Why do doctors encourage such low cal diets/rapid loss?

SezxyStef

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.

rankinsect

Kalikel wrote: »

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.

jgnatca

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.

1. Most people are playing a losing battle with their weight and cannot sustain a diet plan long term.
2. For some people, their weight is literally killing them.
3. 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?

jgnatca

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).

try2again

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.

lyttlewon

try2again wrote: »

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.

100df

jgnatca wrote: »

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.

ki4eld

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.

try2again

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.

ki4eld

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!

brendak76

My endocrinologist told me to be on a 1500 calorie diet AFTER exercise for maintenance! She knows workout 5-7 hours a week plus I walk to work (30 minute commute total) and am very active with 2 kids. MFP puts me at over that number before any exercise is added in for maintenance. I felt like she just pulled a number out of thin air. If I went by what she told me and did not exercise at all it would be the same as eating 1100-1200 just to maintain. I would starve!!

yarwell

jgnatca wrote: »

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.

Good job, on what planet does someone with excess blood glucose need a **** biscuit ?

MondayJune22nd2015

jgnatca wrote: »

How many people are ready to engage in a program that literally takes years to complete, and many hours of training, classes, and monitoring?

@jgnatca your description, is like going to college for a career & hence this was my response, to a post about quitting; within my support group:

"My issue concerning quitting, is that I never have indefinitely. So if you (like me) desire to quit something, quit with having to lose the same weight; that you've (I've) lost before & additional weight, that you (I) didn't have to lose the previous time that you (I) quit. If necessary take a break from eating at a deficit & eat at maintenance, for a couple of weeks.

I tend to think of this commitment as a career, it's okay to take a vacation from it but it isn't okay to quit it, until retirement (completion)."

Jruzer

kshama2001 wrote: »

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.

This is what I always imagine that it was. The physician knows that the patient is almost certainly eating more than they report.

"You're not losing on 1200 kcal per day? (Rolls eyes). OK, why don't you cut to 800 kcal per day and see if that works?"