Is my doctor crazy?
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Seek out a second opinion from a state registered dietitian.
This particular program has several on-staff. The bariatrician prescribes the goal (and medication to those who need it), and a dietician supervises food logs and helps with suggestions about how to meet the goals. It's kind of a smart system for them to work as a team.
As an aside (not directly related to your post), people always confuse "bariatrician" with "bariatric surgeon". I'm not having surgery. A "bariatrician" is just a doctor who specializes in weight loss.0 -
I think that is about right for what a doctor would say. Both my sister and I do a 1200 calorie diet, but I do eat my exercise calories back. Only you will know whether or not your doctor's advice works for you. Protein shake or meal replacement shakes can help too. If you want to try something else find a doctor/nutritionist who agrees with your ideas. For me the 1200 calorie diet works good. (I know it's not the popular way on mfp, but it works for me).0
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I saw my bariatrician yesterday, and she wants me to drop from 1500 to 1300 calories a day, with between 80 and 100 grams each of carbs and protein. And no adding exercise calories. I weigh 270 pounds, and that seems extremely low... waaaay below my TDEE.
You should be eating way below your TDEE. TDEE is maintenance level - it's what you eat to stay the way you are. Unless you don't trust your bariatrician (an expert in weight loss for people with extreme levels of weight to lose) and plan to fire her, you might want to follow orders at least for awhile to see if it works. Typically, extremely overweight people can handle huge deficits. The rules for bariatric patients are not necessarily the same as those for average people looking to cut weight. Don't get sucked in too much by the advice of MFPers. Good luck! :flowerforyou:
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Wow, Sarah! That's great! I'm already low-glycemic. But once I get through the initial month or so of this doctor-prescribed thing, I'll look into the book and see what other tips and strategies I can glean.0
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Seek out a second opinion from a state registered dietitian.
This particular program has several on-staff. The bariatrician prescribes the goal (and medication to those who need it), and a dietician supervises food logs and helps with suggestions about how to meet the goals. It's kind of a smart system for them to work as a team.
As an aside (not directly related to your post), people always confuse "bariatrician" with "bariatric surgeon". I'm not having surgery. A "bariatrician" is just a doctor who specializes in weight loss.
Well, try maybe asking Tony. http://www.myfitnesspal.com/forums/show/13105-ask-the-dietitian
He's a Texas state registered dietitian. If you are having second thoughts about what your dietitian and doctor are telling you, maybe asking another dietitian might help put some of your concerns to rest or at least help you understand more about what is being prescribed.0 -
Im working with my doctor to break the cycle of yo yo weight gain and loss. At this point they have dropped the carbs to 30 a day and I have been loosing weight by about 2-3 lbs a week. Tons of veggies and meat. Try lowering the carbs from fruit (sugar) to veggies and see if that helps. I eat about 1800 calories daily and am now losing weight and I was faithful to 1500 calories with higher carbs for over 1 year and did not lose weight. Switched to the lower carbs and lowered the fruits in my diet and the weight is falling off in a healthy fashion.
Hope this helps.0 -
I have to admit, I lost the bulk of that 20 pounds before I joined MFP and started calorie counting. I did start here at 1200, but after reading a lot of threads about TDEE and eating more to lose more I went up to 1400. I'm trying the 1400 for a few weeks to see if anything changes. If it doesn't I might go up a bit or back down. I'm still trying to figure all of this out. But I hope you figure it out too. Best of luck.Wow, Sarah! That's great! I'm already low-glycemic. But once I get through the initial month or so of this doctor-prescribed thing, I'll look into the book and see what other tips and strategies I can glean.0 -
Joy, I'm loving that "ask the dietician" suggestion. My appointment with my doctor's program-affiliated dietician isn't until next week, so this would be a good way to check in on the advice before that appointment.0
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Is anybody here on a medical weight loss plan that does NOT involve surgery?
I saw my bariatrician yesterday, and she wants me to drop from 1500 to 1300 calories a day, with between 80 and 100 grams each of carbs and protein. And no adding exercise calories. I weigh 270 pounds, and that seems extremely low... waaaay below my TDEE.
I'm not sure whether to be excited by the challenge, or horrified at such seemingly tight restrictions. Does this seem crazy? Or is it reasonable? Is it similar to what you're hearing from your doctor?
Sounds crazy to me. But, later you mention PCOS and I understand that messes with your metabolism a great deal. I would say it is definitely bad otherwise, because I can't see how your TDEE could be any lower than 2500 calories unless you are much older than you look and are very very short. In any case 1500 would be about 1000 calories less than TDEE for most people your weight so in most cases that would have you losing weight at a pretty good clip. If I went that low I would lose weight very rapidly. Anyway, I don't see how even for someone that didn't have PCOS how dropping 200 more calories would be helpful at all, it would just make me hungrier and crankier and more prone to bingeing and I am not usually a binger. So anyway, it looks like you have been losing weight, so I don't understand what your doctor's issue is.0 -
That seems too low to me. I'd bet that at 270 pounds you can still lose easily on 1500 calories.0
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I lost easily at 1800 a day when I was at the height of my weight.
But I was weighing my food pretty religiously, counting every morsel that passed by my lips as well as possible, and I exercise vigorously. (getting heart rate consistently up over 70 percent capacity is pretty important, and I usually get it over 80.0 -
The low carb diet is made for people with PCOS.....I'm surprised your Dr. hasn't recommended that, considering the results of that diet for PCOS.Thanks to everyone for your input. I'm going to try it for a month or so and see how it goes. My doctor's hope is that with 1300 calories a day, plus at least 5 hours of cardio per week, plus resistance training, I can lost up to two pounds a month. This seems like a LOT of effort for such a small slow weight loss, but with PCOS that's how it goes. The good news is that as my weight gets lower, the hormonal imbalance also steadies which will hopefully make weight loss a little faster as I go along.0 -
I am /not/ on a doctor-prescribed weight loss plan (they said, "oh, make sure you be active and don't eat more than 2000 calories a day" like everything is that simple), and I'm definitely not a doctor, but I can tell you what's working for me!
I started off at 300.1 pounds, and was hovering between 285-292 for months. I have PCOS, and you clearly know that makes this a heckuva lot harder. I was floundering, pretty much, until my awesome friend posted this: http://www.myfitnesspal.com/topics/show/943139-weight-loss-cheat-sheet-ipoarm
I put in my numbers. I did the math. It was quick and mostly painless (other than those measurements... ouch!). Day 1, I was at 285. Three weeks in, I'm weighing in at 272.6. In the middle of this I even went out of town and had a pretty excessive day, calorie-wise, and I'm still doing awesome and losing weight. There aren't any diet restrictions, so I can eat real food that I know I love. You're not required to exercise - but if you do, you get your calories.
Honestly, I'd never suggest anything as strongly as I suggest this. It's free, and it's working for me, and the people who've put it all together are amazing at answering questions, double-checking things for you, and giving general support - and there is a Facebook page, and a group on here, as well as tons of us around that are using it. What's to lose, other than some pounds?0 -
Thanks to everyone for your input. I'm going to try it for a month or so and see how it goes. My doctor's hope is that with 1300 calories a day, plus at least 5 hours of cardio per week, plus resistance training, I can lost up to two pounds a month. This seems like a LOT of effort for such a small slow weight loss, but with PCOS that's how it goes. The good news is that as my weight gets lower, the hormonal imbalance also steadies which will hopefully make weight loss a little faster as I go along.
The weight training will help with PCOS, I think (I am NOT a doctor). But improving muscle mass improves the hormonal functioning in your body:
"When it comes to PCOS muscle mass really matters. Strength and resistance training is a very efficient way to bring down insulin levels and help with weight loss and should be part of an exercise routine for all women with PCOS. A study published in the September 2009 issue of Diabetes (1) suggests that exercise stimulates muscles to increase glycogen breakdown. By mobilizing fuel stores in muscle, the researchers propose that exercise may help to restore energy balance (i.e. insulin and glucose)." http://divapcos.wordpress.com/2010/04/01/muscle-matters-with-pcos/
http://www.pcos.insulitelabs.com/blog/3608/is-lifting-weights-as-good-as-running-for-better-pcos-health/
There are articles all over the internet about women who have success with weight training and high intensity cardio (HIIT).
I do think your calories will be too low and result in the opposite effect the doctor wants - eventually, the weight you lose will be a large percentage of lean body mass, screwing up insulin delivery even more (negatively affecting your hormonal processes). I would go to 1450 or so at the least (and that is probably too little, also).
Also, do you limit carbs? If not, you should - to less than 50grams a day (maybe less).
Whatever you decide, I wish you luck!0 -
I do think your calories will be too low and result in the opposite effect the doctor wants - eventually, the weight you lose will be a large percentage of lean body mass, screwing up insulin delivery even more (negatively affecting your hormonal processes). I would go to 1450 or so at the least (and that is probably too little, also).
This is also quite true! I hope you find and decide on something that will work well for you.
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I am definitely NOT a nutritionist nor am I a medical professional... However when you are obese it is often recommended to start at a much higher deficit than when you only need to lose 10 or 20 pounds. I was not under medical guidance during my journey, but I was 127 pounds overweight when I began and I did start with a 1200 calorie goal. I ate back exercise calories as needed when I was hungry. I started at 46% body fat and 300 pounds. I am now 26% body fat and 189 pounds. I have increased my calorie goal as I've gotten closer to my goal weight and now have it set at TDEE -20% which is 1590 calories. Again I eat my exercise calories as needed because I'm hungry.
I wish you sincere luck in your journey. The trick with calorie restriction is to eat as many whole foods as you can so you don't sacrifice your calories on foods that won't fill you up. Also use 10-20% of your calories for treats so you don't feel too restricted, which will help prevent binging and general resentment and bitterness.
Again just my opinions on what has worked for me, there's no "perfect" plan that works for everyone.0 -
If you gained 10 lbs over the course of 8 months, it would mean you ate an average of about 150 calories over maintenance. Meaning, your maintenance for that weight would be 1450 a day. Going down to 800-900 to lose a whole 10 pounds is ridiculous and you should slap your doctor upside the head.im in hte same boat. Was eating 1600 per day , eating back my calories burned since feb...Doc told me I gained 10 lb since Aug and req I go back to 1200 and not eat back my exercise calories. Hubby agrees with her. . Im doing it but not crazy about the whole idea. ehen I exercise my net calories are between 800-900 per day....0 -
I started out at 278, and for the last 10 weeks I have only gone over 1300 once or twice, usually sticking to 1200 but no more than 1400. I can still eat a lot in a day, it's just a lot more veggies and low calorie foods and I don't ever feel starved and I am losing consistently.
Give it a try...see how it works for you, how you feel after a week of sticking to it, and what your results are from it. I would believe a doctor long before I would believe the "experts" of MFP. It's all about what works for you. You have a lot of weight to lose, therefore it's okay to lose it by restricting calories. I have talked to doctors about my weight in the past and they all said the same thing your doc is saying. Lowering calories. It is not unsafe for someone with a lot to lose.0 -
The doctor is a specialist (bariatician) and has referred you to a dietician. Listen to them. If you had any other medical condition and wee speaking to a specialist doctor would you be taking notice of those on the internet off a medical specialist? I very much doubt it.0
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The doctor is a specialist (bariatician) and has referred you to a dietician. Listen to them. If you had any other medical condition and wee speaking to a specialist doctor would you be taking notice of those on the internet off a medical specialist? I very much doubt it.
FWIW, if I was unsure of/uncomfortable with the recommendations of a doctor for whatever reason, I would definitely ask the opinions of other people. Sometimes specialists don't have all the answers. As a matter of fact, when I was put on Metformin I started having serious issues when I was eating too many carbs - which was something my doctor had no idea about the correlation of, but people on the internet had also mentioned. When I lowered my carb intake, it was nothing but smooth sailing.0 -
I have PCOS too. I have worked very hard in the past to lose and saw little to no results. Now I'm reading and going by the book 'The G.I. Diet: Glycemic Index' by Rick Gallop. And have been exercising about 20 minutes a day and have lost 20 pounds in 2 1/2 months! It's really exciting for me because I've worked twice as hard in the past and saw very poor results from it, which caused me to go into a depression and I ended up giving up. Now I'm eating about 1400 calories a day, but I also eat 6 times a day. I don't feel in want of anything, I'm not hungry all the time and my sweet tooth is almost completely gone. If you like, check out the book, it's changing my life. :-)Why does she want you to lower your calories?
I would never discuss nutrition with my doctor. He does not know anything about nutrition. Most PCPs do not.
I wouldn't either, with my regular doctor. But she's a bariatrician...meaning she specializes in weight loss.
Incidentally, she also referred me to a dietician within her office to discuss my current food logs and how to work toward these goals.
Is there a reason you are discussing weight loss & nutrition with them rather than just doing it? I get the impression you don't really need them to advise you.
I have Polycystic Ovarian Syndrome, a hormonal imbalance that impacts insulin sensitivity and metabolism. It makes weight loss very very hard. It's hard for people without this issue too, of course. But with PCOS, the common wisdom is that you have to work twice as hard for half the progress.
I'm curious to know if that book was recommended by the same folks who do the show "The Food Hospital"? I started watching a show all about how choosing the right foods to eat can seriously and drastically reduce certain health symptoms, PCOS being one of them. The folks there are all the tops in their fields of diet, nutrition and obesity.
I would suggest you google "The Food Hospital" and watch the episode they have of the woman with severe PCOS and how they drastically reduce her symptoms, and she drops a lot of weight, because of the changes she made to her diet. VERY impressive.0 -
If you have a lot of fat to lose, you can get away with a bigger deficit. However unless you're on the brink of becoming very ill from obesity, or you're already at that point, losing the weight in a slow, steady and sustainable way is better, as you won't feel like you're torturing yourself in the process, and maintenance is easier.
Very low calorie diets can be used in the short term when there's a medical need to it, i.e. morbid obesity that's severe enough that the health risks of staying obese outweigh the health risks of a very low calorie diet. Additionally, someone who's carrying a huge amount of body fat will be able to get away with a much bigger calorie deficit before health problems due to a very low calorie diet kick in. So in these circumstances, the VLCD may be the best option.
If you're not in that category, then the best advice would be to follow a diet that's sustainable, that you'll be able to stick to in the long term. The aim is to reach the goal weight and stay there for the rest of your life, the goal is not to lose the weight as quickly as possible (unless you're on the brink of becoming seriously ill due to obesity, then there is a time factor in getting rid of the fat). If you're losing steadily on 1500 cals and not feeling excessively hungry, and you're doing a healthy amount of exercise, then I'd stick with that. Ask your doctor what the risks are if you stay at 1500 cals/day, i.e. will it harm your health if you lose the fat more slowly but still lose it and keep it off for life... if the answer is no, then stick with 1500 cals/day.
And nothing wrong with getting a 2nd opinion. very low calorie diets have risks, and should only be prescribed when the benefits outweigh the risks.
Also, I saw from other posts that you have PCOS... a lower carb (not zero carb, but being careful about how any and what kind of carbs you eat) can help with PCOS, so don't just watch calories, watch carbs too.0 -
Goodness, I exercised at 265 lbs. You should be at least walking each day if you can't do something more physical that is. I too agree that slow and steady wins the race. It has taken me 2 yrs to lose 90 lbs and you'll have to deal w/your lose skin too (it sucks) so you'll help yourself out in that area if you lose slowly. Good luck!0
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Not knowing your doctor, and what his credentials are, I would never tell you to go against his recommendations. What I would say, however, is, if you don't trust and have faith in what your doctor recommends, then you need to find a new doctor that you can trust. I have absolute faith in my doctor, and would do what he recommends knowing he has my health and best interests at heart. Anybody who can't say that, needs to find a new doctor.0
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I'm also at 270 pounds right now. I'm eating about 1800 cals a day and I don't eat back my exercise calories.
If I'm consistent I do lose about 1 pound a week.
Feel free to friend me.0 -
Being obese and on a very low calorie diet under a doctors supervision is much different than a very low calorie diet done on your own or a very low calorie diet when you only need to lose a handful of cosmetic pounds. If you really question your bariatrician, get a second opinion...otherwise, listen to your doctor.0
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I know it's an "evil fad diet", but I did Medifast. I was in the weight loss phase for about 9 months, started at 328 and went to 200. I am 6'4", 46 years old. I was eating a little higher than their recommendation of 800-1000 calories. I was usually hitting 1000-1100.
I didn't die. I didn't starve, or really even feel hungry. I was not cranky (more than usual), nor did I feel sick. My metabolism appears to be fine. I lost 3 to 3.5 pounds per week, approximately. As far as I know I did not lose significant muscle mass.
I did 8 weeks of transition, during which I lost down to 193 at one point. I've been in maintenance for 12 weeks and have not gained, beyond returning back up to my goal weight of around 200. I am maintaining at around 2100-2300 calories per day, which is technically lower than my TDEE. But I am not that concerned.
Take it for what it's worth. TDEE-20% isn't the only safe, reliable way to lose weight.0 -
My highest weight was 282 lbs. I weighed 266. lbs. at the beginning of the year when I started on my doctor's diet.
....Which was 1200 calories and Phentermine pills.
I dropped 15-ish lbs. and plateau'd. I put myself on 1600 calories, stopped the pills, and did it MY way. I'm down to 44 lbs. gone since mid-January, and still losing strong. I weigh 222 lbs. right now, down from 266.
My doctor used to work for the bariatric department in a large hospital around here. At my last check up, he nearly fell out of his chair when he saw how much I had lost since he had last seen me. He couldn't believe it. He had put me on thyroid pills, which I stopped cold turkey when my hair started falling out. I'm on a lot of medication for Fibromyalgia that make weight loss nearly impossible. He's never seen anything like it.
I told him everything I was doing. My calories now fluctuate from 1300 - 1500 most days. He told me I'm doing everything right, and that he was proud of me. He told me I'm doing all the right things for my metabolism by exercising and eating enough for my body. In short, my doctor ate crow that day.
My advice: You don't need a bariatric diet. I've dropped two pants sizes, and I'm about to drop another one very soon. Everyone at work looks at me in disbelief.
<---- and ignore my pics. I don't have any new ones posted.
We must have had the same dr..LOL I was told the same and took all the pills. I hated the way they made me feel so I stopped. And I was starving on 1200 calories and cranky so I stopped dieting. Now I am just trying to do it on my own..0 -
Try seeing a dietician. I have seen one monthly since I started in October 2011. I don't use any of the defaults set by mfp. My dietician reviews my food logs and adjusts my calorie intake and other percentages when needed.
I've NOT had any weight loss surgery either. Are you planning on having WLS and having to lose a certain amount of weight before the surgery?
I agree with other posters that doctors aren't the best source for losing weight. My dietician is with the diabetes unit of a major hospital and after my initial consultation, my visits only cost $13 a month. I don't have diabetes and am not pre-diabetic, but I wanted to see someone who was really knowledgeable and she has been a lifesaver. I only see my doctor for regular blood work and the discontinuation of so many meds.0
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