"Families can either be enablers or encouragers. Having a supportive family for patients on a weight loss journey is an important component to their success," Dr. Nowzaradan tells PEOPLE


For Dr. Nowzaradan, he’s seen quite a great deal cases where patients have struggled to keep their weight off prior to undergoing gastric bypass surgery — and here’s why.

“It’s a daily challenge to work with some patients that can be self-destructive,” the surgeon from Houston Obesity Surgery, who performs all of the procedures on My 600-lb. Life, says in this week’s issue of People Magazine. “My job is not to get aggravated, but to find a way to motivate them to work hard to get to their goals. There are times where I think it’s necessary for some tough love and I have to be stern with them, so I show some of my concern and frustration.”

“Even during those times, my job is to find a way to work with them to get their weight to a healthy place,” Dr. Nowzaradan adds. “They are the patient because they need help and it’s my job to help them no matter what.”

  • For more on the success stories of My 600-lb. Life, pick up this week’s issue of People Magazine — on stands now.
Credit: Courtesy TLC

Dr. Nowzaradan, 72, reveals that it’s not just a physical transformation for the patients — it’s mental as well.

“Severe obesity is a complex physical and psychological condition with many components. Not realizing how much of their struggle is psychological and not just physical can be the biggest obstacle for change with patients,” he says. “Many refuse to admit they have any emotional compulsions or compulsive psychological disorders driving them to overeat.”

“However, once we removed the physical compulsion to eat with weight loss surgery, we have our best window to get them to see that and address those issues that will lead to long term success for them,” he continues.

FROM PEN: Half Their Size: Joanne Raymond Struggled With Yo-Yo Dieting Before Finding Success

Then there are the families of patients who could either further the weight loss progression or derail it.

“Families can either be enablers or encouragers. Having a supportive family for patients on a weight loss journey is an important component to their success,” Dr. Nowzaradan says. “If they don’t have that, it’s almost impossible for them to be successful in the long term, unless they remove those people from their environment. So they either have to change their dynamic with those enablers or separate from them if they want to succeed.”

As hard as it is to let go of a patient, Dr. Nowzaradan has had to walk away from some who he could no longer help.

“There have been a few patients I felt I could no longer help,” he admits. “I will always be available if they need me. If they won’t stick to the program, at some point, I can longer help them and they are taking resources from someone else who needs it.”

Season finale of My 600-lb Life: Where Are They Now? season 3 airs Wednesday May 31 at 8 pm ET on TLC.