Doctor Said 600 Calories a Day Was Okay?

mistress_kay

I've been here long enough to have a general idea of what's usually considered healthy and whatnot which is why, after a recent visit to my doctor, I'd really like your opinion. I started off at 361 pounds, and I'm down to 235, but at 235, I'm obviously still overweight. I'm okay with this, and exercise 4-5 times a week.

I recently went into the doctor to get a new primary care doctor. I recently found out I had a single gallstone, and now they want to take my gallbladder (that's a whole 'nother issue). Anyway, I've had some concern about my eating habits lately because, since the gallstone, my research has told me that a low-fat/no-fat diet is what's best for me. However, since a lot of my older diet used to have fat in it, I'm still struggling with what to eat. This means that my caloric intake has been around 600-800 a day. However, I don't feel hungry - but I feel bothered by it since it feels like I should be eating more.

Anyway, I brought this up to my doctor. His exact words were "Well, you are morbidly obese. Does this eating help you lose weight?" I answered that it did, and he said that that the caloric intake was fine as long as I was losing weight. His next statement included something along the lines of "If you were thin, then we'd have to be worried about your food intake." He then said, since I'm overweight, we should do diabetes and cholesterol testing. I'm overweight, and as I'm sure other people on this forum can attest to, as an overweight person, you do get used to this obvious bias from the healthcare community.

I'm 80% sure what my doctor said was wrong, but I'm mostly interested in this: should I keep my doctor (with the understanding that his nutritional information is BS) or should I attempt to find a new one? I want to know what experiences you guys have had since it's going to keep costing me money to try and find a new doctor (yay crappy insurance!)

CLM1227

I'd find a new doctor.

While I don't see much wrong with 600 calories if you are feeling satisfied with it, his response wasn't about satisfaction and healthy lifestyle.

We are the same weight and my doctor has never talked to me like that even while working closely with me to get my weight under control.

ichoose2believe

First ((HUGS)) I have learned that some doctors just don't care and I try not to let them get under my skin. To me 600-800 sounds too low but then again I weigh 312 so yeah. However, I think maybe you should just make sure you are getting all your food groups in each day and see where that goes. IMHO losing weight isn't everything. You HAVE to be healthy about it.
I too have had my gallbladder removed and I have had the "we should test you for ...." conversation a lot. I even had a doctor say "Wow I was pretty sure that because of your weight you were diabetic".

I would say that you should find a new doctor or perhaps a NP (Nurse Practitioner) I love mine. She can do everything that my previous doctor did, less wait time to see her and she seems to really care.

Good luck hon.

neanderthin

Well, morbidly obese people will have more fat to derive energy at around 30/cals/lb/adipose but it's still very low calorie consumption......I suspect that you'll binge frequently, which will kinda negate the low calories.......try upping the calories to around 1500 or so.....trust me you'll still lose weight. The biggest drawback for you will be daily required nutrients, which you don't want to mess with going forward.......

missiontofitness

I would report him, at minimum to the branch. His commentary was absolutely inappropriate and non-conducive to the conversation at hand.

Your caloric intake is way too low, and it will do more harm than good down the line. I would recommend speaking to someone educated and licensed in nutrition, and finding a new doctor to help create a meal plan that is helpful for your body, without overly restricting you.

daydreams_of_pretty

I would get a new doctor. Are you doing the low/no fat thing because of the gallstone? I'm asking because I accidentally went through a period of eating very low fat (under 10 grams a day and sometimes none) when I was vegan, and it really f's up your health. I lost hair and all sorts of stuff, and I was still overweight at the time. It took forever for us to figure out what was happening because I just didn't realize that I wasn't eating enough fat because it didn't seem like a possibility to me. I was a vegan for about 9 months with the low fat thing happening in the later months (at first I kind of lost it eating that high-fat coconut milk ice cream). It doesn't take long for it to start effecting you.

cathleenbowman

I do not agree with your doctor. I am morbidly obese and currently 300lbs and my doctor has told me that anything less than 1200 calories a day and your body thinks it is starving and will convert the energy to fat thinking it needs to save the calories. I have been eating this way and in 1 week I lost 8lbs. I think my doctor is on to something.
I was told by my doctor that it takes about 2000 calories a day to maintain your body functions. So keep that in mind when eating. The big thing my doctor told me is to watch the carbs. I would say you need a second opinion about that calorie intake.

mistress_kay

The ER doctors said "NO FAT" (they were very strict about this) until my gallbladder was removed. Since I think removing an entire organ from a single gallstone doesn't sound like a good idea, I've been slowly increasing my fat to see what's okay and what isn't. At the moment, I stay between 15-20 grams a day, and I haven't noticed too many health side effects. It's definitely because of the gallstone, though. I loved so many foods that had decent fat - including my old protein shakes.

cosmiqrust

find a new doctor Now. it's amazing that some of these people made it out of medical school.

newdaydawning79

Your doctor needs a reality check. I can understand the lower fat because of the gallbladder. So many people I know have had to have theirs taken out and have needed to adjust their diet accordingly. But to insinuate that you should eat that low of calories for a long period of time (and not under a very carefully monitored hospital-sponsored diet) is insanity.

Also, those people that have had to adjust their diet have never eaten that little before or since, except during times of extreme nausea where eating at ALL was daunting.

simplydelish2

Why would you stay with a doctor that didn't have your health as their main concern?

First - congrats on your weight loss so far - that is amazing!
Second - you are correct, 600 calories a day - especially with exercise is not healthy. Any doctor worth their medical license knows this.

As I understand it, a low fat diet is the best for gallbladder issues. But from what I've seen in friends and family members is that it's fried foods, way to much butter or olive oil that can cause issues. Try some healthy fats - avocados, nuts, etc. to help with the calories.

graceylou222

You should figure out your macros. Flexible dieting seems to make the most sense to me. I've lost weight the "meal prepping" boring chicken, rice, and broccoli way. It definately works, but when I cheat, I binge because I have deprived myself.. Shoot me a message and I'm more than happy to help

martinel2099

600 calories is never ok, you need a new doctor and I'd report this guy.

Chose a calorie target appropriate to your goals and weight, I'm a 5'8 male and I'm losing weight on 2,060 calories per day and that does not include calories I get from working out at the gym. My wife is eating at 1,600 calories per day not including exercise and is also losing weight.

I'd like to keep my muscle mass and not go from fat to skinny fat after reach my goal weight. Slow rate of weight loss with heavy lifting also helps mitigate muscle loss, which is my goal. I also don't want to pass out and die from only eating 600 calories per day. I suggest you do the same.

_Zardoz_

You sure it wasn't Dr Seuss?

melinda200208

I would most definately find a new doctor. 600 calories is NOT ok, even if you are overweight. Shame on him Sorryl! You want to have a good relationship with your primary doctor and he is not starting out in the right tracks. Find someone different and if you can express your concerns on a comment card or something, I most definately would.

twrobbel

Interesting post- as I just had a similar convo with my doctor (mine was much more compassionate). My doctor advised me to keep my calories at 1000. I said that goes against everything I read and hear about the body needing at least 1200 calories for BMR. I know all BMR's are different, but I thought all the talk meant that NOBODY should go below 1200.

He explained to me that he has many patients with BMR's less then 1200 and have several at 600. Yes- they only need 600 calories to keep their body functioning. He said that some people just have very low BMR's and I am one of them (I do have thryoid issues, which was why I had the appointment, because I was having symptoms- but he said my levels are perfect). My doctor is well respected by other health care workers (they rave about him everywhere I go).

So that is probably one of the reasons why your doctor wasn't concerned about eating 600 calories if you felt fine on it. Now, this doctor's bedside manner wasn't the best-that alone would be the first reason I would be looking for a new doctor.

HeidiGrrrl

It's okay. The tinfoil-hat-wearing people love to trot out the old "starvation mode" myth that was disproved over 60 years ago, but like a zombie, just won't die. How much do you think people that have had *successful* weight loss surgery are eating? Certainly nowhere near 1000 calories, much less over that. As long as your calories aren't made up by empty fluff like starchy carbs (potatoes, rice, breads, grains, cereals, etc.), and are eating dairy in moderation (although a good source of protein, is still high in carbs due to lactose), and you're filling up on proteins and veggies, you can be perfectly healthy and lose weight on that few calories. After all, veggies hardly contain any calories, so the bulk of your calories would be coming from proteins and fats. It's very hard to eat anywhere near 1000 calories worth of veggies in a day...unless you're a wood chipper.

Songbirdcw

Sorry hun, new doctor, and I pray that you find a more educated and caring one.

Kate7294

Some Doctor's have no bedside manner.
As for the 600 I've always heard never to go bellow 1200. Though I know my Grandmother's sugar was so high her Doctor told her no Carbs ( bread, pasta, rice). She did lose 20 lbs. in the first month but none since.
As for the gallstone.....I'd avoid greasy foods. Mine didn't show up on an ultra sound. My Chiropractor did suggest a supplement called A-F Betafood ( Standard Process is brand name) says take 2 per meal. I rarely took them since cutting back on the greasy food mine has calmed down.

JUDDDing

Nothing he said seems incorrect or particularly biased.

-You are satisfied at your current intake
-You are losing weight well (great job BTW)
-Morbid obesity has huge health risks (that he is probably appropriately focused on)
-You are primarily concerned about his medical advice based on other people's non-medical advice from an Internet forum
-Why would you not want tested for diabetes and cholesterol?

If you have specific concerns, perhaps you should discuss them with him or get a second opinion. Even crappy insurance surely has more than one primary physician option?

You seem very focused on calories. If you are eating quality food and satisfied with this - would you have felt better if he suggested that you should make sure to also eat a couple cupcakes every day to increase your calories to an Internet forum approved level?

As far as the gallstones go... It mostly depends on how much pain you are willing to deal with before you get it removed.

SEAFOODMAN

recommended to lose weight 1000-1600cal
or goal weight multiply by 10

bkthandler

I think you need to ask what you need and want in a primary care physican and if you can find it. Will another professional be able to help more?

Yes this MD sounds like a tool but I don't know if you are going to find much better.

I have been going to a lot of doctor appointments with a parent lately and am generally horrified at what gets ignored or glossed over. Recently we wanted to change one of the doctors and the Primary strongly counseled against it ...not because the docotr was good but because it could be seen as doctor shopping and then no one will see you. I am not happy that the issue isn't the quality of care but if the original doctor gets his feelings hurt.

I am always puzzled when people suggest talking to your doctor as if he or she knows everything. I have been overweight most of my life and doctors have said 2 things to me: "you might want to lose some weight" and "soy is good for you".

Maybe search locally for an RD attached to a hospital that isn't pushing weight loss surgery.

socalkay

If it's a financial burden to change doctors and his care has been adequate in other ways, disregard his diet advice.

I agree that your doctor was less than compassionate but it isn't prejudice to say your diet caused the gallstone or can cause T2 diabetes. Maybe that was his inelegant way of trying to warn you that you are setting yourself up for more than just gallbladder surgery if you were to continue to eat excessive fat, sugar, calories.

Menix8

Your doctor is not crazy, and you should not "report him" as other posters are suggesting. There are different approaches to weight loss for obese patients, and one of those is the Very Low Calorie Diet (VLCD). http://www.win.niddk.nih.gov/publications/low_calorie.htm

If it's working for you, you don't feel deprived, and you've got the go-ahead from your doc, there's nothing inherently wrong with your diet.

katrinadulce

Is the doctor who recommended 600 calories a day the same one who recommended surgery?
I would get a second opinion on both.
The operation may be necessary. Most people who have trouble with stones have actually had them for years, but the stones were small enough to pass without much difficulty, or they did cause symptoms, but they were mild enough that the people didn't worry about them or even know what they meant. You may have damage to your gall bladder that has been going on for a while. However, given his other comments, I would still ask another doctor. This is surgery, and all surgery is major.

The calorie intake is another matter.
#1, It really is an unhealthy range. Telling you basically that "doing whatever it takes to lose weight is fine because you are so fat" is not only inappropriate, it is medically irresponsible. Eating zero calories would also cause you to lose weight, but your fat is not going to protect you from the dangers of that behavior.
#2, rapid weight loss can actually CAUSE gallstones and gallbladder distress.
Yo-yo dieting in general puts stress n the gallbladder, and that's really what you would be doing, because eating 600 calories a day is simply not sustainable. you would end up binging, or going off the diet and then trying to go back on.
If he is worried about putting the gallbladder under additional stress before the surgery, and wants you to avoid fat because of it, fine. But he should also be concerned about stressing it with dramatic calorie reduction.

Get a second opinion before you go under the knife.
You may very well need the surgery, but even if you do, get another doctor to help guide you with a reasonable, healthy and SUSTAINABLE weight loss plan.

williams969

It's okay. The tinfoil-hat-wearing people love to trot out the old "starvation mode" myth that was disproved over 60 years ago, but like a zombie, just won't die. How much do you think people that have had *successful* weight loss surgery are eating? Certainly nowhere near 1000 calories, much less over that. As long as your calories aren't made up by empty fluff like starchy carbs (potatoes, rice, breads, grains, cereals, etc.), and are eating dairy in moderation (although a good source of protein, is still high in carbs due to lactose), and you're filling up on proteins and veggies, you can be perfectly healthy and lose weight on that few calories. After all, veggies hardly contain any calories, so the bulk of your calories would be coming from proteins and fats. It's very hard to eat anywhere near 1000 calories worth of veggies in a day...unless you're a wood chipper.

If you can get all of your daily micro nutrients (including fiber, iron, calcium, vitamins, potassium, etc.) on 600-1000 calories (no cheating, vitamin supplements don't count, we're talking food, and you say "perfectly healthy"), I'll eat a tinfoil hat. Bonus: I'll eat an entire tinfoil suit if such a diet doesn't result in anemia, severe muscle loss, fatigue, significant hair loss and reduced bone density.

mistress_kay

Two separate doctors recommended surgery. It's a single stone (I had to get my records released from the hospital for unrelated reasons, etc.), and that's the first time it's ever bothered me. I only even went to the hospital/ER because I thought I had appendicitis. Of course, the ER doctor saw I was obese and ran a panel for blood sugar as well, so at the least, I know I'm in no danger for diabetes. I'm in the lower range of normal, actually. (yay!) I believe it might be needed for some, but not a single doctor has talked to me about alternatives that I've now learned from the internet. Such as them passing or medications. It's frustrating.

I know the weight loss can cause gallstones. I imagine that's probably what caused the first one.

I'm working on trying to increase my calories against his advice, but I want to do it in a good way. i'm trying to find good low/no-fat options with high-ish protein, but I'm a bit tired of chicken and skim milk. And I can only have so much tuna before I'm concerned about mercury.

SuddenlySlimmerSusan

I would say that you need a new Doctor because you don't feel respected by him or trust his judgment. Trust and respect need to be at the core of your relationship with your primary care physician.

The 600 calories per day depends. I am one of those people who had weight loss surgery (gastric sleeve). I started at 367 lbs, and am currently at 222. I eat about 900 calories per day. (The whole point is to maintain a significant calorie deficit so that my body will use my stored fat resources for energy.) However, I am under close physician supervision, including routine blood work to test my vitamin levels and organ functions. I meet minimum daily protein goals (at least 75 grams) so that my body will not cannibalize my muscles for needed protein. (There are zero carb low calorie protein shakes! - I drink syntrax nectar.) Also I take vitamins and minerals every day, because 900 calories of food does not give me 100% of my RDA of most nutrients. So I don't think 600 calories in and of itself is a problem, but that low of a calorie diet should be closely monitored and supervised by a professional.

Best of luck to you.

MinnieInMaine

I don't think it's a bias at all. You're obese, which puts you at risk for certain diseases which can be easily tested for to rule out the risks. Also, as this is a new doc for you, it's wise for him to get a full range of tests done to see how your overall health is doing if previous results are outdated, missing from your file or if tests have never been done. After my cousin passed away from a sudden heart attack several years ago, I now get a comprehensive blood test done at my annual to rule out any hidden issues. Better to be safe than sorry.

It's my understanding that general practitioners don't get a whole lot of nutrtional education in school. Also, the science behind nutrition changes almost constantly. Just think of how eggs were evil in the not too distant past and now are considered completely fine to eat. Hell, I remember even hearing at one point that oatmeal was bad for us. So much info out there and hard to keep up.

Anyway, my point is, you won't necessarily get better advice from a different GP. How about going to a Nutritionist for a more specilized guidance?

600 is definitely too low. As williams696 pointed out, there's no way you're getting proper nutrition on that little calories. At least with 1200, while it still may be quite low for you, you're more likely to cover all the bases.

ETA: Additional thought. If you don't trust your doc or don't like his bedside manner, you should definitely find someone else. There's nothing more stressful IMHO, than having to go get serious advice about your health from someone that doesn't seem to know what they're talking about. I've had good luck thankfully but my husband has had some of the worst doctors...wish I could find someone local for him (my doc is located by my work, not home).

JUDDDing

i'm trying to find good low/no-fat options with high-ish protein, but I'm a bit tired of chicken and skim milk. And I can only have so much tuna before I'm concerned about mercury.

Lean beef
Lean pork
Wild game
Beans

parkscs

To be honest, his advice probably isn't as wrong as people are making it out to be. Your doctor is coming from the perspective of knowing the health consequences of being obese, which are dire. I can't speak for him, but I suspect he hears that you're losing weight and you're not going hungry, and thus concluded you should keep doing what you're doing to get the weight off as soon as possible for the benefit of your health. Your biggest risk eating such a deficit is probably going to be malnutrition and perhaps a bit more LBM loss, and I suspect your doctor believes those pale in comparison to the risks of continued obesity in your current state.

That sort of advice goes against the typical weight loss forum advice because it's way more aggressive than it typically recommended in fitness circles, but that doesn't mean it's wrong. Honestly, I think a lot of people take the "slow and steady" mentality way too far around here - I've seen recommendations for people that have over 100 pounds to lose to just aim for 1 pound a week, when in reality they can and almost certainly should aim to be more aggressive with their weight loss.

Not saying he's right or that you should go out and eat 600 calories, and certainly it's not a bad idea to get a second opinion, but just that the kneejerk reaction people are having to "OMG it's under 1200 calories!" is probably not warranted. We have tons of examples of obese people losing substantial amounts of weight with VLED's, with many of them keeping that weight off in the long-term. I think a lot of the posts here are well-intentioned but are overlooking the risks of continued obesity.