Why is it safe for a super morbidly obese person to eat 800 cals a day?
Replies
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I suppose it may be debatable, most things are. It seems to be a reasonably accepted medical course though, so I will err on the side of the specialists since this is all conjecture anyway.
Happy debating1 -
I don't know the actual statistics, so I don't know whether or not the risk of remaining obese at any given level of morbid obesity outweighs the risk of losing weight on a medically supervised VLCD, but assuming the data has been collected, the risks are not really "debatable." It's the way standard of care is supposed to be determined.
Saying a risk "may not be realized" is just another way of saying that you can't predict with certainty which group any particular patient is in (the ones who will die in the relatively short term without the intervention in question, or the ones who will live long enough to lose weight slowly on their own, assuming they could accomplish that, despite the fact that both statistics and the personal history of anyone who is morbidly obese argue that weight will not in fact be lost through an attempt to lose weight slowly on their own).
All you can do is determine statistical risks based on available data, and use the data to determine the standard of care. I suppose you could say, "I just feel lucky. I think I'm going to be in the group that will live long enough to lose weight slowly (and that I will have actually have enough success at that, which statistically is another bad bet), so I'm going to refuse the course of treatment that the statistics argue for." But that's not rational.1 -
Thanks for the chart. I was going to add a general statement that people with large fat reserves can draw more energy from fat daily than someone with little fat. That doesn't say that it's safe, necessarily, but it's possible.
There's a rule of thumb floating around (can't verify but would like to) that fat reserves can supply up to 30 cal per lb of fat daily. To use yarwell's example above, a 200lb person with 100lb fat could handle a 3000 cal deficit, whereas a 120lb person with 20lb fat can handle only a 600 cal deficit without jeopardizing LBM
I have seen that 600 calories fat loss a day somewhere but can not find their origins. It said, that a body can lose a maximum of 600 calories fat a day but I can not recollect on what level of obesity. Any further weight loss is drawn from the body's muscles etc. Again, I can not authenticate this. 600 calories would be about 70 gram fat a day, about 26 kg a year. But this does not include water loss during that time. I have lost with MFP about 30 kg after 1 year, so that calculation seems to be right for me. Let's see what happens after year 2...0 -
I had weight loss surgery with a BMI of 40. Doc has me on a low carb diet which believe it or not has eliminated all cravings and provides plenty of energy even without the carbs. (All bariatric surgeons vary in the approach to dieting.) We are told to get at least 75g of protein a day with a rough allotment of about 800 cals (which will increase gradually over time. We're watched closely with frequent lab tests and take supplements.
The 800 cals/day is actually a bit difficult to achieve given how little we can eat at a time. As to why a doctor would prescribe such a restrictive diet for a morbidly obese person....it might be, as others have said, that the patient must lose weight now to survive. But there's also a psychological factor... if you see that you are losing weight relatively quickly, you're more likely to be encouraged to stay with the program. If you're accustomed to eating a lot as food addicts are), it can be disheartening to switch to a lifestyle-changing diet and exercise program and only lose a pound or two a week. Doing the math, it could then take a 500 lb person 3 years to get the weight down to, say, 200 lbs. It can be extremely difficult to stay motivated for that length of time. The doctor is likely trying to jump start the patient's weight loss to motivate him/her to experience success.
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It may be warranted, under a closely monitored physician’s supervision.
As a general rule, everyone should consult with their health care professionals before starting a weight loss program.1 -
lynn_glenmont wrote: »
I don't know the actual statistics, so I don't know whether or not the risk of remaining obese at any given level of morbid obesity outweighs the risk of losing weight on a medically supervised VLCD, but assuming the data has been collected, the risks are not really "debatable." It's the way standard of care is supposed to be determined.
Saying a risk "may not be realized" is just another way of saying that you can't predict with certainty which group any particular patient is in (the ones who will die in the relatively short term without the intervention in question, or the ones who will live long enough to lose weight slowly on their own, assuming they could accomplish that, despite the fact that both statistics and the personal history of anyone who is morbidly obese argue that weight will not in fact be lost through an attempt to lose weight slowly on their own).
All you can do is determine statistical risks based on available data, and use the data to determine the standard of care. I suppose you could say, "I just feel lucky. I think I'm going to be in the group that will live long enough to lose weight slowly (and that I will have actually have enough success at that, which statistically is another bad bet), so I'm going to refuse the course of treatment that the statistics argue for." But that's not rational.
I would not base a decision like that on statistics. I would only base it on my actual current health. Otherwise I might as well start eating like a diabetic because statistically I am at a super high risk because of my family history and my weight. That is not wise.
Risks do not mean anything is imminently threatening. Risks could simply mean that in 5 or more years you may have serious complications from carrying excess weight. Genetics play a big role here so it is not like a person who is 200 pounds overweight is necessarily knocking down death's door. Genetics can mean that a person that is a perfectly healthy weight can be in seriously bad health though.
My reply was not meant to exclude the need for medical intervention when warranted. It was meant to dissuade anyone from thinking that just because they are very obese that the risk of losing too fast was justified because they were already in mortal jeopardy. You know that people read things on here and pick the parts they want to apply to themselves and ignore the part where a medical team should be supervising.
There are not a lot of people here that represent this super obese category from what I can tell. I happen to be one of them and my health has been checked forwards and backwards and all said and done I have plenty of time to lose weight at a safe rate. Even at a safe rate I still averaged over 3 pounds a week my first full year. It is very possible to be aggressive without going to an extreme.4 -
I suppose it may be debatable, most things are. It seems to be a reasonably accepted medical course though, so I will err on the side of the specialists since this is all conjecture anyway.
Happy debating
It's not necessarily a reasonably accepted medical course though. And it's not conjecture. Doctors who specialize in the co-morbidities that go along with being morbidly obese are usually well versed about when the confirmed risks of under-eating are warranted for someone with other health concerns. There are some obese folks for whom the health conditions their weight is complicating require their doctors to help them with a VLCD to essentially save their lives. But there are other obese individuals who are not at that point and for whom the greatest risk is the extreme stress a VLCD would put on their already stressed body.
And unfortunately now there are "weight loss centers" with bariatric surgeons who are more than happy to gamble on dramatic results so they can make bigger claims in their TV commercials
Regarding the zombie title of this thread, it is NOT "safe" for a morbidly obese person to eat 800 calories per day. But in certain instances, with the participation of their medical team, it's possibly safer than slower weight loss that will keep them morbidly obese for longer. In subjects like this, when it's possible there are folks reading who are looking for confirmation to do something stupid, IMHO it's important to use careful and precise wording.4 -
I suppose it may be debatable, most things are. It seems to be a reasonably accepted medical course though, so I will err on the side of the specialists since this is all conjecture anyway.
Happy debating
I feel like part of the family❤❤❤ getting wooed for saying something basic and rational ❤❤❤3 -
I suppose it may be debatable, most things are. It seems to be a reasonably accepted medical course though, so I will err on the side of the specialists since this is all conjecture anyway.
Happy debating
It's not necessarily a reasonably accepted medical course though. And it's not conjecture. Doctors who specialize in the co-morbidities that go along with being morbidly obese are usually well versed about when the confirmed risks of under-eating are warranted for someone with other health concerns. There are some obese folks for whom the health conditions their weight is complicating require their doctors to help them with a VLCD to essentially save their lives. But there are other obese individuals who are not at that point and for whom the greatest risk is the extreme stress a VLCD would put on their already stressed body.
And unfortunately now there are "weight loss centers" with bariatric surgeons who are more than happy to gamble on dramatic results so they can make bigger claims in their TV commercials
Regarding the zombie title of this thread, it is NOT "safe" for a morbidly obese person to eat 800 calories per day. But in certain instances, with the participation of their medical team, it's possibly safer than slower weight loss that will keep them morbidly obese for longer. In subjects like this, when it's possible there are folks reading who are looking for confirmation to do something stupid, IMHO it's important to use careful and precise wording.
I apologize. I assumed we were all talking about medically supervised vlcd. I do not support someone who is morbidly obese starving themselves on a whim.4 -
Is it safe, or is it judged (whether correctly or incorrectly, and with all the outcomes not known ahead of time) as a better alternative than other options?
About the only statement *I* would make about that safety is that it's relatively safer for them as compared to someone with less fat available to lose.
Safer does not equal safe and problem-free.
Boom.1 -
I suppose it may be debatable, most things are. It seems to be a reasonably accepted medical course though, so I will err on the side of the specialists since this is all conjecture anyway.
Happy debating
It's not necessarily a reasonably accepted medical course though. And it's not conjecture. Doctors who specialize in the co-morbidities that go along with being morbidly obese are usually well versed about when the confirmed risks of under-eating are warranted for someone with other health concerns. There are some obese folks for whom the health conditions their weight is complicating require their doctors to help them with a VLCD to essentially save their lives. But there are other obese individuals who are not at that point and for whom the greatest risk is the extreme stress a VLCD would put on their already stressed body.
And unfortunately now there are "weight loss centers" with bariatric surgeons who are more than happy to gamble on dramatic results so they can make bigger claims in their TV commercials
Regarding the zombie title of this thread, it is NOT "safe" for a morbidly obese person to eat 800 calories per day. But in certain instances, with the participation of their medical team, it's possibly safer than slower weight loss that will keep them morbidly obese for longer. In subjects like this, when it's possible there are folks reading who are looking for confirmation to do something stupid, IMHO it's important to use careful and precise wording.
I apologize. I assumed we were all talking about medically supervised vlcd. I do not support someone who is morbidly obese starving themselves on a whim.
Oh sure, I didn't think it looked like that was the case. I've just seen too many people wander into those shady weight loss centers and have a doctor convince them they need to go on his VLCD that requires buying products from themk and then have surgery, while glossing over the risks and ignoring the statistics. My understanding is there is disagreement in the field over whether there are actually long term benefits to the VLCD/surgery option as opposed to the slower paced path for the majority of people.
And for what it's worth, I didn't woo you and I doubt anyone posting with you here did either
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Sometimes, a doctor will put a morbidly obese person on a VLCD because they need surgery, but it would be too dangerous to operate on them at that weight.2
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I suppose it may be debatable, most things are. It seems to be a reasonably accepted medical course though, so I will err on the side of the specialists since this is all conjecture anyway.
Happy debating
It's not necessarily a reasonably accepted medical course though. And it's not conjecture. Doctors who specialize in the co-morbidities that go along with being morbidly obese are usually well versed about when the confirmed risks of under-eating are warranted for someone with other health concerns. There are some obese folks for whom the health conditions their weight is complicating require their doctors to help them with a VLCD to essentially save their lives. But there are other obese individuals who are not at that point and for whom the greatest risk is the extreme stress a VLCD would put on their already stressed body.
And unfortunately now there are "weight loss centers" with bariatric surgeons who are more than happy to gamble on dramatic results so they can make bigger claims in their TV commercials
Regarding the zombie title of this thread, it is NOT "safe" for a morbidly obese person to eat 800 calories per day. But in certain instances, with the participation of their medical team, it's possibly safer than slower weight loss that will keep them morbidly obese for longer. In subjects like this, when it's possible there are folks reading who are looking for confirmation to do something stupid, IMHO it's important to use careful and precise wording.
I think if a doctor suggested a vlcd to me outside of a need for surgery I would push back and ask why it was necessary and I would strongly suggest that anyone else do the same.
Even on a vlcd weight loss still takes time and depending on whether you are a woman eating at the minimum level of 1200 or man eating at 1500 you are only speeding up by .8 or 1.4 more pounds per week some of which could include lean body mass.3 -
That’s the sad thing is I see young folks on this app thinking it’s okay to eat 1000 calories y under they just had babies are not over weight it’s normal baby gain. Sometimes I think those tv 📺 y computer adds for extreme weight loss is so not good for them to get their information from.
I had a friend who did gastric supervised his Doctor had him loose slowly as he got adjusted to less y less y less calories then leveled him off to what he should eat. He was fine for decades then on the anniversary of his surgery he described a weird issue he was having y pain.Told him it sounded like a gastric bypass issue to go back to his doctor even tho decades had passed.Sure enough a rupture Rare but happens with any surgery.He was glad we caught it if he wouldn’t have confided in me about his stool issues y pain it would have been missed. He also went from eating granola bars like they were candy to not wanting one was a something wrong sign.He’s doing great again.1 -
I'm not as clued up on anatomy, biology and nutrition as I'd like to be but I do feel I can add a sentence or 2 on this.
I've been watching a series about bariatric surgery on morbidly obese patients and in the 2 weeks prior to the operation, and after losing a set amount of weight, the patients are given a vlc diet of milk. Only milk with the exception of a pint of sugar free jelly a day. This is to reduce the size of the liver so the surgeon is able to move it to carry out the keyhole surgery.
I've often wondered how post op diets can be be enough. I know it's only liquid for a few weeks but after that the stomach which was once the size of a melon is the size of an egg. Eating egg sized meals for the rest of your life must be vlc.
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When I was scheduled for Bariatric surgery I was on a liquid diet two weeks leading up to the surgery date and I struggled to achieve the minimum calories daily, six weeks following.
I gave it the heroes try, however, logging all my calories here and working very hard to hit my minimum protein target.
I’ll list some of the symptoms I went through during this medically supervised VLCD, just to give you an idea.
- on the liquid diet I got in to the habit to think “no” every time I saw food. It’s stunning to consider how often we are bombarded with images of delicious food. On billboards, television, shopping and social occasions.
- By the second day my hunger pangs subsided and my stomach was just....sad.
- I lost all energy and had to temporarily give up my daily walking routine.
- Getting in enough liquid to prevent dehydration took planning. I started a routine that continues to this day to start and end my day with a glass of water and always have a tea at hand during the day.
- I got the “Wobblies” from overall weakness and didn’t walk exactly in a straight line. I made sure there was a hand rail nearby.
- Many bariatric patients suffer from hair loss, brittle nails and dry skin. I kept my hair but I have to continue to watch my protein levels and my vitamins to save my nails.
- The weight loss is dramatic and it was difficult to readjust my body image. It was expensive to keep a wardrobe that fit me. My shopping was exclusively from second hand shops except for the bra.
- At six months I was cleared to restart my fitness goals and that was glorious.
- The significant weight loss meant a recovery of my mobility and a whole range of activities I had not considered before.
- My blood pressure went in normal range, my diabetes went in remission, I saved my knees, and my feet. Plantars Fasciitis gone.
- People reacted weirdly to the changes, except for my son and my husband who see me as I always was. I had a few responses ready to deflect inappropriate questions. “No I don’t have cancer.”
So would I suggest that a VLCD is safe or even desirable? It’s drastic. Do it to save your health and never alone. Don’t do it for vanity pounds.7 -
The problem is, a) the stomach is very stretchy, so that egg-sized remaining bit can get bigger again and b) it doesn't matter if you can only eat egg-sized meals, if they're calorie-dense meals and you eat them every couple of hours.
Given that WLS patients have to be really diligent about their diet in order to keep the benefits of the surgery and minimise the risk of side effects, I do wonder why they don't just... exercise the same diligence, without the surgery part...6 -
I havent read the whole thread but I presume its to get weight off as much as you can in as short time period as you can. If you're 60 stone odd, then if you can lose a huge amount of water weight initially ( I seem to recall a programme, might have been in America where this woman was in a hospital bed for about 2 months and the water literally just came out of her all over the floor and bed, she lost about 20 stone in 2 months or something ridiculous) and that is off your joints, losing fat around your heart and organs etc etc
So its a balance between another 2 months at that dangerous weight where you could have a heart attack any minute, or 2 months on a very low calorie programme where you might get a bit dizzy, faint and bad tempered but with vitamin tablets might not actually do yourself any harm. If the person is in hospital then they will be monitored.0 -
Plus the concept of 'safe' needs to be looked at in context. Chemotherapy is not 'safe', it causes dangerous side effects but is vital for treatment of cancer tumours so its 'safer' than cancer but not 'safe' if you havent got cancer.6
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neugebauer52 wrote: »Thanks for the chart. I was going to add a general statement that people with large fat reserves can draw more energy from fat daily than someone with little fat. That doesn't say that it's safe, necessarily, but it's possible.
There's a rule of thumb floating around (can't verify but would like to) that fat reserves can supply up to 30 cal per lb of fat daily. To use yarwell's example above, a 200lb person with 100lb fat could handle a 3000 cal deficit, whereas a 120lb person with 20lb fat can handle only a 600 cal deficit without jeopardizing LBM
I have seen that 600 calories fat loss a day somewhere but can not find their origins. It said, that a body can lose a maximum of 600 calories fat a day but I can not recollect on what level of obesity. Any further weight loss is drawn from the body's muscles etc. Again, I can not authenticate this. 600 calories would be about 70 gram fat a day, about 26 kg a year. But this does not include water loss during that time. I have lost with MFP about 30 kg after 1 year, so that calculation seems to be right for me. Let's see what happens after year 2...
Not true.
There was a couple scientist that used the MN starvation study results and came up with what they figured was max possible fat loss.
Never any testing of their theory though, nor examining other studies.
Muscle burning is a misunderstanding anyway.
Body breaks down some muscle somewhere daily already.
If you don't eat enough protein (nutrients too) for the body to satisfy basal life sustaining needs, that muscle build-back is missed.
If you use the muscle, the body treats it as tad more needed, and other things may be not built back with those amino acids. Think hair, nails, skin, ect. But some of the muscle will be.
Make the deficit or lack of protein bad enough - you'll lose some muscle.
Oh, why that max fat burning is incorrect - they've done tests on marathoners who burn just slight majority of energy source from fat, because going too fast carbs would never make it.
And considering how much fat those guys have on them in the first place - they are burning way over that supposed max per lb of fat.4 -
The muscle thing as well, surely the heavier you are, the more muscle you use holding yourself up I would have thought, although for those who are so heavy they cant move around, that becomes counterproductive.0
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I was going to mention about getting the liver smaller to prepare for surgery as someone above said. Some bariatric docs want you to eat really light before the surgery to see that you can do it and adhere to the eating schedule after the surgery. My girlfriend who just had some type of foot surgery wasn't able to walk for about 3 months or so. Her friend/trainer put her on an 800 calorie diet so she wouldn't gain any weight during this time. All her doctors knew about this. No side effects.1
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The problem is, a) the stomach is very stretchy, so that egg-sized remaining bit can get bigger again and b) it doesn't matter if you can only eat egg-sized meals, if they're calorie-dense meals and you eat them every couple of hours.
Given that WLS patients have to be really diligent about their diet in order to keep the benefits of the surgery and minimise the risk of side effects, I do wonder why they don't just... exercise the same diligence, without the surgery part...
Anyone I've talked to about it has either said fear for their health and well-being or desperation and feeling hopeless. That's not to say those are everyone's reasons, but they seem to be common.1 -
The problem is, a) the stomach is very stretchy, so that egg-sized remaining bit can get bigger again and b) it doesn't matter if you can only eat egg-sized meals, if they're calorie-dense meals and you eat them every couple of hours.
Given that WLS patients have to be really diligent about their diet in order to keep the benefits of the surgery and minimise the risk of side effects, I do wonder why they don't just... exercise the same diligence, without the surgery part...
Yes, I thought of 3 egg sized meals for the whole day
And of course the stomach egg would stretch duh.
For the people on the series it was a way of breaking their eating habits so they could have normal(ish) lives. These were people who'd taken eating to the max and their legs couldn't hold their weight for longer than a minute and they couldn't complete any personal care. I suppose it's all relative and the extremely strict lifelong eating regime is worth it?
One thing I had expected to see but didn't was the involvement of mental health practitioners. I don't believe anyone intentionally sets out to cause themselves so much damage and just fixing the physical side isn't the answer. Psychiatric support for the cause of the over eating, for the damaged self esteem due to being so large and for the complex life long effects - excess skin, very restrictive diet, relationships etc, should be part of the package.3 -
It has to do with the amount of fat you have on your body. There was a study that postulated that fat can give off energy at a certain rate, meaning if you had enough on you, your body would be able to draw enough energy from your fat stores without effecting lean mass, so long as the lean mass was getting an appropriate amount of stimulation and protein.
A limit on the energy transfer rate from the human fat store in hypophagia
https://www.ncbi.nlm.nih.gov/pubmed/15615615
Essentially, this study explains the rate at which body fat can release energy, which is aparently about 69 calories per kg per day. So say you are 100 kg, with 30 kg of body fat, your daily "possible" deficit would be 69*30= 2070, or about 4 pounds a week. This rate of loss is not actually possible as there are other nutritional needs we have, but it is possible to lose that much weight from just your fat per week without metabolizing any muscle or anything else, so long as you are consuming enough to maintain your musculature.
Now its worth noting that this wasn't a rigorous research study, but instead They took data from the MN starvation experiment and extrapolated to some conclusions that they never tested or examined with another study, but this is a reasonable reason to explain why really extreme deficits with a high enough body fat is acceptable.
Long term, this absolutely isn't a healthy way to go as our body requires other nutrition other than just energy to function well, but I imagine that by the time you get put on one of these starvation diets, your health is extremely compromised and it's probably more important to just get the fat off.
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The problem with that research "non-study" is indeed your commented not a research study, just analyzing data from another study.
There was a study years ago - wasn't even about diet or weight loss and I can't find it right now.
Look at pro marathoners, and looked at their rate of fat burn vs carb burn during a whole run at race pace.
So actual VCO2 measurements showing what was burned
Since carb stores are limited, and pace must be such for those to reach the end, means fat is doing rest of the energy source.
They were measuring what ratio started out and ended at. IIRC, pretty even throughout. Wanted to see if their normal training and knowledge were truly allowing them to hit the fastest pace possible and yet still stretch the glucose out, or improvements to it.
I saw that study at time during hearing about the research on the MN study - did the math on the several participant's avg 5-7% body fat on 130-140 lb body - and how much fat was supplied for that effort of a marathon.
Way more fat used than the non-study research would suggest.
Say chunky 140 lb @ 7% BF = 4.44kg x 69cal = 306 cal per day. Let's just say during the 3 hr race.
140 lb @ slowish 7:00/mile for 26.2 = 183 min = 3005 calories for that chunk of time.
That would mean only burning about 10% fat during the race for that 69 cal/kg of fat to be true - and that ain't going to happen.
As soon as I saw that I knew those researchers left something major out in their thought process to using that available data.
Think water weight from original MN study.
And just because that value was maxed reached in that non-study, doesn't mean it's max possible, as evidenced by other actual research studies.
I think I've seen several examples since their research that disproves their max value.4 -
The problem with that research "non-study" is indeed your commented not a research study, just analyzing data from another study.
There was a study years ago - wasn't even about diet or weight loss and I can't find it right now.
Look at pro marathoners, and looked at their rate of fat burn vs carb burn during a whole run at race pace.
So actual VCO2 measurements showing what was burned
Since carb stores are limited, and pace must be such for those to reach the end, means fat is doing rest of the energy source.
They were measuring what ratio started out and ended at. IIRC, pretty even throughout. Wanted to see if their normal training and knowledge were truly allowing them to hit the fastest pace possible and yet still stretch the glucose out, or improvements to it.
I saw that study at time during hearing about the research on the MN study - did the math on the several participant's avg 5-7% body fat on 130-140 lb body - and how much fat was supplied for that effort of a marathon.
Way more fat used than the non-study research would suggest.
Say chunky 140 lb @ 7% BF = 4.44kg x 69cal = 306 cal per day. Let's just say during the 3 hr race.
140 lb @ slowish 7:00/mile for 26.2 = 183 min = 3005 calories for that chunk of time.
That would mean only burning about 10% fat during the race for that 69 cal/kg of fat to be true - and that ain't going to happen.
As soon as I saw that I knew those researchers left something major out in their thought process to using that available data.
Think water weight from original MN study.
And just because that value was maxed reached in that non-study, doesn't mean it's max possible, as evidenced by other actual research studies.
I think I've seen several examples since their research that disproves their max value.
The max value, sure, but there probably is some truth in it to explain why it's possible and healthy for the morbidly obese to have such a calorie restricted diet. Heck there was a guy in Ireland that was incredibly morbidly obese, and just literally fasted for a year, lost like 200 pounds, functioned and has no ill health effects. There is a legitimate research study about him kicking around somewhere. Without something like this, that seems like black magic. I'm guessing the rate isn't linear but has an inverse parabolic loss in potential the lower your body fat is.0
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