Frustrated/Confused over Doctor's Recommendations

It seems like when a weight loss doctor prescribes a weight loss plan, he or she just recommends the one he prefers or is most familiar with, or the weight loss clinic promotes. It doesn't seem he or she gives any real thought as to whether or not the patient can actually LIVE with the plan. It also seems he or she doesn't give any real thought to the behavioral changes necessary for permanent weight loss, and ideally small changes are more sustainable than big ones all at once.

Like others said, if you think you can live with the things the doctor told you, then by all means do it. However, if you don't think you'll be able to keep it up long-term, take what you think you can do and combine it with what you've already doing.
Also, I'd ask the doctor what his specific reasoning is for his suggestions, and what evidence he has to back it up. That'll probably throw him for a loop.

I am baffled that the doctor gave you a new plan to follow when you are clearly having great success with what you are already doing. I would continue to do what you have been since you find it sustainable. And I agree with the person above who advised you don't need to follow up with that clinic if it wasn't helpful.

Have you visited the Larger Losers group? There is a bunch of people there who have either faced or are facing challenges similar to your own: https://community.myfitnesspal.com/en/group/133315-larger-losers

There are some very good posts there by @NovusDies

@AnnPT77 (a tad bit shy she is; but she hides it well! and if, you ask her nicely, she) will link you to her "sticky posted" thread on how to develop your own diet plan.

Am I seeing right that you've dropped almost 40 lbs in just over two months and that you dropped another 7 lbs in two weeks? So close to double the maximum rate recommended on MFP? OR operating on a 1750 to 2000 Cal deficit a day?

There may also exist an expectations issue here. You're at or exceeding a 1% of body weight per week loss rate both during the past two months and during the past 14 days.

I've heard of very few people who find such a large deficit long term sustainable.

And you may want to keep in mind that (UNLESS THERE ARE UNDISCLOSED MEDICAL REASONS NECESSITATING IMMEDIATE RAPID WEIGHT LOSS to say engage in life saving surgery) that faster loss is not always better... especially if you push things to the point where you start to experience some negative side effects.

The goal is to lose the weight AND MAINTAIN THE WEIGHT LOSS for YEARS... not months. You need to figure out how you will be eating and moving now and in the future... not just and only how you can consume the least amount of calories for a few months to drop a tonne of weight... and then what?

AnnPT77 wrote: »

I think the OP already has some kind of plan from the doctor? If it's just macro goals from the doctor, yes, this process could be used:

Not sure. The OP, in my opinion, has to take charge and filter through everything and make this process his own.

Is there a medical exigency for some of the things he is told to do? Or are these general recommendations and suggestions as to how he should lose weight? If he is unsure about the answer to that he has access to the medical staff to ask and confirm why he is receiving certain recommendations.

If there is medical necessity for the recommendations then obviously he should follow them and the issue is out of anyone's pay grade to discuss other than between the OP and their medical provider!

If this is a more general "you need to lose weight and here is THE ONE way you can do it" discussion... well that's a more open discussion. And since the doctor won't be living the OP's life over the next several years, the OP will have to balance things out so that they can actually work out for them.

Maverick6714 wrote: »

It is 40 pounds total since March 8th. I was simply saying 7 of those pounds were since the meeting at the clinic. I really don't have any specific expectations, except want to continue to make progress

Your body is happy to lose weight. But your body is also stressed by you losing weight. And stress generates reactions and side effects at the physical level. Some short term and some longer term. Some of these side effects have the potential to derail. Faster is not always better. Sustainability is important.

A back of the napkin calculation is 3500 Calories of deficit = 1lb of fat loss. 40lbs = 140,000 Cal, 7lbs = 24,500.

Divide by the number of days and you find your ACTUAL daily deficit as calculated by your body (as opposed to your logging)

You said you're eating around 1800. My back of the napkin says you're creating deficits in the 1600 Cal to the more than 2000 Cal range DAILY.

MFP maxes out at 1000 Cal daily. There is a reason for that!

Because of your initial weigh things are not actually dire yet... but as you're losing weight you're moving further and further from what's sustainable

So, I am highlighting for you that you're creating a deficit that on average is equal to 50% of your TDEE. You're taking in about half the energy you would have needed to take in to maintain your weight.

But, deficits that exceed 25% of TDEE when people cary obese levels of energy reserves (or 20% when the energy reserves they are carrying are such where they would have been correctly characterized as overweight or normal weight)... are aggressive!

And as you can probably surmise, if 25% is an aggressive deficit, 50% is a heck of a lot more aggressive!

You can cross reference the above with the fact that most people find deficits that generate a loss of 0.5% of body weight a week to be easier to sustain that deficits that generate a loss of 1% of body weight a week. And that generally speaking most people would consider losing more than 1% of body weight a week to be a very aggressive attempt at weight loss increasing the potential for unwanted side effects.

I've heard of very few aggressive weight loss attempts going past the six month mark. And fewer still where the aggressive dieter was able to retain that weight loss once they reached the I give up stage.

Nothing stops you from making an adjustment before things become too hard!

You will still lose weight when you lose 2lbs a week and 1.5lbs a week and even 1lb a week. I still lost weight when I lost less than 1lb a month and I still haven't regained those last 11 lbs almost five years later. But had I continued to try and lose 3+ lbs a week like I was doing when I first found MFP... I would have given up while I was still in the 240lb range (and regained) instead of continuing on to 155 (and maintain).

You can sustain a higher loss rate when you are obese than when you have less energy reserves, but in neither case can you sustain an unlimited loss rate.

In the general theme started above when discussing macros... don't make things too hard on you.

Your big money is on finding something you can sustain long term...