NHS very low calorie diet help

-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.

Can I just say, I don't even think this adds up right?

50 calorie fruit X 2 = 100 calories
1/2 pint skim milk = 100 calories
75 calorie veg X 2 = 150 calories
Total = 350 calories max

I think you have mis-interpreted something in the advice given. That is not even approaching "1000 calories max."

Generally I am sympathetic when people have a hard time sticking to a VLCD, but the diet plan you outlined is NOT actually something that a nutritionist or dietician would recommend for anyone for 12 weeks. So either:

1) you're leaving some crucial piece of information about the diet out, or
2) you have massively misunderstood the advice you were given
3) your "dietician" should be prosecuted for fraud and/or malpractice.

I know you want us all to go with door number 3 here. But given the history with your medical providers you've provided I'm suspecting something a little willful going on around door number 1.

Actually I stated in the original post that it included 3 meal replacements as shown in the diet plan. Also I stated I think my dietitian is doing the best he can with the data available hence why I started a topic asking for recipes that work within the limitations of the diet so i'm not munching carrot sticks every day.

To be specific, you didn't STATE this, you just included the meal replacements in the daily meal plan without comment. But in the meal plan you've included 3 meal replacement shakes. Based on the 1000 calorie limit I'm assuming that each one is about 200 calories, and you're getting about 2/3 of your daily calories from them. But how many grams of protein does each have? How much fat?

I still feel it's at best misleading and at worst a little disingenuous for you to have not included the three 200-calorie meal replacement shakes in the upfront list of foods you eat, because that upfront list suggests to the the casual reader here that your only sustenance is fruit and veg with a little bit of milk, and there is only like 10 g of protein and zero fat in the list.

VLCD diets including meal replacement shakes are NOT FOR EVERYONE, certainly not for people who are not under direct medical supervision (indeed they are a terrible idea for most people), but a medical professional will sometimes suggest them for limited periods in extreme cases like yours, partly as a way of identifying other potential problems (e.g. a food intolerance, or an eating disorder).

You say you've tried everything, but you're also suggesting you're simply not willing to give this particular plan a chance. That's entirely your choice. But then you can't say you've tried everything. And if you give up your doctor is I think at least partially justified in dismissing you as having made a valid attempt to work with him or her. If you've legitimately tried / exhausted reasonable diet plans and they didn't work, and you don't want to follow a VLCD diet, you've been tested for metabolic issues, what exactly do you EXPECT your doctor (or us) to advise you to do?

Again, I say all this from a position of someone who DOES NOT RECOMMEND VLCD diets for casual or self-directed dieters and is horrified by the idea of "meal replacements" in any form. I think they're absolutely terrible. But I believe when a doctor prescribes such a diet in concert with a nutritionist for a limited period of time there's usually a reason, and I think that giving the advice a shot for 12 weeks is not unreasonable and is something you should consider. You'll be unhappy, but it won't kill you. It's a 12 week investment in peace of mind knowing that you're actually following medical advice and giving something an honest shot. Asking a bunch of diet and fitness enthusiasts on the internet -- who incidentally know you and your habits and history a lot less well than your doctor -- for validation in rejecting medical advice is not likely to end in results for you. If you don't like this doctor's advice, fine, get other PROFESSIONAL guidance. And yes, you may have to pay for it.

For whatever it's worth, having looked at some older entries in your diary, the one red flag I see is that it looks like you're not weighing your food. Not everyone needs to weigh their food, but if you've been tracking a calorie deficit for a long time (> 2 months) with no results, this is an important thing to consider. When I was your age I used to think I was good at eyeballing portions, or that the portions served to me in restaurants were standard. I was NOT good at it, and restaurant portions vary A LOT (especially takeaway). I am not even exaggerating here: if you don't weigh portions (and when you're using database entries for generic takeaway food, making sure you're using database entries that allow you to enter things by the gram or ounce instead "per portion"), then you could EASILY be eating 2X what you think you are, or even worse. SERIOUSLY. Like, a typical takeaway container for curry may hold 16 oz of food, and the database entry for "1 portion" might be assuming about 4-6 oz per portion. A person eats half the food in the container and feels virtuous for not eating the whole thing, but you'd need to log it as 1.5 -2 portions to be accurate. Just for example. Try weighing food for 1 month and wow, it's a real eye-opener.

I was referred to them because my doctor was convinced I was stuffing my face because of my depression despite no evidence for and a lot against.
I've had multiple blood tests to check thyroxine levels over the years all coming back normal.
My new dietitian put me on this because he's found no issues with my diet at all to see if an even lower calorie rate will yield results [previous 1200 calories] and as documented evidence to my doctor that I'm not stuffing my face.

Are you on meds for the depression?

Has your doctor considered / tested you for metabolic syndrome? I've read that can stop people from losing weight even when they are exercising and eating right.

Depends is that the same as hypothyroidism?

ETA: You don't 'test' for metabolic syndrome - you fit into a criteria, it is usually used to describe a person's hightened risk of complications like CVD. Mostly it's a combination of diabetes, high blood pressure, and obesity. So rather than an actual thing in itself it's a term to describe a cluster of conditions in one individual. - Metabolic syndrome is not a "thing" that would effect your weight, as it's not an individual condition, however along the same lines - insulin resistance /// pre-diabetes is something that can make it very difficult for someone to lose weight, it's very hard to diagnose as it basically has little/un-noticable symptoms if any are present at all.

Insulin resistance and pre-diabetes are not hard to diagnose.

You can be diagnosed through a simple blood test or mixed meals test.

Has your doctor considered / tested you for metabolic syndrome? I've read that can stop people from losing weight even when they are exercising and eating right.

Depends is that the same as hypothyroidism?

Metabolic syndrome is not the same as hypothyroidism. Metabolic syndrome is a cluster of conditions. Individuals who have metabolic syndrome have: a large waistline (abdominal obesity), high blood pressure, high blood sugar, high triglycerides, a low HDL cholesterol.

There are many endocrine disorders… hypo/hyperthyroidism, insulin resistance, pre-diabetes, diabetes, PCOS, insulinoma, hyperglycemia, hypoglycemia, carcinoid disease, Cushing's syndrome, goiter's, Grave's disease, Addison's disease, pituitary tumors, adrenal cancer.

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

THis^^ x1000

Responses like this always amaze me. Did you read the thread? If the OP swears she's not losing at 1200 calories per day over a sufficiently lengthy period of time such that fat loss could not be masked by water retention, why would eating more ever produce better results in terms of weight loss? That's just illogical. What's more likely is that due to inaccuracy in logging, the OP's 1200 calories is not truly 1200 calories. Just because I log 1200 calories doesn't mean that I didn't eat 1600 or 1800 calories, and telling me to start eating more just exacerbates this problem (e.g., I log 1600 and eat 2200). What's also a very real possibility is that all of these diets the OP has tried haven't lasted long enough for the OP to see results. Yoyo'ing between various diets with breaks of uncontrolled eating in between and not sticking with any of them long enough to see results is a great recipe for getting bigger over time. But if that's the case, eating more during the diet phase of the yoyo will just make things worse. And there's always the possibility that the OP is 100% accurate and is dealing with an undiagnosed medical issue or a side-effect of a drug she's taking, but if that's the case, telling her to eat more is again just going to exacerbate the problem. In short, there's almost never a situation where eating more will break a long-term plateau or will stop long-term weight gain as we're seeing here.

This is a bit of a rant on my part at this point, but weight loss goes beyond just plugging numbers into a calculator and getting a calorie target. That simply gives you a rough estimate for your starting point and going forward you should be adjusting your targets around the results you're seeing. If you're not losing at the rate you should be over a lengthy period of time, drop the calories ~10%. If you're losing too fast over a lengthy period of time, up the calories. But it needs to be based on results, not just ballpark estimates based on someone's stats.

Just my $0.02, but the OP's doctor is probably putting her on "meal replacement" products because it's a controlled environment. I can log 1200 calories but that doesn't mean I actually ate 1200 calories, and if I'm not weighing my foods and/or preparing my own foods, it can be difficult to get a very accurate estimate. On the other hand, "meal replacement" products are fairly well controlled. A shake is always going to be around X calories, a prepackaged meal will always be around Y calories, and so on. I suspect they're recommending that sort of diet plan to see whether the OP truly can't lose at 1000 calories or if perhaps the reason for the lack of loss was inaccurate tracking. But in any event, I just can't understand all the posts saying "your doctor is a quack, eat more!"

Couldn't agree more. People haven't read the thread or diary - OP has an answer for everything and not many sound plausible.

This may sound harsh. But it 100% (still) sounds like you aren't logging accurately and consistently. And as above poster has said, probably jumped from diet to diet with periods of overeating in between. I hadn't heard of NHS dieticians recommending slimfast but it could be for the reasons above I suppose.

OP try giving this diet your best effort for more than a few weeks and if you are tempted to binge (I'd find it very hard to believe that you didn't occasionally especially if you have been depressed about your appearance and you are using such restrictive diets) then log every single thing - at least then you can look back and say, 'okay I had 3 days were I blew my calories by 1000, that explains that 1lb gain' - surely that would be better than logging 600-800 calories and saying you don't understand why you have 65 or 80 lb (depending on which was accurate) to lose and it's not happening.

If you did that, I think you would get a better take on how this works and could then probably deal with a more sensible deficit. I hope you get a handle on it and it works for you this time.

Did your dr specifically recommend Slimfast? Or just suggest any meal replacement? Slimfast is very high in sugar and low in protein. I would ask if you could use a protein shake that has higher protein and less sugar.

I have heard of people having good results with Medifast as well, altho they generally gain it back after they go back to real food. But at least you could see if you could lose weight with a strictly regimented calorie plan, which is what it sounds like your doctor is trying to find out.

You say you tried Atkins and it didn't work. Did you count calories as well as carbs? Most people who fail on Atkins are simply eating too many calories. If you eat low carb on a strict 1200 cals, you SHOULD lose weight. But you still have to be very accurate in your measuring/weighing and logging. Most people who cant seem to lose weight, even on lower calorie diets, are insulin resistant and need to go lower carb as well as lower calorie.

Regardless of whether your doctor is giving you sound advice or not, I've checked your diary and I think you're eating more calories than you think you are.

Accurate logging means weighing your solid foods. From your lunch today:
Broccoli - Raw, 0.25 bunch
Napolina - Chopped Tomatoes - Canned, 25 g (did you weigh this?)
Aldi Quixo - Vegetable Stock Cube, 0.25 cube
Medium - Yellow Onion, 0.25 medium
Slim-Fast - Summer Strawberry Milshake Powder, 2 scoops (heaping or level?)

From last Sunday:
Homemade - Ratatouille, 1 cup (did you make this recipe in the recipe maker?)

Your diary shows a lot of estimation, which works only if you're very good at estimating as evidenced by weight loss. That's not the case here, so I think you need to start using a food scale religiously.

I run a Health and Wellness Center and if any of my dietitians gave out a diet like that they wouldn't be working for me much longer. Find a new dietitian and make sure they are actually an RD and not someone who took some courses and is passing themselves off as one.

Read this post, as many times as it takes to sink in:
http://www.myfitnesspal.com/topics/show/1080242-a-guide-to-get-you-started-on-your-path-to-sexypants
If fewer calories are taken in than are burned, the person will lose weight.
Weigh &/or measure everything.

5 foot 2 inches
weight: 109kg
Activity: 30 minutes a day total aerobic and strength exercises, moderate activity rest of day.

OK, so you're 240 lb and a healthy weight range is 105-130. (48-59 kg) http://www.shapeup.org/bmi/bmi6.pdf
To maintain your current weight, you'd need to eat 2400 cal per day. (TOTAL, not net. Ignore net.)
To lose 2 lb per week, drop 1000 cal per day, so 1400 cal.
You might even lose more than that, because you have so much weight to lose.

Exercise is a bonus, but to _maintain_ a certain weight, do at least 150 minutes of moderate activity per week, which it sounds like you're doing. To lose weight, you might need to do twice that.

"Most weight loss occurs because of decreased caloric intake. However, evidence shows the only way to maintain weight loss is to be engaged in regular physical activity."
http://www.cdc.gov/healthyweight/physical_activity/index.html

Meal replacements are a bad idea, because you're not learning how to eat healthfully and as soon as you run out of money to buy their crap you'll be eating real food & not know how to handle it. Also, as others have already pointed out, many have high sugar. If you're going to try this crazy plan, find some whey protein that's high in protein and low (or no) sugar.

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.

If fewer calories are taken in than are burned, the person will lose weight.
I've been pretty successful at losing weight despite being on drugs for a brain chemical imbalance.
So has my ex-BF and usual workout partner.
Depression lowers motivation, so the person is more likely not to exercise.
Depression lowers self-esteem, so the person is more likely to overeat to self-medicate.

Seems quite dangerous. Hope you are no longer doing this

Hey, didn't read the whole thread so sorry if this has already been said...

There's a history of thyroid probs in my family, my blood tests all always came back normal and I was in a similar situation to you, eating well, exercising and my body would NOT drop weight. People didn't believe me and I was told it was just a case of calories in vs calories out, I was eating too much. I do loads of sport and ate better than I do now, until my thyroid stuff was sorted the weight would not shift.

So I did some reading. the NHS has a HUGE 'normal' range for TSH (thyroid stimulating hormone), which rises to ask your body to produce thyroxine. If your TSH is between 1 and 5 you are normal, by having a range that size they admit that everyone is different. I happen to feel 'right' at 1, so my TSH was 4.5 and I couldn't get treated, whereas if I'd been 'right' at 5 then my TSH would have been 8.5 and I would have been treated straight away. Grr.

Anyway, long story short, I argued until I was blue in the face, eventually my GP agreed to put me on a trial of thyroxine on the condition that I would drop the subject when I found that it didn't help. His face when I was a billion times better on it was amusing, but he never admitted he was wrong (although he did continue prescribing).

Not saying your problem is thyroid, but it can be a sneaky one, you can look up symptoms online, depression and anxiety is one of them - ask your surgery for the actual results and the range and pop them over to me if you like and I can tell you what it looks like to me, also see if you can get tested for free t3 and free t4 - your thyroid produces t4 (thyroxine) which it converts to t3 which your body can use. In my case my t4 levels were a bit low but the main problem was that I wasn't converting properly so my t3 was on the floor...

I found this lentil soup recipe in The Guardian a while ago, it's super filling and low calorie:
http://www.theguardian.com/lifeandstyle/2012/oct/27/readers-favourite-photographs-songs-recipes
too many lentils can be Interesting if you're not used to them, be warned

You can see the rating of your GP surgery by other people here - the people you are seeing do not seem very competent:
http://www.nhs.uk/service-search

I also doubt that reducing your daily intake by an additional 200 cals will suddenly solve all your problems, especially as you are supposed to reduce your intake the more you lose weight - you will probably end up on (minus) -100 calories (which is physically impossible).