don’t just treat the behavior; it’s not what they eat, but why they eat,” said Piotrowski, who says that weight loss success is not as much about dieting as lifestyle changes. She cites the story of a big 6’5” Italian attorney who weighed in at 510 pounds. He lived with his mother, who was feeding him huge meals of pasta and “loving him to death” with food, said Piotrowski. She enlisted the support of his friends and family to help him lose weight; encouraged him to balance his protein to carbohydrate ratio, start exercising, and stop turning to food for comfort. He lost more than 100 pounds and is now able to fit into his business suits again. Still, this isn’t the story of NBC’s “Biggest Loser.” “I’m not going to fool you,” said Piotrowski. “Losing weight is hard work. There is no magic pill.”

Q: How did you get into bariatric medicine?
A: I started out in family practice, and always had a special interest in health and weight issues, but didn’t have time to devote only to weight loss. Through the American Board of Bariatric Medicine (ABBM), I took a certification exam which allows me to specialize in the non-surgical medical management of overweight and obese patients. There are only about 400 bariatricians in the country, and there’s such a need for more physicians who specialize in the treatment of overweight and obese patients who also often suffer from related conditions, such as diabetes, heart disease, high blood pressure, sleep apnea, and arthritis.

Q: What’s the most satisfying part of your job, and the most frustrating?
A: Of course it’s most satisfying when patients lose weight. But some patients can’t get beyond their limitations; I can provide them with the tools, but only they can determine their readiness. Even weight loss surgery is not the answer, because some people will always find a way to eat ice cream and chocolate, no matter what.

Q: Who is the heaviest patient you have seen?
A: I’ve seen patients who topped the scale at 650 pounds.

Q: What advice would you give to those who would like to pursue medicine as a career?
A: My daughter was a freshman in college and asked about becoming a physician, and frankly, I discouraged her. I told her, “If you want to be a doctor like me, you won’t have a life.” I feel burnt out from constantly battling with the bureaucracy over issues like reimbursement. But if you feel this is your calling, you have to realize that your job won’t end at 5 p.m. when you leave the office.

Q: How much do you weigh?
A: I’m 5’10, 130 pounds, but as a teenager, I worried about my weight and went on every diet known to man. So, I understand what my patients are going through.