Why do doctors encourage such low cal diets/rapid loss?
try2again
Posts: 3,565 Member
Why do doctors so often (according to posters) sign off on or even prescribe extremely low cal diets? Even if there is concern about a medical condition, isn't this extremely hard on the body and much more difficult to achieve, sustain, and later transition from to maintenance? It seems extremely counter-productive and like it's setting people up for failure. I'd especially be interested in a doctor's point of view.
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Guessing that they think that losing the weight fast is less dangerous than the extra weight is. Most doctors are clueless about nutrition though.0
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Most doctor-approved VLCD that I've heard of have been for limited time periods and prescribed for extremely overweight people who have sufficient energy stores (i.e., fat) to take them through them. They are not meant to be long term weight loss strategies but, instead, are meant to be used for a period of weeks before transitioning to more moderate deficits.
Here is some info about VLCDs and why doctors may prescribe them: http://www.niddk.nih.gov/health-information/health-topics/weight-control/very-low-calorie-diets/Pages/very-low-calorie-diets.aspx0 -
I think the problem is an outdated point of view: one, that the benefits of the loss outweigh the additional strain on the organs, and two, that simply losing weight will "cure" obesity, so the person will be just the same as anyone else of the same weight. The latter is certainly false. The former is possible depending on the person.
Also, I suspect many VLCD proponents aren't accurately portraying things - either not telling their doctor how fast they intend to lose, or taking their doctor's advice to lose weight as a carte blanche approval of any diet however extreme.0 -
Many different reasons because there are many different doctors and patients!
Next time you're at the doctor, ask him!
They know more than people here do, generally. Most people here google for info. Doctors have google, too, but they also have years of studying and instruction, then experience treating patients and talking to other doctors. So, they have their reasons and many of those reasons would require someone to spend years being instructed and studying to understand.
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because a doctor unless a specialist in nutrition and diet only gets 23.9 hours of nutritional/diet course time in their entire school career per this article
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2430660/
along with speaking to a few doctors in the family who have told me that their training in nutrition is dismal and they refuse to give patients advice but instead refer them to a RD (register dietician)
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My understanding was that losing slowly shows no greater advantage than losing quickly, as far as gaining the weight back is concerned.
And there's a point where people lose motivation to focus on their weight and consumption, so I think the logic is that it's better for someone who needs to lose 100 lbs to have lost most of that weight before they lose motivation, than it is to have lost only 50 of it when they reach that point. But a person who is 100 or more lbs overweight, even if they give up after a month it's probably better for their health if they lost 20 lbs in that time instead of, say, 5 lbs.
Also I think a lot of doctors prescribe vlcd to prepare patients for other medical things they need where time is of the essence, like surgery.0 -
Most doctor-approved VLCD that I've heard of have been for limited time periods and prescribed for extremely overweight people who have sufficient energy stores (i.e., fat) to take them through them. They are not meant to be long term weight loss strategies but, instead, are meant to be used for a period of weeks before transitioning to more moderate deficits.
Here is some info about VLCDs and why doctors may prescribe them: http://www.niddk.nih.gov/health-information/health-topics/weight-control/very-low-calorie-diets/Pages/very-low-calorie-diets.aspx
Thank you for the link.
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Lourdesong wrote: »My understanding was that losing slowly shows no greater advantage than losing quickly, as far as gaining the weight back is concerned.
And there's a point where people lose motivation to focus on their weight and consumption, so I think the logic is that it's better for someone who needs to lose 100 lbs to have lost most of that weight before they lose motivation, than it is to have lost only 50 of it when they reach that point. But a person who is 100 or more lbs overweight, even if they give up after a month it's probably better for their health if they lost 20 lbs in that time instead of, say, 5 lbs.
Also I think a lot of doctors prescribe vlcd to prepare patients for other medical things they need where time is of the essence, like surgery.
It was my understanding (I have not researched it) that studies have shown that those who lose weight more slowly have better long-term success rates. As to losing motivation, that's exactly my point- why put people on an extremely restrictive diet that isn't sustainable only to have them drop some weight and immediately return to their old eating habits?0 -
Most of them just don't know any better.0
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Part of a VLCD should also be education. That's usually the piece that's lacking and one of the reasons why so many failures happen. If you don't address the behavior, the problem still exists. People don't become obese because they have good habits and new habits take time to learn.
I'm one of those prescribed a VLCD. I've been on it for a year. I'm now coming off it, but going up to a normal level of calories will take a few months. It was either allow the doctor to starve me (and he cut up my guts as well) or die of heart failure in a year. I chose starvation and surgery over a casket.
Yes, there's been education. That started before the diet or surgery began. I now have a way of eating that works for me and that I can sustain long-term. And yes, there's monitoring. Lots of it. Weekly bloodwork and weigh-ins, a public diary so my med team and insurance company can monitor me, and a heart monitor that I wear all the time. There have been plenty of complications, but they were better than dying.
It's a medical tool and it can be life-saving. It can also be mis-prescribed or poorly managed.0 -
Most of the studies say that isn't true. It doesn't matter how quickly the weight comes off. The success rates are the same, either way.Lourdesong wrote: »My understanding was that losing slowly shows no greater advantage than losing quickly, as far as gaining the weight back is concerned.
And there's a point where people lose motivation to focus on their weight and consumption, so I think the logic is that it's better for someone who needs to lose 100 lbs to have lost most of that weight before they lose motivation, than it is to have lost only 50 of it when they reach that point. But a person who is 100 or more lbs overweight, even if they give up after a month it's probably better for their health if they lost 20 lbs in that time instead of, say, 5 lbs.
Also I think a lot of doctors prescribe vlcd to prepare patients for other medical things they need where time is of the essence, like surgery.
It was my understanding (I have not researched it) that studies have shown that those who lose weight more slowly have better long-term success rates. As to losing motivation, that's exactly my point- why put people on an extremely restrictive diet that isn't sustainable only to have them drop some weight and immediately return to their old eating habits?
The odds are against us, as keeping it off goes. Most people regain it, but it has nothing to do with how fast they lost it.
The reasons people get put on low or VLCDs are many and sometimes multi-faceted. They're generally medical reasons, though. It doesn't matter how much the doctor knows about nutrition. Even if they do know a lot (and some do), they will generally not be spending much time on it. There are dieititans for that. They make decisions based on the person's condition...and based on their own, personal beliefs/experience on what works best.
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A morbidity obese person will loose more quicker on a 2000 a day calorie diet than a 20lb overweight person will. Also what doctors are you talking about?0
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From what I've read, it's because the health of the person involved is in very serious state. It's either/or time. Either lose or die.
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I think we need to remember that Doctor's aren't nutritionists.
When my Doctor told me I was overweight and needed to lose, his first 'tip' was "Cut your carbs". Wildly inaccurate and something I'm glad I didn't act on.
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Part of a VLCD should also be education. That's usually the piece that's lacking and one of the reasons why so many failures happen. If you don't address the behavior, the problem still exists. People don't become obese because they have good habits and new habits take time to learn.
I'm one of those prescribed a VLCD. I've been on it for a year. I'm now coming off it, but going up to a normal level of calories will take a few months. It was either allow the doctor to starve me (and he cut up my guts as well) or die of heart failure in a year. I chose starvation and surgery over a casket.
Yes, there's been education. That started before the diet or surgery began. I now have a way of eating that works for me and that I can sustain long-term. And yes, there's monitoring. Lots of it. Weekly bloodwork and weigh-ins, a public diary so my med team and insurance company can monitor me, and a heart monitor that I wear all the time. There have been plenty of complications, but they were better than dying.
It's a medical tool and it can be life-saving. It can also be mis-prescribed or poorly managed.
This.
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The long term success rate of most diets is poor, if it's safe and appropriate to lose faster for 8 weeks then more fat will be lost before the patient gets bored and gives up. They may even stick it out for longer having seen better results.
Most national bodies support the use of VLCDs in obese patients esp with comorbidities like diabetes or hypertension. Committees review evidence and produce guidelines summarised in articles like http://www.gponline.com/role-low-calorie-diets/nutrition/article/9946490 -
strong_curves wrote: »Most of them just don't know any better.
truth0 -
The long term success rate of most diets is poor, if it's safe and appropriate to lose faster for 8 weeks then more fat will be lost before the patient gets bored and gives up. They may even stick it out for longer having seen better results.
Most national bodies support the use of VLCDs in obese patients esp with comorbidities like diabetes or hypertension. Committees review evidence and produce guidelines summarised in articles like http://www.gponline.com/role-low-calorie-diets/nutrition/article/994649
That's such a weird logic. If they give up at any point and regain, having lost a bit quickly for a short period doesn't make much of a difference, does it?
Other than the fact that this generally dangerous way of eating has now been legitimized for them, and they'll probably now have some distortions going on around food?
And if they gain back more than they lost (very common), they'll lose ffm and increase body fat % (more adiposity = more risk for lifestyle diseases, usually), & experience additional consequences to their metabolism, right?
Does this actually work for most long-term? (Long-term, not 1-2 years)0 -
Part of a VLCD should also be education. That's usually the piece that's lacking and one of the reasons why so many failures happen. If you don't address the behavior, the problem still exists. People don't become obese because they have good habits and new habits take time to learn.
I'm one of those prescribed a VLCD. I've been on it for a year. I'm now coming off it, but going up to a normal level of calories will take a few months. It was either allow the doctor to starve me (and he cut up my guts as well) or die of heart failure in a year. I chose starvation and surgery over a casket.
Yes, there's been education. That started before the diet or surgery began. I now have a way of eating that works for me and that I can sustain long-term. And yes, there's monitoring. Lots of it. Weekly bloodwork and weigh-ins, a public diary so my med team and insurance company can monitor me, and a heart monitor that I wear all the time. There have been plenty of complications, but they were better than dying.
It's a medical tool and it can be life-saving. It can also be mis-prescribed or poorly managed.
Ah missed your post. Yes I can see that if it's equivalent to an emergency, drastic measures might be needed. Glad you've done so well 0 -
The long term success rate of most diets is poor, if it's safe and appropriate to lose faster for 8 weeks then more fat will be lost before the patient gets bored and gives up. They may even stick it out for longer having seen better results.
Most national bodies support the use of VLCDs in obese patients esp with comorbidities like diabetes or hypertension. Committees review evidence and produce guidelines summarised in articles like http://www.gponline.com/role-low-calorie-diets/nutrition/article/994649
That's such a weird logic. If they give up at any point and regain, having lost a bit quickly for a short period doesn't make much of a difference, does it?
Other than the fact that this generally dangerous way of eating has now been legitimized for them, and they'll probably now have some distortions going on around food?
And if they gain back more than they lost (very common), they'll lose ffm and increase body fat % (more adiposity = more risk for lifestyle diseases, usually), & experience additional consequences to their metabolism, right?
Does this actually work for most long-term? (Long-term, not 1-2 years)
The loss of FFM on VLCDs is mainly water, that's why they are called PSMF 'cos they retain (spare) protein.
If you were to give up after 8 weeks and had lost 20 lbs rather than 4 you would be in a better metabolic state perhaps ? Fired up to lose more rather than giving up because you can't see the difference ? This happens.
I haven't seen any data for long term as you describe it. Bariatric surgery is mainly a surgically enforced VLCD and over many years they tend to have lost about half their initial excess weight.
Do you have any objective data on long term success ? The guy who ate nothing for over a year maintained his loss (n=1).
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This is from the NHS website:
"Very low calorie diets
A very low calorie diet (VLCD) is where you consume less than 1,000 calories a day.
These diets can lead to rapid weight loss, but they are not a suitable or safe method for everyone. VLCDs are usually only recommended if you have an obesity-related complication that would benefit from rapid weight loss, such as severe sleep apnoea.
VLCDs should usually not be followed for any longer than 12 weeks at a time, and they should only be adopted under the supervision of a suitably qualified healthcare professional."
see here: Obesity Treatment
The benefits outweigh the costs in limited circumstances.0 -
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2692623/figure/F2/
14% weight loss at 10 weeks vs 8‰ of bodyweight. Evidence like that, combined with things like diabetes remission (see Newcastle Diet) are why doctors prescribe these things in appropriate circumstances.0 -
strong_curves wrote: »Most of them just don't know any better.
This. Doctors have very little training in nutrition.0 -
Perhaps some doctors expect non-compliance as statistically people are terrible at estimating how much they eat, so tell patients to eat 800 calories per day when they'd be happy with 1600.0
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Thank you for the interesting discussion. I should have clarified that I didn't have in mind an extreme VLCD for an urgent medical condition. Yesterday I was reading a thread, and I've seen others like it, where a 350 lb man was on a 1300 calorie diet. It didn't sound like there was an urgent medical crisis involved, but this person had told his doctor how many calories he was eating and the doctor gave his "consent". I had a friend on my list who was recommended a 1200 calorie diet by her doctor for a condition that was serious, but not urgent (not something she could potentially drop dead from tomorrow.) I keep my mouth closed, but it frustrates me that people be subjected, or subject themselves, to such a restrictive diet when, as obese people, they could lose many pounds a week at a more moderate calorie deficit and feel better during the process. And I appreciated tomatoey's comment that, when given a doctor's stamp of approval, it tends to legitimize an otherwise unwise approach to dieting (again, barring a dire medical crisis).0
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If anyone is reading this and thinking about getting medical help from their doctor to manage their weight, don't be scared off by the negative comments about doctors. I am receiving spectacular care with weight management from a medical team.
This forum and Google are great but they can't replace a doctor's exam, blood tests and counseling. If you think you need to see a doctor, do it.
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susan100df wrote: »If anyone is reading this and thinking about getting medical help from their doctor to manage their weight, don't be scared off by the negative comments about doctors. I am receiving spectacular care with weight management from a medical team.
This forum and Google are great but they can't replace a doctor's exam, blood tests and counseling. If you think you need to see a doctor, do it.
I agree with that whole-heartedly 0 -
Thank you for the interesting discussion. I should have clarified that I didn't have in mind an extreme VLCD for an urgent medical condition. Yesterday I was reading a thread, and I've seen others like it, where a 350 lb man was on a 1300 calorie diet. It didn't sound like there was an urgent medical crisis involved, but this person had told his doctor how many calories he was eating and the doctor gave his "consent". I had a friend on my list who was recommended a 1200 calorie diet by her doctor for a condition that was serious, but not urgent (not something she could potentially drop dead from tomorrow.) I keep my mouth closed, but it frustrates me that people be subjected, or subject themselves, to such a restrictive diet when, as obese people, they could lose many pounds a week at a more moderate calorie deficit and feel better during the process. And I appreciated tomatoey's comment that, when given a doctor's stamp of approval, it tends to legitimize an otherwise unwise approach to dieting (again, barring a dire medical crisis).
I think that person was me haha.
My medical crisis was me being morbidly obese and having blood pressure through the roof. I've started to up my calories a bit above the 1250 mark being that I'm working out more now. I'm never under 1200 on a daily basis really. We've done routine bloodwork since I've started and nothing is out of the ordinary, it's just getting my blood pressure under control and working towards getting healthier. I was going down a very bad path.0 -
Thank you for the interesting discussion. I should have clarified that I didn't have in mind an extreme VLCD for an urgent medical condition. Yesterday I was reading a thread, and I've seen others like it, where a 350 lb man was on a 1300 calorie diet. It didn't sound like there was an urgent medical crisis involved, but this person had told his doctor how many calories he was eating and the doctor gave his "consent". I had a friend on my list who was recommended a 1200 calorie diet by her doctor for a condition that was serious, but not urgent (not something she could potentially drop dead from tomorrow.) I keep my mouth closed, but it frustrates me that people be subjected, or subject themselves, to such a restrictive diet when, as obese people, they could lose many pounds a week at a more moderate calorie deficit and feel better during the process. And I appreciated tomatoey's comment that, when given a doctor's stamp of approval, it tends to legitimize an otherwise unwise approach to dieting (again, barring a dire medical crisis).
I think that person was me haha.
My medical crisis was me being morbidly obese and having blood pressure through the roof. I've started to up my calories a bit above the 1250 mark being that I'm working out more now. I'm never under 1200 on a daily basis really. We've done routine bloodwork since I've started and nothing is out of the ordinary, it's just getting my blood pressure under control and working towards getting healthier. I was going down a very bad path.
You're right!
I really am glad things are going well, and very glad you're receiving ongoing medical supervision. I would never encourage someone to go against their doctor's advice (which is why I came here to vent instead!) You seem like a very reasonable person who has educated themselves about these matters. I suspect many probably do not and take a doctor's "OK" as a blanket endorsement. I have friends on my list who started on MFP at well over 300 lbs and have lost 3-5 lbs a week at a calorie allowance of nearly 2000, and then they lower that as they go and get comfortable with the changes they've made. I guess I just wish for this kind of gentle health journey for everyone. 0
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