concerned about a friend
laropmet
Posts: 52 Member
I have a friend at work that has been trying to lose weight for as long as i've known her. About 2 months ago her doctor put her on orlistat and she began eating a low fat diet. About a month after that she was diagnosed with diabetes and the diabetic clinic put her on a low carb diet. Her doctor now knows about the diabetes but hasn't stopped prescribing the orlistat. In my head eating a low carb diet while taking a fat blocker doesn't make any sense and I can't figure out where she will be getting nutrients from, besides the protein. So far she hasn't been losing any weight. She always seems to be on the verge of tears from hunger and is suffering from shakiness and dizzy spells presumable because of low blood sugar. I've advised her to go back to her doctor but does anyone have any realistic advice beside this I could use to encourage her. I know I shouldn't get so wrapped up in other people's struggles but I can't stop being worried.
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Replies
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She hasn't lost weight in 2 months?
She's not doing it right
Tell her to go back to doctor0 -
I think the problem is she is always hungry and there is no way anyone can fight hunger forever. Ive already told her to go back but the doctor is pretty much saying stick to the diet and you aren't working hard enough. I've been saying that she needs to eat some fat but obviously with the orlistat that's not an option. I don't claim to know more than the doctor but i can't help but feel that he's wrong by prescribing that.0
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She could have hypothyroidism. Maybe also see if she is weighing her food, introduce her to mfp. For some ppl being on a diet means no "cheat" food, and don't realise that eating too much chicken and broccoli will make you gain weight too.0
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The UK has Orlistat as a treatment of last resort in Obesity, see section 8 in http://pathways.nice.org.uk/pathways/obesity/overweight-and-obese-adults.pdf
"Orlistat
Only prescribe orlistat as part of an overall plan for managing obesity in adults who meet one of
the following criteria:
a BMI of 28 kg/m2
or more with associated risk factors
a BMI of 30 kg/m2
or more.
Continue orlistat therapy beyond 3 months only if the person has lost at least 5% of their initial
body weight since starting drug treatment. Also see below for advice on targets for people with
type 2 diabetes.
Make the decision to use drug treatment for longer than 12 months (usually for weight
maintenance) after discussing potential benefits and limitations with the person."
If she can't hack a low fat diet with Orlistat and doesn't lose weight then changing to a restricted carbohydrate increased fat diet without orlistat would be an option to discuss with the doctor.0 -
PS to add that I don't see how a low carb (for the diabetes) low fat (for the Orlistat) regime is going to work without it being excessive protein / rabbit starvation.0
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To me it doesn't sound like your friend really benefits from the low fat or low carb diets. Do you think it's possible your friend could try a balanced, more plant-based diet?0
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I would tell her to see a new doctor asap.0
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I think the problem is she is always hungry and there is no way anyone can fight hunger forever. Ive already told her to go back but the doctor is pretty much saying stick to the diet and you aren't working hard enough. I've been saying that she needs to eat some fat but obviously with the orlistat that's not an option. I don't claim to know more than the doctor but i can't help but feel that he's wrong by prescribing that.
It sounds like the dr is telling her the truth: no weight loss in 2 months, means she is actually not following the diet. Maybe she is trying to follow the diet, then ends up eating everything because she is hungry. If she has a diet from the diabetic clininc, orlistat or not, she should be losing. She is not following her diet. No matter what meds she takes or does not take, unless she actually follows the eatign plan, nothing will change0 -
She should get a second opinion from another doctor.0
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What is she eating at the moment then? does she end up binging because the diet is too restrictive?0
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Agree on seeing another doctor or maybe a certified dietitian.
As far as low carb/low fat it is hard to say without more detail since we don't know from your post exactly what is being prescribed as far as "low carb".Carb-friendly: less than or equal to 30 g/serving
Low-carb: less than or equal to 15 g/serving
Very low-carb: less than or equal to 3 g/serving
Lots of diabetes in my family. If her plan is something like "3 meals/2 snacks, no more than 30 grams of carbs each" then being low fat too isn't that scary. Especially if "low fat" means something like 30% of calories from fat. The 30 grams of carbs limit is something my relatives have had prescribed. Eating 5 times that could be up to 150 grams of carbs a day, so not at risk of "rabbit starvation".0 -
You can't go low fat AND low carb at the same time. No wonder she hasn't lost weight, while still hungry, and shaky, she must be terrified as well as confused. Tell her to get a new doctor, pronto.0
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If she's not losing weight I wouldn't worry about her not getting nutrients. I also would take another dieter's claims with a grain of salt and let the doctors do the diagnosing. In my opinion, usually when someone says they're doing it right but not losing, they're not doing it right at all, or they're doing it right 80% of the time and blowing their diet out of the water the other 20%.0
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kommodevaran wrote: »You can't go low fat AND low carb at the same time. No wonder she hasn't lost weight, while still hungry, and shaky, she must be terrified as well as confused. Tell her to get a new doctor, pronto.
Cosigned.0 -
kshama2001 wrote: »kommodevaran wrote: »You can't go low fat AND low carb at the same time. No wonder she hasn't lost weight, while still hungry, and shaky, she must be terrified as well as confused. Tell her to get a new doctor, pronto.
Cosigned.
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I would advise her to switch doctors, and to go to the new one with a detailed list of her symptoms as a result of what the old one advised.0
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I totally agree with everything, everyone has said in this post. Even the ones that are saying she's not sticking to it. I don't believe she is sticking to it because she keeps telling me things like "I got shaky on the way home so had a coke to help", or "It got to dinner time and I had a whole packet of biscuits". The impression I'm getting is that she is so hungry that she grabs whatever is handy rather than cooking and part of me can't blame her for that because who among us can tolerate low fat and low carb at the same time. I don't know her ratio's. She's in her 50's, probably around 225lbs although she has never actually told me her weight. Definitely at risk and probably an ideal candidate for Orlistat. I just don't feel this is too healthy.0
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I totally agree with everything, everyone has said in this post. Even the ones that are saying she's not sticking to it. I don't believe she is sticking to it because she keeps telling me things like "I got shaky on the way home so had a coke to help", or "It got to dinner time and I had a whole packet of biscuits". The impression I'm getting is that she is so hungry that she grabs whatever is handy rather than cooking and part of me can't blame her for that because who among us can tolerate low fat and low carb at the same time. I don't know her ratio's. She's in her 50's, probably around 225lbs although she has never actually told me her weight. Definitely at risk and probably an ideal candidate for Orlistat. I just don't feel this is too healthy.
Sorry, but if this is what she is doing, this is suicide by eating and no dr can help her. Nothing is stopping her from grabbing an apple, or a yoghurt if she needs to eat something immediately. Usually a diabetic clinic will give an eating plan and this eating plan will be low-ish carb and also low-ish fat, until there is improvement. Which means mostly high protein at first, which also means lots of cooking options. Meat, fish, chicken, grilled, sauteed, in tomato based sauces, in lemon etc based sauces, lots of salads, a couple of fruit per day, yoghurt, low fat cheese, milk, nuts, legumes, eggs. Lots of things that are easy to prepare, and will not leave her starving.
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I totally agree with everything, everyone has said in this post. Even the ones that are saying she's not sticking to it. I don't believe she is sticking to it because she keeps telling me things like "I got shaky on the way home so had a coke to help", or "It got to dinner time and I had a whole packet of biscuits". The impression I'm getting is that she is so hungry that she grabs whatever is handy rather than cooking and part of me can't blame her for that because who among us can tolerate low fat and low carb at the same time. I don't know her ratio's. She's in her 50's, probably around 225lbs although she has never actually told me her weight. Definitely at risk and probably an ideal candidate for Orlistat. I just don't feel this is too healthy.
Sorry, but if this is what she is doing, this is suicide by eating and no dr can help her. Nothing is stopping her from grabbing an apple, or a yoghurt if she needs to eat something immediately. Usually a diabetic clinic will give an eating plan and this eating plan will be low-ish carb and also low-ish fat, until there is improvement. Which means mostly high protein at first, which also means lots of cooking options. Meat, fish, chicken, grilled, sauteed, in tomato based sauces, in lemon etc based sauces, lots of salads, a couple of fruit per day, yoghurt, low fat cheese, milk, nuts, legumes, eggs. Lots of things that are easy to prepare, and will not leave her starving.
But she didn't get an eating plan, and wasn't told to eat moderate fat, moderate carbs, plenty of protein, and get cooking - she has been told to, practically, "not eat". She's panicking.
I recognize this pattern of behavior from my own experience. I took the nutritional guidelines so seriously and literarily that I tried to avoid fat as much as possible, which of course wasn't possible, and instead of allowing more fat from real, nutritious food, I caved and bought lots of junk. Looking back, I understand that I was too scared by the health warnings, of cancer, heart failure and even diabetes, to think straight and investigate alternatives. I regard myself as both sensible and literate, and this makes me feel more sad and angry than stupid. I love to talk about myself, sorry, but I hope this is useful to understand this seemingly irrational behavior.0 -
We don't really know what she's been told. I think someone who tells themselves they needed to get a Coke because they were shaky on the drive home also tells their friends that their doctor's advice is too strict to follow. We tell ourselves all kinds of things to justify not changing, especially when the change is doctor-imposed and not something we chose to take on. Just my opinion.
But I also know that people can be so "black and white" about diets they sabotage themselves by that, too.
How low fat are you supposed to go with Orlistat? I tried Alli once and I think it suggested you cap each meal's fat at 15g. It didn't seem that difficult. That's like the fat in three eggs. I could do low carb at that level, especially temporarily with diabetes looming.0 -
kommodevaran wrote: »I totally agree with everything, everyone has said in this post. Even the ones that are saying she's not sticking to it. I don't believe she is sticking to it because she keeps telling me things like "I got shaky on the way home so had a coke to help", or "It got to dinner time and I had a whole packet of biscuits". The impression I'm getting is that she is so hungry that she grabs whatever is handy rather than cooking and part of me can't blame her for that because who among us can tolerate low fat and low carb at the same time. I don't know her ratio's. She's in her 50's, probably around 225lbs although she has never actually told me her weight. Definitely at risk and probably an ideal candidate for Orlistat. I just don't feel this is too healthy.
Sorry, but if this is what she is doing, this is suicide by eating and no dr can help her. Nothing is stopping her from grabbing an apple, or a yoghurt if she needs to eat something immediately. Usually a diabetic clinic will give an eating plan and this eating plan will be low-ish carb and also low-ish fat, until there is improvement. Which means mostly high protein at first, which also means lots of cooking options. Meat, fish, chicken, grilled, sauteed, in tomato based sauces, in lemon etc based sauces, lots of salads, a couple of fruit per day, yoghurt, low fat cheese, milk, nuts, legumes, eggs. Lots of things that are easy to prepare, and will not leave her starving.
But she didn't get an eating plan, and wasn't told to eat moderate fat, moderate carbs, plenty of protein, and get cooking - she has been told to, practically, "not eat". She's panicking.
I recognize this pattern of behavior from my own experience. I took the nutritional guidelines so seriously and literarily that I tried to avoid fat as much as possible, which of course wasn't possible, and instead of allowing more fat from real, nutritious food, I caved and bought lots of junk. Looking back, I understand that I was too scared by the health warnings, of cancer, heart failure and even diabetes, to think straight and investigate alternatives. I regard myself as both sensible and literate, and this makes me feel more sad and angry than stupid. I love to talk about myself, sorry, but I hope this is useful to understand this seemingly irrational behavior.
Nutritional guidelines for diabetes have some pretty standard parts, so I find it hard to believe she has even been to a diabetes clinic and was just told a generic "avoid carbs". And if she was panicking, she wouldn't be eating a package of biscuits or looking for a coke. It is pretty obvious these have sugar and I think it is also rather clear to most adults that sugar is not good for diabetics. I think OP is taking this more seriously than the patient.0 -
kommodevaran wrote: »I totally agree with everything, everyone has said in this post. Even the ones that are saying she's not sticking to it. I don't believe she is sticking to it because she keeps telling me things like "I got shaky on the way home so had a coke to help", or "It got to dinner time and I had a whole packet of biscuits". The impression I'm getting is that she is so hungry that she grabs whatever is handy rather than cooking and part of me can't blame her for that because who among us can tolerate low fat and low carb at the same time. I don't know her ratio's. She's in her 50's, probably around 225lbs although she has never actually told me her weight. Definitely at risk and probably an ideal candidate for Orlistat. I just don't feel this is too healthy.
Sorry, but if this is what she is doing, this is suicide by eating and no dr can help her. Nothing is stopping her from grabbing an apple, or a yoghurt if she needs to eat something immediately. Usually a diabetic clinic will give an eating plan and this eating plan will be low-ish carb and also low-ish fat, until there is improvement. Which means mostly high protein at first, which also means lots of cooking options. Meat, fish, chicken, grilled, sauteed, in tomato based sauces, in lemon etc based sauces, lots of salads, a couple of fruit per day, yoghurt, low fat cheese, milk, nuts, legumes, eggs. Lots of things that are easy to prepare, and will not leave her starving.
But she didn't get an eating plan, and wasn't told to eat moderate fat, moderate carbs, plenty of protein, and get cooking - she has been told to, practically, "not eat". She's panicking.
I recognize this pattern of behavior from my own experience. I took the nutritional guidelines so seriously and literarily that I tried to avoid fat as much as possible, which of course wasn't possible, and instead of allowing more fat from real, nutritious food, I caved and bought lots of junk. Looking back, I understand that I was too scared by the health warnings, of cancer, heart failure and even diabetes, to think straight and investigate alternatives. I regard myself as both sensible and literate, and this makes me feel more sad and angry than stupid. I love to talk about myself, sorry, but I hope this is useful to understand this seemingly irrational behavior.
Nutritional guidelines for diabetes have some pretty standard parts, so I find it hard to believe she has even been to a diabetes clinic and was just told a generic "avoid carbs". And if she was panicking, she wouldn't be eating a package of biscuits or looking for a coke. It is pretty obvious these have sugar and I think it is also rather clear to most adults that sugar is not good for diabetics. I think OP is taking this more seriously than the patient.
I disagree - that's exactly what panic does to you. You can't make good decisions when frightened, shameful, hungry, deprived, stressed out AND misinformed, surrounded by every opportunity to make bad choices.
If that is the case at all. Good points about us not knowing the whole story.
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I'm pretty sure I don't even know her whole story. I just feel bad that she seems to be suffering to my eyes. The clinic that she went to sent her around the supermarket to look at nutritional information panels and find foods that had less than 5g of carbs per 100g. Although I'm not sure if that's what they are setting her target as. I'm not sure if she managed to find anything because that seems really low for a moderate carb diet. She has never mentioned protein to me so i'm not even sure if she has been told to increase her protein. I see her eating a lot of low fat yogurts and fruit at work, so she is trying at the start of the day. We mostly finish work at 2.30pm which is when i think most of her problems start. Probably because she has only eaten around 150 calories while doing a fairly active job. I walk around 5 miles in an 8 hour shift to give you an idea of calories burned. I'm really frustrated because i'm out of supportive advice to give her.0
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If your friend wants to do this seriously, there are several options:
- call her dr
- call the diabetes clinic to ask for a more specific plan
- check whatever reading material she was given (I find it hard to believe there were no instructions other than find food with less than 5% carbs)
- google it
- access diabetes.org, the American Diabetes Association website. They have plans, instructions and even recipes.
But, you need to understand that many times people choose convenience over health. And you cannot help someone who does not want help. Do not confuse feeling miserable with actually asking for help. There is the "I am miserable because I am ill and need to change things" and there is "I am so miserable, life is not worth living with all these restrictions, poor me will surely die".
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I echo those suggesting a different doctor. Sounds like she needs to see a new doctor and request a FULL workup - blood tests, everything. If she's THAT hungry, they need to figure out what's going on with her so they can make sure she's on the right medication and eating plan. I have PCOS, so for more, low-carb, low-sugar is the way to go. But I didn't know that until my doctor got a correct diagnosis through blood tests.
Another possibility here is this: could the binging be psychological? I don't know her, so I can't say, but it's a side of the issue to consider.0 -
I'm pretty sure I don't even know her whole story. I just feel bad that she seems to be suffering to my eyes. The clinic that she went to sent her around the supermarket to look at nutritional information panels and find foods that had less than 5g of carbs per 100g. Although I'm not sure if that's what they are setting her target as. I'm not sure if she managed to find anything because that seems really low for a moderate carb diet. She has never mentioned protein to me so i'm not even sure if she has been told to increase her protein. I see her eating a lot of low fat yogurts and fruit at work, so she is trying at the start of the day. We mostly finish work at 2.30pm which is when i think most of her problems start. Probably because she has only eaten around 150 calories while doing a fairly active job. I walk around 5 miles in an 8 hour shift to give you an idea of calories burned. I'm really frustrated because i'm out of supportive advice to give her.
Almost everything you have mentioned her eating is very high carb and she is eating fruit every morning... Have you talked to her about carbs or is she even really trying. Sounds like she mostly eats sugar. Also low fat yogurt and fruit ever morning can be low cal it can also be much higher than you think. Just a small yogurt and normal banana is over 150 calories.0
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