Why do doctors encourage such low cal diets/rapid loss?
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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)
The loss of FFM on VLCDs is mainly water, that's why they are called PSMF 'cos they retain (spare) protein.
If you were to give up after 8 weeks and had lost 20 lbs rather than 4 you would be in a better metabolic state perhaps ? Fired up to lose more rather than giving up because you can't see the difference ? This happens.
I haven't seen any data for long term as you describe it. Bariatric surgery is mainly a surgically enforced VLCD and over many years they tend to have lost about half their initial excess weight.
Do you have any objective data on long term success ? The guy who ate nothing for over a year maintained his loss (n=1).
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This is from the NHS website:
"Very low calorie diets
A very low calorie diet (VLCD) is where you consume less than 1,000 calories a day.
These diets can lead to rapid weight loss, but they are not a suitable or safe method for everyone. VLCDs are usually only recommended if you have an obesity-related complication that would benefit from rapid weight loss, such as severe sleep apnoea.
VLCDs should usually not be followed for any longer than 12 weeks at a time, and they should only be adopted under the supervision of a suitably qualified healthcare professional."
see here: Obesity Treatment
The benefits outweigh the costs in limited circumstances.0 -
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2692623/figure/F2/
14% weight loss at 10 weeks vs 8‰ of bodyweight. Evidence like that, combined with things like diabetes remission (see Newcastle Diet) are why doctors prescribe these things in appropriate circumstances.0 -
strong_curves wrote: »Most of them just don't know any better.
This. Doctors have very little training in nutrition.0 -
Perhaps some doctors expect non-compliance as statistically people are terrible at estimating how much they eat, so tell patients to eat 800 calories per day when they'd be happy with 1600.0
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Thank you for the interesting discussion. I should have clarified that I didn't have in mind an extreme VLCD for an urgent medical condition. Yesterday I was reading a thread, and I've seen others like it, where a 350 lb man was on a 1300 calorie diet. It didn't sound like there was an urgent medical crisis involved, but this person had told his doctor how many calories he was eating and the doctor gave his "consent". I had a friend on my list who was recommended a 1200 calorie diet by her doctor for a condition that was serious, but not urgent (not something she could potentially drop dead from tomorrow.) I keep my mouth closed, but it frustrates me that people be subjected, or subject themselves, to such a restrictive diet when, as obese people, they could lose many pounds a week at a more moderate calorie deficit and feel better during the process. And I appreciated tomatoey's comment that, when given a doctor's stamp of approval, it tends to legitimize an otherwise unwise approach to dieting (again, barring a dire medical crisis).0
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If anyone is reading this and thinking about getting medical help from their doctor to manage their weight, don't be scared off by the negative comments about doctors. I am receiving spectacular care with weight management from a medical team.
This forum and Google are great but they can't replace a doctor's exam, blood tests and counseling. If you think you need to see a doctor, do it.
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susan100df wrote: »If anyone is reading this and thinking about getting medical help from their doctor to manage their weight, don't be scared off by the negative comments about doctors. I am receiving spectacular care with weight management from a medical team.
This forum and Google are great but they can't replace a doctor's exam, blood tests and counseling. If you think you need to see a doctor, do it.
I agree with that whole-heartedly
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Thank you for the interesting discussion. I should have clarified that I didn't have in mind an extreme VLCD for an urgent medical condition. Yesterday I was reading a thread, and I've seen others like it, where a 350 lb man was on a 1300 calorie diet. It didn't sound like there was an urgent medical crisis involved, but this person had told his doctor how many calories he was eating and the doctor gave his "consent". I had a friend on my list who was recommended a 1200 calorie diet by her doctor for a condition that was serious, but not urgent (not something she could potentially drop dead from tomorrow.) I keep my mouth closed, but it frustrates me that people be subjected, or subject themselves, to such a restrictive diet when, as obese people, they could lose many pounds a week at a more moderate calorie deficit and feel better during the process. And I appreciated tomatoey's comment that, when given a doctor's stamp of approval, it tends to legitimize an otherwise unwise approach to dieting (again, barring a dire medical crisis).
I think that person was me haha.
My medical crisis was me being morbidly obese and having blood pressure through the roof. I've started to up my calories a bit above the 1250 mark being that I'm working out more now. I'm never under 1200 on a daily basis really. We've done routine bloodwork since I've started and nothing is out of the ordinary, it's just getting my blood pressure under control and working towards getting healthier. I was going down a very bad path.0 -
Thank you for the interesting discussion. I should have clarified that I didn't have in mind an extreme VLCD for an urgent medical condition. Yesterday I was reading a thread, and I've seen others like it, where a 350 lb man was on a 1300 calorie diet. It didn't sound like there was an urgent medical crisis involved, but this person had told his doctor how many calories he was eating and the doctor gave his "consent". I had a friend on my list who was recommended a 1200 calorie diet by her doctor for a condition that was serious, but not urgent (not something she could potentially drop dead from tomorrow.) I keep my mouth closed, but it frustrates me that people be subjected, or subject themselves, to such a restrictive diet when, as obese people, they could lose many pounds a week at a more moderate calorie deficit and feel better during the process. And I appreciated tomatoey's comment that, when given a doctor's stamp of approval, it tends to legitimize an otherwise unwise approach to dieting (again, barring a dire medical crisis).
I think that person was me haha.
My medical crisis was me being morbidly obese and having blood pressure through the roof. I've started to up my calories a bit above the 1250 mark being that I'm working out more now. I'm never under 1200 on a daily basis really. We've done routine bloodwork since I've started and nothing is out of the ordinary, it's just getting my blood pressure under control and working towards getting healthier. I was going down a very bad path.
You're right!
I really am glad things are going well, and very glad you're receiving ongoing medical supervision. I would never encourage someone to go against their doctor's advice (which is why I came here to vent instead!) You seem like a very reasonable person who has educated themselves about these matters. I suspect many probably do not and take a doctor's "OK" as a blanket endorsement. I have friends on my list who started on MFP at well over 300 lbs and have lost 3-5 lbs a week at a calorie allowance of nearly 2000, and then they lower that as they go and get comfortable with the changes they've made. I guess I just wish for this kind of gentle health journey for everyone. 0 -
susan100df wrote: »If anyone is reading this and thinking about getting medical help from their doctor to manage their weight, don't be scared off by the negative comments about doctors. I am receiving spectacular care with weight management from a medical team.
This forum and Google are great but they can't replace a doctor's exam, blood tests and counseling. If you think you need to see a doctor, do it.
If I ever need medical advice on nutrition or diet I will be requesting it be with a qualified up to date RD not a GP...ever...per my family who are doctors...they refuse to give that sort of advice they feel it's tantamount to malpractice to give advice on something they aren't specifically trained for.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.
I think the biggest problem with VLCDs is that they really need expert planning. The studies you mention were pitting different rates of loss against each other, but all else was the same - the participants weren't planning their own meals and thus weren't learning how to plan their own meals.
With a higher calorie limit, it's reasonable for people to plan their own meals without needing to worry about malnutrition as long as they are sensible. Plan your own food but manage portions is the hallmark of the commercial diet plan with the best long term success, weight watchers.0 -
I read an article where hospitalized morbidly obese patients are often put on a VLCD diet, and I witnessed that first hand visiting a friend. Her diabetes was out of control and she had open sores on her legs as a result. Her afternoon snack was a single Peek Freans biscuit. She set it aside without enthusiasm.
The thinking goes this way.- Most people are playing a losing battle with their weight and cannot sustain a diet plan long term.
- For some people, their weight is literally killing them.
- Better to have them lose as much as possible while in a supervised environment, and extend their health for a little while.
I am sure this is what many family doctors witness in their practice every day. A winning story like mine is rare.
How many people are ready to engage in a program that literally takes years to complete, and many hours of training, classes, and monitoring?0 -
How many insurance companies are willing to invest in a counselling and training program that literally takes weeks and months to complete? I wonder why something like the Stanford Chronic Disease Self Management program doesn't get legs.
http://patienteducation.stanford.edu/programs/cdsmp.html
"Subjects who took the Program, when compared to those who did not, demonstrated significant improvements in exercise, cognitive symptom management, communication with physicians, self-reported general health, health distress, fatigue, disability, and social/role activities limitations. They also spent fewer days in the hospital, and there was also a trend toward fewer outpatients visits and hospitalizations. These data yield a cost to savings ratio of approximately 1:4. Many of these results persist for as long as three years."*** Studies by others have reported similar results (see our bibliography).0 -
Excellent points, jgnatca. I admit that I overlooked the role of the patient- that many facing weight-related health issues aren't necessarily interested in, or up to the task, of revamping their entire lifestyle. I suppose in these cases doctors are just trying to "stop the bleeding"- deal with the crisis at hand.0
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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.
It's hard to answer such a vague question. My niece had bariatric surgery this year, which forced her into a VLCD. The specialist works very closely with the patient to monitor their health. When recovering from surgery diet is heavily monitored, and suggested foods are typically healthy. It is extremely hard on the body. She was also overweight enough that the weight was hard on her body. So far she has lost 122lbs.
From what I understand in some cases doctors want the patient to do a VLCD instead of bariatric surgery, if this is possible, or the patient might be losing weight to qualify for the surgery in the first place. I wouldn't just assume based upon a post that the doctor is ignorant, or that what they are doing is not in the best interest of the patient. I am sure this does happen, but there are cases where what they are doing is necessary.0 -
How many insurance companies are willing to invest in a counselling and training program that literally takes weeks and months to complete? I wonder why something like the Stanford Chronic Disease Self Management program doesn't get legs.
http://patienteducation.stanford.edu/programs/cdsmp.html
"Subjects who took the Program, when compared to those who did not, demonstrated significant improvements in exercise, cognitive symptom management, communication with physicians, self-reported general health, health distress, fatigue, disability, and social/role activities limitations. They also spent fewer days in the hospital, and there was also a trend toward fewer outpatients visits and hospitalizations. These data yield a cost to savings ratio of approximately 1:4. Many of these results persist for as long as three years."*** Studies by others have reported similar results (see our bibliography).
Not many. Premiums are usually big bucks if long-term treatment for obesity is covered.0 -
The biggest problem with VLCDs is when they're poorly executed and managed regardless of why they're prescribed. Anyone who does it without a medical team and direct supervision is ...well... an idiot.
Having someone make your food for you won't teach you anything. "Give a man a fish... teach a man to fish..." The patient needs to spend a few hours with a registered dietitian and many, many hours studying to learn about nutrition and the content of food. Then they need a few months before the diet begins to put all those lessons into practice. How to weigh and log food, how and when to weigh oneself, basic exercise habits. You know... all the lessons harped on by the forums to ensure people are giving themselves and their efforts a fair shake.
I started classes with a dietitian in June. In July, my calories were cut to the minimum my body could handle safely without constant monitoring (25% below TDEE). Low Carb began in October when 25% didn't work fast enough. VLCD and bariatric surgery were in January when LC didn't work fast enough. It was a slow roll-out into a VLCD diet (and surgery) to see if better tracking and better eating would help me in the time frame I had. Slow roll-out is the key, especially when not hospitalized, because there's no sense in going extreme if that's unnecessary.
And then there's the management... the bloodwork, food log, weigh-ins, constant doctor appointments. All very necessary to keep a close eye on how fast I'm losing and how that's affecting my body. Extremely rapid weight loss can be very bad on the organs, especially kidney, liver, and heart. If that's not being constantly monitored, then it's being managed improperly.
I can't say I recommend a VLCD despite my successes. It's time consuming on my part (and not cheap) and it's incredibly expensive for my insurance carrier. In 18 months, 132k in billed expenses, although 40k was the surgery alone. Losing my hair was very hard. The skin and nail issues have been difficult to manage. With a VLCD, my immune system is highly taxed, so healing those skin and nail issues has been more difficult. It's hard work finding food I can eat that fits into the macros I have. Getting 101g of protein with less than 30g carbs on 800 calories a day and eating actual food ain't easy.
Just like bariatric surgery, if it's your only choice, then do it. Because dying ain't such a good idea. But don't just jump into it, because a VLCD can kill you too. Just like every other diet, they require dedication, hard work, exercise, and constant food monitoring. There is no magic.0 -
ki4eld-Thanks for sharing your experience- I would think that would give people a lot to think about. Again, my initial post really didn't have in mind a critical medical situation, but rather a more general situation where an obese person is encouraged to pursue an unnecessarily low calorie diet where a higher calorie diet might serve them just fine.0
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Hey, if it's just a general post without medical need or supervision, I'm going to jump into it too! Starting conversations like this helps the lurkers who won't ask for themselves!0
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