NHS very low calorie diet help

SLLRunner

I've been given a diet by my dietitian for twelve weeks, I was hoping people could help me find ways to makes this diet less of a strain, e.g. vegetable recipes i.e. soups/stews/roasted etc.

-Can add spices/herbs/stock
-1000 Calories max per day.
- 2 Fruit portions 50 calories max each
-Skimmed milk allowance = 1/2 pint
-2 Portions of veg [no potatoes] = 75 calories max
-No other foods allowed.


The diet:
Breakfast: 1 meal replacement + Tea/coffee with skimmed milk allowance

Mid-Morning: Tea/Coffee or low calorie drink

Lunch: Serving of salad/vegetables + 1 portion of fruit.

Mid-Afternoon: 1 meal replacement

Evening Meal: Serving of vegetables/ Salad

Bed-Time: 1 meal replacement.

Make the diet less of a strain? Dump the dietician and eat whatever you normally eat but do so at a calorie deficit.

WBB55

Unfortunately, there are medical conditions that (can) require either a) consuming a ridiculously low number of calories paired with a lot of exercise, or b) doing an "extreme" diet like Atkins. Endocrine issues are far from uncommon among women, and it largely stems from the fact that those of us with them can't really handle the low-fat/high-carb way of eating that has been pushed on us for decades. We're "incompatible," so to speak, and our body, for whatever hormonal reason, doesn't react to a sane calorie deficit of the typical Western diet by burning body fat, but rather by clocking down our processes (ie - slows metabolism). As such, unless we change the mechanism by which our body burns fuel (ie - do Atkins, keto, or something similar), some of us have to gross sub-1000 calories in order to lose weight (because that small of an amount defeats the initial clocking-down reaction and forces the body to start burning stored energy).

Does the endocrine system release other chemicals related to weight besides thyroxine?

Just about everything
edit to add: i missed the part about weight

But yes, the endocrine system releases all kinds of weight related hormones. Leptin, HGH, TSH, estrogen, ghrelin...

Meikakiri

No it isn't, my doctor has told me despite my referral from another GP that I will not receive bariatric surgery as my BMI isn't high enough at 43.

We recommend surgery for people with a BMI of 40 or higher, that have exhausted other methods of weightloss actually. So I'm not sure wth is going on with your local service.

I know what you mean and I've asked them about it but they never give me an answer and i'm sure it ignores NHS guidelines on BMI.

Meikakiri

Unfortunately, there are medical conditions that (can) require either a) consuming a ridiculously low number of calories paired with a lot of exercise, or b) doing an "extreme" diet like Atkins. Endocrine issues are far from uncommon among women, and it largely stems from the fact that those of us with them can't really handle the low-fat/high-carb way of eating that has been pushed on us for decades. We're "incompatible," so to speak, and our body, for whatever hormonal reason, doesn't react to a sane calorie deficit of the typical Western diet by burning body fat, but rather by clocking down our processes (ie - slows metabolism). As such, unless we change the mechanism by which our body burns fuel (ie - do Atkins, keto, or something similar), some of us have to gross sub-1000 calories in order to lose weight (because that small of an amount defeats the initial clocking-down reaction and forces the body to start burning stored energy).

Does the endocrine system release other chemicals related to weight besides thyroxine?

Just about everything
edit to add: i missed the part about weight

But yes, the endocrine system releases all kinds of weight related hormones. Leptin, HGH, TSH, estrogen, ghrelin...

I've only been tested for thyroxine issues because my family has a history of thyroid problems in the women.

SLLRunner

What works for you may not work for all. 1200 calories seems to work for me. Who are you to judge? What certifications do you hold?

Most people on here are going to tell you to up your calories despite the fact that you are working with a professional. I hAve been on every diet you can think of and even the ones that come with pre packaged measured food I have difficulty loosing weight.
For me to lose weight I have to either
1) cut calories to 1000-1200 a day or
2) exercise 90-120 minutes a day and eat approx 1500 calories a day or
3) do Atkins or a low carb diet

I have meticulously counted my calories over the past month measure everything and using a food scale. For the last 30 days I averaged 1496 calories a day. I have done moderate exercise about 30 min 4x a week of which twice is with a trainer. also I have a 3 month old a two year old and a twelve year old whom I would say keep me pretty active. I lost 11 pds in the first 10 days when I averaged 1236 calories and have stayed the same since then. So I have decided to stick to 1200 calories for the next month and track my progress. Every body is different, I'm guessing my bmr is lower than the average person my age/weight and I may have underling medical issue but haven't figure that out yet.

Here is one recipe I find helpful when Im hungry and don't have a lot of calories to spare:

low cal cream of broccoli soup in my vitamix.
I just threw in about a cup of leftover broccoli
3 baby carrots
1 cup unsweetened almond milk
1 cup water
1 bouillon cube
Dash of chili powder
( I usually add a chunk of tofu for creaminess and protein but ran out and it was awesome anyway)
Threw in the vitamix and put it on soup setting. Or you can throw in a regular blender then heat on the stove or microwave.

Advice like yours is just as bad as the OP'S dietician.

I actually hold several certifications.

And you promoting that people should net 1000 calories or less is irresponsible and reckless. I think you should educate yourself a little better when it comes to nutrition.

I agree with this. At first, I netted under a thousand calories with exercise because I thought that was the only way to lose weight. Then I learned that if I fuel my body properly by eating more while staying in a calorie deficit, I will have more energy to exercise, move about, and just live my life. Netting that low of calories did not last long.

Advising someone to net 1,000 calories or less is not good.

CloudyMao

Well this will depend on your local service - but we don't have a lot of clients rushed through for this. I currently have a client sitting pretty with a BMI of 48, and surgery is not being considered as an option for her yet, as we believe diet, and activity is the solution - the issue is that she is not consistent - and that is usually how it is for any individual suffering with obesity it may be a decade before surgery is considered for you - even with little-no change in your situation. Sometimes it's a funding problem too, even a band surgery can run up to £9,000, telling people to eat less is much cheaper.

---

In reply to other users still discussing the restrictive nature of a VLCD, they are temporary - and not sustainable, yes the fuel intake is too low for someone to function on if it's intended to last a long time, but they never are - even 12 weeks seems a very long time to me.

MSeel1984

http://www.win.niddk.nih.gov/publications/low_calorie.htm

This is from the NIH...
Please proceed with caution with the VLCD...not a good idea for sustainable weight loss. Please also seek a second opinion as far as the RD/dietitian.

WBB55

Unfortunately, there are medical conditions that (can) require either a) consuming a ridiculously low number of calories paired with a lot of exercise, or b) doing an "extreme" diet like Atkins. Endocrine issues are far from uncommon among women, and it largely stems from the fact that those of us with them can't really handle the low-fat/high-carb way of eating that has been pushed on us for decades. We're "incompatible," so to speak, and our body, for whatever hormonal reason, doesn't react to a sane calorie deficit of the typical Western diet by burning body fat, but rather by clocking down our processes (ie - slows metabolism). As such, unless we change the mechanism by which our body burns fuel (ie - do Atkins, keto, or something similar), some of us have to gross sub-1000 calories in order to lose weight (because that small of an amount defeats the initial clocking-down reaction and forces the body to start burning stored energy).

Does the endocrine system release other chemicals related to weight besides thyroxine?

Just about everything
edit to add: i missed the part about weight

But yes, the endocrine system releases all kinds of weight related hormones. Leptin, HGH, TSH, estrogen, ghrelin...

I've only been tested for thyroxine issues because my family has a history of thyroid problems in the women.

If you have the money, I'd recommend a couple things (though you have to pay for them)
(1) have your RMR tested. This gets an approximation of your true BMR
(2) buy a fitbit. Maybe take an inch off of the height you tell it you are, to lower your estimated BMR a bit.

A mostly liquid diet for 6 weeks or whatever won't kill you. And if you're under your doctor's care, you'll probably be ok. But I'd get a second opinion and at least try using a fitbit for at least a couple months before I did it, personally.

Dragonwolf

Unfortunately, there are medical conditions that (can) require either a) consuming a ridiculously low number of calories paired with a lot of exercise, or b) doing an "extreme" diet like Atkins. Endocrine issues are far from uncommon among women, and it largely stems from the fact that those of us with them can't really handle the low-fat/high-carb way of eating that has been pushed on us for decades. We're "incompatible," so to speak, and our body, for whatever hormonal reason, doesn't react to a sane calorie deficit of the typical Western diet by burning body fat, but rather by clocking down our processes (ie - slows metabolism). As such, unless we change the mechanism by which our body burns fuel (ie - do Atkins, keto, or something similar), some of us have to gross sub-1000 calories in order to lose weight (because that small of an amount defeats the initial clocking-down reaction and forces the body to start burning stored energy).

Does the endocrine system release other chemicals related to weight besides thyroxine?

Yes, it does. The endocrine system controls the bulk of the body's most basic functions, including maintaining weight and homeostasis. Medical causes of weight issues are not necessarily from the thyroid. Insulin level can play a huge role, as can the balance of the sex hormones (testosterone, estrogen, progesterone, aldosterone, etc), as well as other hormones, such as cortisol (the stress hormone).

I highly recommend getting your fasting insulin, estrogen, progesterone, and androgens checked, to make sure you're not dealing with some non-thyroid hormonal imbalance or adrenal fatigue.

Meikakiri

I highly recommend getting your fasting insulin, estrogen, progesterone, and androgens checked, to make sure you're not dealing with some non-thyroid hormonal imbalance or adrenal fatigue.

I'll bring up the information on my next appointment see if I can get them checked, I've lost some faith in my gp's surgery based on the harsh non evidence based analysis I received from the doctor last time, and the fact they took over a year to post my referral for surgery.

CloudyMao

I highly recommend getting your fasting insulin, estrogen, progesterone, and androgens checked, to make sure you're not dealing with some non-thyroid hormonal imbalance or adrenal fatigue.

I'll bring up the information on my next appointment see if I can get them checked, I've lost some faith in my gp's surgery based on the harsh non evidence based analysis I received from the doctor last time, and the fact they took over a year to post my referral for surgery.

From your info it doesn't appear the surgery has been very by-the-book, as it were. It can never hurt to get the opinion of more professionals, from another surgery. You may even be able to ask your dietician to recommend/refer a GP who may be more into your situation. The thing with a lot of GPs is their speciality before becoming a GP isn't related to your condition/situation - and so they need to treat you out of a text book - with obesity the text book treatment is literally - eat less and the text book cause is - the person ate too much. I don't believe it's a problem with your motivation/efforts - especially if your log is accurate, as it shows a clear deficit ---- and it'd take a hell of a lot of motivation to keep me chugging down meal replacements (ew) Yeah, it really doesn't hurt to visit another practice, really stress with any other professionals (and indeed the one that made the assumption themselves) that you found the assumption was very dismissive of your issue/situation, and you are concerned that your efforts are being diminished as opposed to finding out why everything you're doing isn't working.

It's a huge issue with anything weight related in the field, it doesn't matter how much someone diets - our books tell us "the individual just isn't being healthy enough/putting in enough effort" it is a concern when there's other possible medical conditions. You sound like you have enough faith in you dietician, but honestly I do not believe you're seeing him enough to be on a VLCD - there should be at least weekly observations, it's potentially quite dangerous.

Athijade

What really REALLY concerns me is that they are suggesting this to someone who has depression. As someone who deals with depression (and a few other things), that diet would only make me feel horrible and most likely make things worse. In general, diet can be an important aspect at controlling depressive episodes (along with getting enough sleep). I know from personal experience that under eating at that amount would cause my depression to actually get worse.

BlueBombers

OMG I would die on that diet.

I say find a new dietician, that's just insane.

Dragonwolf

Unfortunately, there are medical conditions that (can) require either a) consuming a ridiculously low number of calories paired with a lot of exercise, or b) doing an "extreme" diet like Atkins. Endocrine issues are far from uncommon among women, and it largely stems from the fact that those of us with them can't really handle the low-fat/high-carb way of eating that has been pushed on us for decades. We're "incompatible," so to speak, and our body, for whatever hormonal reason, doesn't react to a sane calorie deficit of the typical Western diet by burning body fat, but rather by clocking down our processes (ie - slows metabolism). As such, unless we change the mechanism by which our body burns fuel (ie - do Atkins, keto, or something similar), some of us have to gross sub-1000 calories in order to lose weight (because that small of an amount defeats the initial clocking-down reaction and forces the body to start burning stored energy).

No need to try and turn this into a metabolic damage situation to justify 1000 calorie diets. That's not what I'm talking about. I'm talking about the snowflakes that don't have metabolic issues that managed to become overweight but not can only lose on 1000 calories. Absurd.

The OP isn't necessarily a "special snowflake that [doesn't] have metabolic issues yet still can't lose weight." A number of people here have already stated that it's "impossible" to not lose weight on 1200 or fewer calories, yet that's what appears to be happening here (it's kind of hard to miscalculate pre-made/individually-wrapped meal replacement shakes by that much). It is, in fact, possible to not lose, and even gain, weight on a stupidly low caloric intake if there's an underlying medical condition complicating matters, and just because it hasn't been diagnosed yet, it doesn't mean it's not there. The OP has stated that her thyroid has been checked several times (and even then, it seems only the T4 was checked), but the thyroid is far from the only part of the body that controls weight outside of the usual hunger/full signals. From the sound of it, they haven't even touched the other 95% of the endocrine system.

I don't like the idea of doing insanely low calorie intakes, either (even with medical conditions), which is why I generally advocate changes in diet (yes, even to the "extreme" diets of Atkins/keto), but that is exactly what a lot of medical professionals do, because the idea that "fat = bad" is so ingrained (or they're bound by stupid laws) that they can't recommend a ketogenic or similar diet that drops carbs and increases fats, or anything else that manipulates what the person is eating, instead of just how much, and since weight loss is supposed to only be about "calories in vs calories out," the logic follows that if you're not losing weight, you're eating too much. In my opinion, when you're starting to recommend the amount of food and activity level that's akin to an Auschwitz prisoner, it's time to rethink the idea that calories are the only thing at issue here. It makes more sense that there's something else interfering with the weight loss.

FatFreeFrolicking

Your dietician is a quack.

Since you don't have any endocrine disorders, your problem is probably Prozac. Anti-depressants are notorious for weight gain. The longer you stay on them, the more weight you put on. It can be very difficult to lose weight while on anti-depressants.

What is this so called "meal replacement?" Any diet that makes a person consume 3 meal replacements a day is BS and a gimmick.

Find a new dietician who is licensed and who promotes REAL food (and doesn't limit vegetable intake to 2 portions a day), not meal replacement shakes/bars.

fatboyliz

NHS can often be bad at running tests due to costs. And GP's can get very funny when you say 'can you please test for this..' Or 'I think I may have this...' It is a total nightmare. Push for more information, don't be afraid to question their judgement - they are doctors, not magicians and they don't always have all the answers! Best of luck.

teenie_71

Find a new dietician.
With 65lbs to lose, there is no reason to eat that little.

THis^^ x1000

jenanon1

You poor poor thing, I feel for you that your doctor doesn't believe you and you are having to go through this to prove that you can't lose weight
I'm absolutely not suggesting that this is the case for you, but I have had similar problems until I started logging accurately, weighing and measuring, but my weight still doesn't go down like it should, my tdee is loads lower than the textbook says it should be. The only way to find out how your body works is to log religiously and consistently for a long time and crunch the numbers. If this doesn't work then maybe it's time to eat more and see where that gets you, you never know.
Hugs.

defauIt

It is literally impossible not to lose weight on 1200 calories a day at 240 pounds without some serious medical condition.

There are only 2 options:

1) You're eating way more than you think
2) You have an extremely rare metabolic disorder

To be honest, I'm not even aware of a metabolic disorder severe enough to cut your metabolism by over 50% but I'm not intimately familiar with all of them.