Disappointing drs appointment - advised 1200 cals

LernRach

Good morning,

Will give a little history before I pour out my heart! I have a Mixed connective tissue disorder, was put on steroids in pregnancy a year ago and still not weaned off. In addition, I have PCOS. All in all, that makes it very very challenging to lose weight! In the 9 months post pregnancy, I have dieted, like proper dieted, no fads. I did Slimming world, I didn't lose, I went off gluten and sugar - I didn't lose... I exercised - I didn't lose.
Eventually, I went to my GP, hoping he would refer me to a dietitian who could perhaps work out if there was a group of food that was stopping my weight loss. He said, its great that I haven't gained, considering the steroids etc. But I should reduce calories, 100 a month. There will be a time where my body will drop weight, it may take time to find out what the number is! HE said I should keep trying until i get to 600 a day, and if i really get to that and don't lose, then I should I go back to him!!!! WTH

Anyway, 1200 calories it is! my question is, when I exercise (yesterday I burnt 850 calories!!!) do I eat those back? are they counted? If not, that means I consumed all of about 400 calories yesterday!!! I know that the HRM aren't entirely accurate, so it wasn't precisely 850, but even so...

What you think?

RodaRose

Yes. Eat about half of them back.
He is wrong about the 600 calories. Ask him to send you to a dietician who knows about food and diet.

Here is a guide with links.
http://www.myfitnesspal.com/topics/show/1080242-a-guide-to-get-you-started-on-your-path-to-sexypants

jennifer907

I don't know anything about the conditions you have, but 600 cals a day is drastically low. Even 1200 is too low in my opinion. I've literally stalled out on weight loss from eating too little, so I'm a big advocate of the "eat more to weigh less" train of thought. If you are just eating 1200, I'd say definitely eat back the exercise cals.

MissTomGettingThin

Eat them all back. Fuel your body

Arachnapheria

Your doctor sounds like a hack! I'd defo ask to be referred to a dietitian (and if he won't then I would find a new doctor).

As for exercise calories, eat them back as you are already at a deficite without exercise.

(As a side note: dairy intolerance can inhibit weight loss so in the mean time, if you haven't already, you could try reducing or eliminating dairy from your diet for a couple of weeks to see if that makes any diference)

LernRach

I don't eat that much dairy - only one coffee in the morning!

Dr isn't a hack - he said the wait to see a dietitian is months on end, and seeing as I am a sensible person, who knows about dieting etc, it is unlikely they can tell me anything I don't know already!

Steroids can often make you gain weight, increase appetite, store water weight etc.
PCOS is a hormone imbalance that also causes weight issues...

I didn't eat calories back yesterday and I wasn't hungry, but woke up this am absolutely starving... like shaking starving..

IHateThinkingOfAUsername

I'm not advocating a 600 calorie diet... but...

Just to clarify did he mean you should reduce your daily calorie allowance by 100cals each month until you start seeing a weight loss and then continue at that level?

So suppose you are eating 1800 at the moment daily, you try 1700 daily.
If there is no weight loss, next month you try 1600 daily.
No weight loss, try 1500 daily the month after.
Then suppose during that month you find that you've lost some weight then you carry on eating at 1500?

Seems kinda sensible to me. After all the reverse is often suggested as a way to find your maintenance calories.

Chances are you'd find you started to lose weight before hitting that ridiculous 600 figure.

(*edit to say* - all of these figures should be net calories).

LernRach

yup, that's what he meant! He said there are morbidly obese patients who he puts on 600 calories prior to surgery or something and they watch them closely etc. But Im 5 7 and weigh 192, so whilst Im overweight, Im not huge if that makes sense!!

When you say net, you mean eating back right? But do I take into account that unlikely to be accurate so eat back a couple hundred less then Polar says, or do I eat same amount??

tranquility17

I know a few people with PCOS who have done well with a reduced carb diet or low GI/GL diet. It is always a slow loss process though with this condition.

You are entitled to a referral if your request one.

LifeModel

With PCOS ask to see an endocrinologist or maybe a doctor who specialises in womens health or diabetes.

Its helped me to chat with a doc on a regular basis who knows the difficulties of having PCOS

Ask to be put on metformin and oristat. Both will help with the weight loss. (promise!) and also with PCOS symptoms

I also have PCOS and am on both -I've lost 2 stone in 6 months.

Weight loss is a slow process but not unachievable with PCOS.

I stick to between 1200 and 1500 cals a day.

I tend to eat a maximum of half my calories back.

If you want add me as a friend so you can see what Im eating.

IHateThinkingOfAUsername

yup, that's what he meant! He said there are morbidly obese patients who he puts on 600 calories prior to surgery or something and they watch them closely etc. But Im 5 7 and weigh 192, so whilst Im overweight, Im not huge if that makes sense!!

When you say net, you mean eating back right? But do I take into account that unlikely to be accurate so eat back a couple hundred less then Polar says, or do I eat same amount??

It's up to you. Some eat all, most each half-three quarters back, few each none. Nothing is ever going to be 100% accurate. As long as you're good enough with your logging it should work.

As far as the 600cal strict diet prior to weight loss surgery goes, I am imagining that those patients do so with appropriate medical supervision. With your medical history (including the steroids) it may be that you struggle to lose weight with conventional means. But trying the 'drop 100 cals a month' thing outlined above gives you a good chance of investigating and finding out if it will work without just jumping right in at the deep (or very shallow) end. There would be nothing to stop you going back to your doc in 4-5 months when you're at 1200 calories and saying 'what now doc?'

prensis

I have PCOS too. Reducing calories alone doesn't really help. Check out low-carb - please don't think of it as a fad diet.


Check this out : The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: A pilot study - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1334192/.

"This pilot study showed that adherence to a low-carbohydrate, ketogenic diet led to improvement in body weight, percent free testosterone, LH/FSH ratio, fasting serum insulin, and symptoms in women diagnosed with PCOS over a six-month period. Further research is needed to determine if the benefits were from weight loss or from carbohydrate restriction specifically."


Low carb is generally beneficial for PCOS. Check out this article too: http://www.medpagetoday.com/Endocrinology/GeneralEndocrinology/39302

"Despite the higher fat content of the lower-carbohydrate diet, patients' lipid profile improved significantly on this diet, the researchers wrote. The standard diet, on the other hand, led to declines in HDL cholesterol and increases in the total-cholesterol-to-HDL-cholesterol ratio."


It's definitely helping me!

LernRach

interesting... going to stick to just counting calories for now, and aiming for eating healthy, and once I'm a bit used to it, I will cut carbs, increase protein etc.... limit to how much I can focus on at once!! i want to see if tho sis what will kickstart my weight loss!! wanted to try for another kid in about 3 months, but can't possibly even think about it at this weight

AllOutof_Bubblegum

This is no reflection on you, OP, but your Dr. is an unbelievable idiot, and you should get a new one, pronto. Or at the VERY least, stop taking this one's advice on diet and find a registered dietitian for nutrition counseling and advice.

So many people don't realize how little schooling in nutrition doctors need to earn their degrees. It would be laughable, if it weren't so horrifying. I am a sophomore dietetics student, and I can guaran-damn-tee that I've received more education in nutrition than any general practitioner. THAT is how little schooling they get. It's awful.

With that said, educate yourself, since clearly and sadly we cannot always rely on our doctors to know what the hell they are talking about. Find your TDEE, and eat just below that. Under no circumstances should you be aiming to work down to 600 calories a day, that is completely asinine and very irresponsible advice from your doctor.

Go to

http://iifym.com/tdee-calculator/

and enter your height/weight/activity level.

Subtract 10-20% from the number it calculates for you, and that is the number of calories you should be eating a day in order to lose weight. With this method you do not eat back your exercise calories, as they are already figured into your daily goal.

Good luck.

FindingAmy77

Yes. Eat about half of them back.
He is wrong about the 600 calories. Ask him to send you to a dietician who knows about food and diet.

Here is a guide with links.
http://www.myfitnesspal.com/topics/show/1080242-a-guide-to-get-you-started-on-your-path-to-sexypants

please get a second opinion from a registered dietician or nutritionist. 600 is way too low.

Eselte

yup, that's what he meant! He said there are morbidly obese patients who he puts on 600 calories prior to surgery or something and they watch them closely etc. But Im 5 7 and weigh 192, so whilst Im overweight, Im not huge if that makes sense!!

When you say net, you mean eating back right? But do I take into account that unlikely to be accurate so eat back a couple hundred less then Polar says, or do I eat same amount??

5'7 and 192?? That's not even that bad. By reading your first post I assumed off the bat that you were 400+ lbs judging by the doctor's recommendations. I hope you are able to straighten it out soon.

Kate7294

PCOS here too. Also on Metformalin. I would suggest cutting out white carbs. Switching to brown or wheat as much as possible. I still eat carbs just try not to eat the refined( white). When I used to eat biscuits with husband in the morning I found I was groggy within an hour.

HEATHERACU73

You know what they call a person that graduates last in his med school? Doctor. That's a joke I tell my patients as an acupuncturist when they talk about how their doctor screwed up their surgeries etc.

If my doctor gave me the advice he gave you, I'd go find another one. He doesn't understand nutrition and why should he? Until the last decade, doctors only spent a semester in nutrition.

karenj_m

Yup....you're going to need a nutritionist who understands PCOS and the mixed connective tissue disorder.

PCOS already has it issues with obesity, and you are taking steroids for the MCTO ....which definitely puffs you out depending on how much you have to take (my mom has Lupus).

A nutritionist might be able to cut thru the chase.

Good luck
Karen

meridianova

Ask to be put on metformin and oristat. Both will help with the weight loss. (promise!)

i'm sorry, but... no. hell no.

metformin is for people who are insulin resistant. unless you've been properly tested and diagnosed, taking a drug meant to alleviate a problem you don't have is just stupid. people on metformin have been known to lose weight as a side-effect, but only when insulin levels are too high and are inhibiting the body's natural ability to burn fat.

orlistat (brand name alli) is a weight loss drug, but its purpose is to bind with fat and prevent it from being absorbed by the body. you still have to be conscious of calorie intake. so unless you enjoy having ultra-greasy poops, from what i understand the point is that it changes your behaviors to eat less fat. but since a lot of vitamins need fat in order to be properly absorbed, i can't help but think that this would also inhibit that process.

i hate this culture we've gotten into of "oh, you want to do this? ask your doctor to prescribe this other drug (that's meant for people who have this totally valid, serious, and specific condition) even though you don't have the condition yourself!" it's far too easy to screw up your body further by taking prescription drugs that aren't meant for you.

BusyRaeNOTBusty

Start with the 1200 calories. Eat your exercise calories. Do this for 4 weeks. See what happens.

Synchronicity

I disagree with those condemning the doctor. Prednisone and PCOS is going to make it very difficult to lose weight, and under medical supervision (KEY WORDS: MEDICAL SUPERVISION) a 600 calorie a day diet can be safe for a relatively short time. Its not something you want to make a life out of, but there's not really any reason to lynch the doctor especially since he didn't send you straight to 600 and instead asked you to step back bit by bit until you find the calorie intake you need to lose. You will probably start losing well before you go so low.

But I do agree with those saying insist on seeing a specialist. Sometimes, you just need to be pushy, and I think this is one of those times. You'd be better off in the long run.

Synchronicity

yup, that's what he meant! He said there are morbidly obese patients who he puts on 600 calories prior to surgery or something and they watch them closely etc. But Im 5 7 and weigh 192, so whilst Im overweight, Im not huge if that makes sense!!

When you say net, you mean eating back right? But do I take into account that unlikely to be accurate so eat back a couple hundred less then Polar says, or do I eat same amount??

The thing about eating back exercise calories that you need to be careful of is that MFP is overly generous about the calories burned in each exercise. So, based on MFP's recommendations, you might think you are burning 850 calories, but you really are only burning 425 calories (or something like that). If you eat back all of your calories, then you over-eat by 425 calories, which can hinder wait loss.

So... for me personally, I prefer to set my calorie consumption higher (1500-1700 range) and not really worry about exercise calories. But if you are at 1200 calories, that's already low enough to make most people uncomfortable and hungry, so I'd eat back some but not all of your calories. I'd also focus on lotsa protein to keep you full if possible.

AllOutof_Bubblegum

Start with the 1200 calories. Eat your exercise calories. Do this for 4 weeks. See what happens.

No. Do not start on 1200. Start at just below your TDEE. 1200 cals is not a one-size-fits-all number, it is for extremely short (significantly under 5 feet) and sedentary (meaning bedridden or wheelchair-bound) people.

onionparsleysage

Ask to be put on metformin and oristat. Both will help with the weight loss. (promise!)

i'm sorry, but... no. hell no.

metformin is for people who are insulin resistant. unless you've been properly tested and diagnosed, taking a drug meant to alleviate a problem you don't have is just stupid. people on metformin have been known to lose weight as a side-effect, but only when insulin levels are too high and are inhibiting the body's natural ability to burn fat.

That's an uneducated reply. The OP knows that she has PCOS, which is strongly linked to insulin resistance. That's why the lower carb diets are so important for losing weight with that condition. And it also means that women with PCOS are often put on Metformin to help with losing weight even if their bloodwork doesn't show insulin resistance outright.

OP: Here's an interesting article on switching your calories around during the day to lose weight (specifically for PCOSers). Those who ate a large breakfast did much better than those who ate a large dinner. I've tried it a few times, but social pressures meant I was just eating a large breakfast AND a normal sized dinner. http://www.medicalnewstoday.com/articles/264791.php

600 kcal/day sounds like a good gateway to anorexia. I don't think I could keep my jaw off the floor if anyone recommended that to me. You're a bit overweight, so you'll reach your goals with sensible diet & exercise.

BusyRaeNOTBusty

Start with the 1200 calories. Eat your exercise calories. Do this for 4 weeks. See what happens.

No. Do not start on 1200. Start at just below your TDEE. 1200 cals is not a one-size-fits-all number, it is for extremely short (significantly under 5 feet) and sedentary (meaning bedridden or wheelchair-bound) people.

In general, I'd agree with you. I eat 2000 to lose. However OP has PCOS, is on steriods and has a connective tissue disorder which I assume will get better with weight loss. I'm guessing that this is why her doctor is pushing it so hard, and why rapid weight loss might be preferred over the usual slow and steady. I have seen many doctors throw out the 1200 number without taking the patient's needs into consideration but in this circumstance this doesn't seem to be the case.

kelfran1

I don't have any advice, just a question. What workout did you do to use 850 cal (or even 425, as Synchronicity suggests) in one session? I think the most I've ever used was ~350 doing Insanity. Now I'm wondering if there is some crazy exercise that I should be adding to the schedule.

Irenaekl

Did he specifically tell you to start at 1200 cals per day then reduce until you were on 600 per day or did he mean to reduce by 100 cals per month until you had reduced BY 600 cals. I think you should check with him exactly what he meant.

JennyBilyeu

Your body needs at LEAST 1200 calories a day just to sustain itself. Eat back at LEAST half of your burned cals, if not all of them. I'm on 1200 a day, and I eat extremely well, and am always full, so it is possible, I promise.

cabive

When Doctors tell you to lose weight, in theory most Doctors seem to think just cut your calories and it will work ( usually the skinny Doctors say that). But with the health ailments you have you definitely need to see a nutritionist and one that specializes in woman's health i.e. PCOS. I am seeing a Doctor who has his patients see a nutritionist in conjunction with his visits.

I am on a 1200 a day low glycemic diet. He put me on glucophage as an earlier responder also said and it did wonders for my weight loss. I am not a diabetic but for some reason the glucophage helps control your sugar and allows for the pounds to come off. You should read Dr. Louis Arrone's book "The Skinny", I think it will give you some insight to achieving weight loss.

lkhaycook

Start with the 1200 calories. Eat your exercise calories. Do this for 4 weeks. See what happens.

No. Do not start on 1200. Start at just below your TDEE. 1200 cals is not a one-size-fits-all number, it is for extremely short (significantly under 5 feet) and sedentary (meaning bedridden or wheelchair-bound) people.

The problem with a TDEE calculator is there are some medical conditions and circumstances that cause people to have a lower basal metabolic rate so I think you are going to have to experiment a bit. A TDEE calculator will give you an idea what calories should be consumed for someone at your height/weight/age without a medical condition. I assume you are probably a little lower than that number. Hang in there!