Why do doctors encourage such low cal diets/rapid loss?
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try2again
Posts: 3,562 Member
Why do doctors so often (according to posters) sign off on or even prescribe extremely low cal diets? Even if there is concern about a medical condition, isn't this extremely hard on the body and much more difficult to achieve, sustain, and later transition from to maintenance? It seems extremely counter-productive and like it's setting people up for failure. I'd especially be interested in a doctor's point of view.
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Guessing that they think that losing the weight fast is less dangerous than the extra weight is. Most doctors are clueless about nutrition though.0
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Most doctor-approved VLCD that I've heard of have been for limited time periods and prescribed for extremely overweight people who have sufficient energy stores (i.e., fat) to take them through them. They are not meant to be long term weight loss strategies but, instead, are meant to be used for a period of weeks before transitioning to more moderate deficits.
Here is some info about VLCDs and why doctors may prescribe them: http://www.niddk.nih.gov/health-information/health-topics/weight-control/very-low-calorie-diets/Pages/very-low-calorie-diets.aspx0 -
I think the problem is an outdated point of view: one, that the benefits of the loss outweigh the additional strain on the organs, and two, that simply losing weight will "cure" obesity, so the person will be just the same as anyone else of the same weight. The latter is certainly false. The former is possible depending on the person.
Also, I suspect many VLCD proponents aren't accurately portraying things - either not telling their doctor how fast they intend to lose, or taking their doctor's advice to lose weight as a carte blanche approval of any diet however extreme.0 -
Many different reasons because there are many different doctors and patients!
Next time you're at the doctor, ask him!
They know more than people here do, generally. Most people here google for info. Doctors have google, too, but they also have years of studying and instruction, then experience treating patients and talking to other doctors. So, they have their reasons and many of those reasons would require someone to spend years being instructed and studying to understand.
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because a doctor unless a specialist in nutrition and diet only gets 23.9 hours of nutritional/diet course time in their entire school career per this article
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2430660/
along with speaking to a few doctors in the family who have told me that their training in nutrition is dismal and they refuse to give patients advice but instead refer them to a RD (register dietician)
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My understanding was that losing slowly shows no greater advantage than losing quickly, as far as gaining the weight back is concerned.
And there's a point where people lose motivation to focus on their weight and consumption, so I think the logic is that it's better for someone who needs to lose 100 lbs to have lost most of that weight before they lose motivation, than it is to have lost only 50 of it when they reach that point. But a person who is 100 or more lbs overweight, even if they give up after a month it's probably better for their health if they lost 20 lbs in that time instead of, say, 5 lbs.
Also I think a lot of doctors prescribe vlcd to prepare patients for other medical things they need where time is of the essence, like surgery.0 -
Most doctor-approved VLCD that I've heard of have been for limited time periods and prescribed for extremely overweight people who have sufficient energy stores (i.e., fat) to take them through them. They are not meant to be long term weight loss strategies but, instead, are meant to be used for a period of weeks before transitioning to more moderate deficits.
Here is some info about VLCDs and why doctors may prescribe them: http://www.niddk.nih.gov/health-information/health-topics/weight-control/very-low-calorie-diets/Pages/very-low-calorie-diets.aspx
Thank you for the link.
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Lourdesong wrote: »My understanding was that losing slowly shows no greater advantage than losing quickly, as far as gaining the weight back is concerned.
And there's a point where people lose motivation to focus on their weight and consumption, so I think the logic is that it's better for someone who needs to lose 100 lbs to have lost most of that weight before they lose motivation, than it is to have lost only 50 of it when they reach that point. But a person who is 100 or more lbs overweight, even if they give up after a month it's probably better for their health if they lost 20 lbs in that time instead of, say, 5 lbs.
Also I think a lot of doctors prescribe vlcd to prepare patients for other medical things they need where time is of the essence, like surgery.
It was my understanding (I have not researched it) that studies have shown that those who lose weight more slowly have better long-term success rates. As to losing motivation, that's exactly my point- why put people on an extremely restrictive diet that isn't sustainable only to have them drop some weight and immediately return to their old eating habits?0 -
Most of them just don't know any better.0
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Part of a VLCD should also be education. That's usually the piece that's lacking and one of the reasons why so many failures happen. If you don't address the behavior, the problem still exists. People don't become obese because they have good habits and new habits take time to learn.
I'm one of those prescribed a VLCD. I've been on it for a year. I'm now coming off it, but going up to a normal level of calories will take a few months. It was either allow the doctor to starve me (and he cut up my guts as well) or die of heart failure in a year. I chose starvation and surgery over a casket.
Yes, there's been education. That started before the diet or surgery began. I now have a way of eating that works for me and that I can sustain long-term. And yes, there's monitoring. Lots of it. Weekly bloodwork and weigh-ins, a public diary so my med team and insurance company can monitor me, and a heart monitor that I wear all the time. There have been plenty of complications, but they were better than dying.
It's a medical tool and it can be life-saving. It can also be mis-prescribed or poorly managed.0 -
Most of the studies say that isn't true. It doesn't matter how quickly the weight comes off. The success rates are the same, either way.Lourdesong wrote: »My understanding was that losing slowly shows no greater advantage than losing quickly, as far as gaining the weight back is concerned.
And there's a point where people lose motivation to focus on their weight and consumption, so I think the logic is that it's better for someone who needs to lose 100 lbs to have lost most of that weight before they lose motivation, than it is to have lost only 50 of it when they reach that point. But a person who is 100 or more lbs overweight, even if they give up after a month it's probably better for their health if they lost 20 lbs in that time instead of, say, 5 lbs.
Also I think a lot of doctors prescribe vlcd to prepare patients for other medical things they need where time is of the essence, like surgery.
It was my understanding (I have not researched it) that studies have shown that those who lose weight more slowly have better long-term success rates. As to losing motivation, that's exactly my point- why put people on an extremely restrictive diet that isn't sustainable only to have them drop some weight and immediately return to their old eating habits?
The odds are against us, as keeping it off goes. Most people regain it, but it has nothing to do with how fast they lost it.
The reasons people get put on low or VLCDs are many and sometimes multi-faceted. They're generally medical reasons, though. It doesn't matter how much the doctor knows about nutrition. Even if they do know a lot (and some do), they will generally not be spending much time on it. There are dieititans for that. They make decisions based on the person's condition...and based on their own, personal beliefs/experience on what works best.
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A morbidity obese person will loose more quicker on a 2000 a day calorie diet than a 20lb overweight person will. Also what doctors are you talking about?0
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From what I've read, it's because the health of the person involved is in very serious state. It's either/or time. Either lose or die.
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I think we need to remember that Doctor's aren't nutritionists.
When my Doctor told me I was overweight and needed to lose, his first 'tip' was "Cut your carbs". Wildly inaccurate and something I'm glad I didn't act on.
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Part of a VLCD should also be education. That's usually the piece that's lacking and one of the reasons why so many failures happen. If you don't address the behavior, the problem still exists. People don't become obese because they have good habits and new habits take time to learn.
I'm one of those prescribed a VLCD. I've been on it for a year. I'm now coming off it, but going up to a normal level of calories will take a few months. It was either allow the doctor to starve me (and he cut up my guts as well) or die of heart failure in a year. I chose starvation and surgery over a casket.
Yes, there's been education. That started before the diet or surgery began. I now have a way of eating that works for me and that I can sustain long-term. And yes, there's monitoring. Lots of it. Weekly bloodwork and weigh-ins, a public diary so my med team and insurance company can monitor me, and a heart monitor that I wear all the time. There have been plenty of complications, but they were better than dying.
It's a medical tool and it can be life-saving. It can also be mis-prescribed or poorly managed.
This.
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The long term success rate of most diets is poor, if it's safe and appropriate to lose faster for 8 weeks then more fat will be lost before the patient gets bored and gives up. They may even stick it out for longer having seen better results.
Most national bodies support the use of VLCDs in obese patients esp with comorbidities like diabetes or hypertension. Committees review evidence and produce guidelines summarised in articles like http://www.gponline.com/role-low-calorie-diets/nutrition/article/9946490 -
strong_curves wrote: »Most of them just don't know any better.
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The long term success rate of most diets is poor, if it's safe and appropriate to lose faster for 8 weeks then more fat will be lost before the patient gets bored and gives up. They may even stick it out for longer having seen better results.
Most national bodies support the use of VLCDs in obese patients esp with comorbidities like diabetes or hypertension. Committees review evidence and produce guidelines summarised in articles like http://www.gponline.com/role-low-calorie-diets/nutrition/article/994649
That's such a weird logic. If they give up at any point and regain, having lost a bit quickly for a short period doesn't make much of a difference, does it?
Other than the fact that this generally dangerous way of eating has now been legitimized for them, and they'll probably now have some distortions going on around food?
And if they gain back more than they lost (very common), they'll lose ffm and increase body fat % (more adiposity = more risk for lifestyle diseases, usually), & experience additional consequences to their metabolism, right?
Does this actually work for most long-term? (Long-term, not 1-2 years)0 -
Part of a VLCD should also be education. That's usually the piece that's lacking and one of the reasons why so many failures happen. If you don't address the behavior, the problem still exists. People don't become obese because they have good habits and new habits take time to learn.
I'm one of those prescribed a VLCD. I've been on it for a year. I'm now coming off it, but going up to a normal level of calories will take a few months. It was either allow the doctor to starve me (and he cut up my guts as well) or die of heart failure in a year. I chose starvation and surgery over a casket.
Yes, there's been education. That started before the diet or surgery began. I now have a way of eating that works for me and that I can sustain long-term. And yes, there's monitoring. Lots of it. Weekly bloodwork and weigh-ins, a public diary so my med team and insurance company can monitor me, and a heart monitor that I wear all the time. There have been plenty of complications, but they were better than dying.
It's a medical tool and it can be life-saving. It can also be mis-prescribed or poorly managed.
Ah missed your post. Yes I can see that if it's equivalent to an emergency, drastic measures might be needed. Glad you've done so well 0
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