Frustrated/Confused over Doctor's Recommendations
Maverick6714
Posts: 9 Member
I started my weight loss journey on March 8th, 2021 at 371 pounds. I am 6'3". That was the day my primary doctor strongly recommended me to the weight loss center at the hospital. He was pushing the surgical option, however I told him I was not interested in surgery as it wouldn't be for me as my issue is primarily a lifestyle issue. I scheduled an appointment at the weight loss center, but for non-surgical. My appointment was for April 29th. Between March 8, 2021 and April 29, 2021, I change my eating habits to limit my calories and used Myfitnesspal. When I went to my weight loss center appointment on April 29th, I weighed 338 pounds for a loss of 33 pounds. While the weight loss doctor was congratulatory over my weight loss, he provided me with a "custom" diet plan based on my Body Composition Scan. This custom plan called for 1800 calories a day, with 3 meals of 45 grams of protein and less than 30 grams of carbs. I have followed this diet pretty closely since. I have not only struggled to find foods to eat, but am typically finding it harder to enjoy my meals. I have also actually gained 2 and a half pounds since that appointment. I am started to struggle and become frustrated every meal time. Unless something clicks soon, this will not be sustainable for long. What I was doing prior to the appointment was very sustainable and I was starting to feel pretty good about it. I am confused on what I should do.
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Maverick6714 wrote: »I started my weight loss journey on March 8th, 2021 at 371 pounds. I am 6'3". That was the day my primary doctor strongly recommended me to the weight loss center at the hospital. He was pushing the surgical option, however I told him I was not interested in surgery as it wouldn't be for me as my issue is primarily a lifestyle issue. I scheduled an appointment at the weight loss center, but for non-surgical. My appointment was for April 29th. Between March 8, 2021 and April 29, 2021, I change my eating habits to limit my calories and used Myfitnesspal. When I went to my weight loss center appointment on April 29th, I weighed 338 pounds for a loss of 33 pounds. While the weight loss doctor was congratulatory over my weight loss, he provided me with a "custom" diet plan based on my Body Composition Scan. This custom plan called for 1800 calories a day, with 3 meals of 45 grams of protein and less than 30 grams of carbs. I have followed this diet pretty closely since. I have not only struggled to find foods to eat, but am typically finding it harder to enjoy my meals. I have also actually gained 2 and a half pounds since that appointment. I am started to struggle and become frustrated every meal time. Unless something clicks soon, this will not be sustainable for long. What I was doing prior to the appointment was very sustainable and I was starting to feel pretty good about it. I am confused on what I should do.
When do you follow up with the doctor again? Did you go over what you were doing with him before and what did he have to say about it?
Not sure where you are, but it's very common here to be able to call the office for quick questions and clarifications from someone on staff, or to make a phone appointment with the doctor. That would be my first step if it's still a while until your next appointment.0 -
Do what works. Full stop.
You listened to the doctor and you're struggling. The low carb thing works for SOME people but it is difficult to do, for sure.
I think any weight loss clinic is trying to sell you something. Either their services, a surgery or a supplement or meal delivery plan.
Do what works for YOU.
To thine own self be true.26 -
That sounds TOO low carb. Even as a diabetic I eat more than 30 carbs a day. If your previous method of counting calories and macros was working, I think you should go back to it.11
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Totally agree, go back to what was working before. The priority is to lose the excess weight in a way you can sustain without struggling.
Unless you were given a very compelling reason to adhere strictly to the doctor’s plan I would do what you know was doable and was working. Take your food diary to your next appointment to show the doctor what you’ve been eating so he can join the dots for himself!9 -
penguinmama87 wrote: »
When do you follow up with the doctor again? Did you go over what you were doing with him before and what did he have to say about it?
Not sure where you are, but it's very common here to be able to call the office for quick questions and clarifications from someone on staff, or to make a phone appointment with the doctor. That would be my first step if it's still a while until your next appointment.
We did go over what I have been eating and he had a few critiques and information on a few of the items I had been eating. Like discouraging eating bananas instead of other options etc. Then quickly went to providing the plan I am on now.
My follow-up appointment is mid June. I will take your advice and check into if I can contact him with questions. Thank you.5 -
Maverick6714 wrote: »
Oh, well that's a lot different.
When I was losing weight I used the default macros on here = 50%C 30%F 20%P
I really preferred to eat more fat and less in carbs so I ended up at about 125-150 total carbs per day. I kind of ignored the macros other than getting enough protein.
Why don't you just try to get close to the recommendation and understand that there is a big learning curve AND you don't have to hit that 100g a day every day...I bet you're trying to revamp your entire food plan. It takes time and effort.
Congrats on your weight loss so far, BTW.1 -
Is the new diet designed to address a particular health condition? If not, I would think that what worked for you so far is a better option. If yes, was this doctor trained in nutrition counseling like a registered dietitian is?
Congratulations on your weight loss and your determination to continue!1 -
I don't understand why they changed something that was working so well for you, unless it was an unhealthy eating plan you were following? As others have said, I'd definitely go back to what was working and ignore their advice. Not everything is meant to be followed. You have to question everybody these days, even experts, doctors, etc.6
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When I was ready to give up on my (to that point successful from the point of view of losing a good 40+lbs) random dieting to lose weight because I *knew* it was unsustainable long term, I started looking for something that just might have a chance of long-term success
And for the first time truely realized and internalized that ONLY the final true balance of calories in versus calories out determines our long term weight trend change.
Which changed my focus from what was to me unsustainable rules and plans into an experiment of me trying to figure out how to extract maximum utility out off and how to optimize my available calories.
Initially I mostly concentrated on finding satiating items for fewer calories.
Over the years other considerations have come to dominate including better macros, significantly more plant food sources , gratuitously spending calories on fun and not necessarily nutritionally optimal items.
but the point is that counting calories has allowed me to explore options while meeting my goals.
You will have to make changes to get from where you are to a normal healthy weight. But you don't have to make them all on the same day.
However how you go about losing may well prove the difference between reaching your goal and achieving maintenance for enough years such that the odds to continue to maintain eventually shift in your favor, OR giving up before you succeed in losing the weight, and/or a fairly prompt regain on completion of the diet
These days I eat fairly lightly in the morning, have a large early dinner and have a fairly large and calorific meal right before bed! It sure as heck is not something I would recommend as optimal to anyone else... but it doesn't seem to have stopped me from maintaining! During weight loss there were times I didn't stop eating.... 3-400 Cal or so snacks and mini meals with no large meals at all! Again not recommended as optimal! And while right now, because of family, I tend to eat a main meal between 5 and 6 pm, on my own I just eat when hungry at random times that tend to be more related to my activities and have often dropped a meal I was planning later because on the way home I grabbed a soup, a scone(tea biscuit), or even ice cream.
The whole point is you have to, in my opinion, figure out the things that actually can work for you. While maintaining an appropriate caloric balance such that you're moving towards achieving your appropriately defined goals.
Even while obese I don't know that I would attempt to lose more than 1% of my body weight a week. And most people find the 0.5% to 1% range more sustainable long term, especially after the first few months of losses.
Adjust and move forward and stay in the game!
PS: they are suggesting a fairly low carb, but probably not ketogenic level, food plan. And basically having three meals a day probably without excessive snacking. And adequate protein.
Would it help you to think of this as aspirational as opposed to a rule?
You don't have to hit macros everyday or exactly!
Given your 6ft 3", 135+g protein is definitely a minimum to aspire to to preserve lean mass. Beyond that I would be guided by satiation and remember that I will still lose weight as long as my total calories in are less than the out. So eating 2000 is not the end of the world, especially if 1800 makes you give up!
Have a look at the larger losers group, there might be some stuff there to help, though personally I would just count calories and make selections based on satiety, at least initially....4 -
No specific health conditions being addressed with the diet other than weight control/obesity. The doctor is focused on the Body Composition Scans and the amount of lean mass and body fat. I understand his intent to increase lower body fat while maintaining muscle mass. My problems with the eating is not the 1800 calories, because that is about where I was prior to his appointment. My struggle is more putting together meals with 45 grams of protein and less than the 30 grams of carbs, especially quicker breakfasts and lunches.
During my weight loss prior to the appointment, my typical day of eating might have been:
Breakfast - During week: Yogurt (was starting to be more greek yogurt than regular), banana or two clementines On the weekend: two scrambled eggs (no milk) and 1/4 cup of turkey sausage crumbles
Morning Snack - 150 calories cereal bar
Lunch - Lean Cuisine or Smart Ones Meal, Crystal Light Beverage
Afternoon Snack - 150 cal Kind Granola Bar
Dinner - Hello Fresh meal of baked chicken, roasted green beans, and roasted potatoes
After Dinner Snack - Under 200 calories, typical either half a Lenny and Larry's cookie, small dole whip, turkey/cheese, or wheat thins
I really appreciate all of the advice and comments!! Helps keep my head up a little and work through this.
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cmriverside wrote: »Do what works. Full stop.
You listened to the doctor and you're struggling. The low carb thing works for SOME people but it is difficult to do, for sure.
I think any weight loss clinic is trying to sell you something. Either their services, a surgery or a supplement or meal delivery plan.
Do what works for YOU.
To thine own self be true.
^----This.
When I was pregnant with my 3rd child, my doctor told me I couldn't have strawberries because "they'll make you fat." I was about 5 weeks pregnant, severely depressed, and it was strawberry season. I stuck with her for a few months, but ultimately found another doctor. Her terrible advice hadn't stopped there, and she'd been a practicing MD for 25+ years.
You were doing something that was working. It was sustainable. You felt good about it. (And it doesn't appear to have any glaring dangers.) Stick with what works. Who knows what "services" they'll want you to subscribe to when you don't make their predicted progress on their plan...4 -
Did the body scan include a brain scan that determines what your will find the most sustainable?
If not, and there are no specific health issues that require a specialized diet, do what you find to be easiest.
Other than an RD I have never gotten good diet related advice from a medical professional. In fact, some of it was quite terrible.
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Maverick6714 wrote: »No specific health conditions being addressed with the diet other than weight control/obesity. The doctor is focused on the Body Composition Scans and the amount of lean mass and body fat. I understand his intent to increase lower body fat while maintaining muscle mass. My problems with the eating is not the 1800 calories, because that is about where I was prior to his appointment. My struggle is more putting together meals with 45 grams of protein and less than the 30 grams of carbs, especially quicker breakfasts and lunches.
During my weight loss prior to the appointment, my typical day of eating might have been:
Breakfast - During week: Yogurt (was starting to be more greek yogurt than regular), banana or two clementines On the weekend: two scrambled eggs (no milk) and 1/4 cup of turkey sausage crumbles
Morning Snack - 150 calories cereal bar
Lunch - Lean Cuisine or Smart Ones Meal, Crystal Light Beverage
Afternoon Snack - 150 cal Kind Granola Bar
Dinner - Hello Fresh meal of baked chicken, roasted green beans, and roasted potatoes
After Dinner Snack - Under 200 calories, typical either half a Lenny and Larry's cookie, small dole whip, turkey/cheese, or wheat thins
I really appreciate all of the advice and comments!! Helps keep my head up a little and work through this.
In your yogurt.. try apples. try berries. try high fiber cereal (I use all bran buds when I want something more filling).
Try egg whites added to your eggs. Count the oil spray even if it claims to be 0 calories... it isn't. A gram of oil is still a gram of oil! Check out how many calories ham or Canadian bacon have. different brans of turkey bacon have totally different profile and calories.
You've seen what's in the hello fresh box... now how would you modify and cook it yourself! I've only dealt with about 8 hello fresh dinners on a couple of deliveries my dad tried. In my opinion they were all a few more calories than I would have liked for the quantity when cooked as directed. I very easily increased the size of the meals and reduced the calories with only a few modifications (mostly having with increasing vegies and changing some of the cooking steps and for some of the meals the oil used.
Reviewing your logged meals really does help you "optimize"
again 45g protein x 3 meals = 135g... given your size it is certainly not a high protein target. You don't HAVE to hit it but it would not be a terrible aspiration to work towards it.
30g carbs x 3 meals = 90g is a lower carb; but not a low carb diet.
Within 1800 Cal this leaves room for about 100g of fats. Unless there are some more details in the "doctor" plan.
If it helps you not "waste" calories by eating close to 90g of carbs go for it.
Otherwise just think of it as balancing your fats (some of which are necessary) and your carbs within the context of your calories (the 1800 you're aiming for).
I don't think that a good and helpful clinic would be "upset" if you keep losing weight in the 0.5% to 1% of your bodyweight per week range and come "closer" to the various nutritional targets and suggestion they offer...
.... how far off are their targets compared to your "regular" ? What is causing you "issues" in terms of their targets?
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Are you sure it was grams and not % of those macros?
45g + 30g = 75 g x 4 cal/g = 300 c x 3 meals = 900 calories
That means 900 calories of fat daily to hit 1800 calories total?
or 900 / 9 cal/g = 100 g / 3 = 33 g per meal?
By % it still may not be super easy - but easier with planning.1 -
Related to what @PAV8888 said above, I almost wonder with these diet plans if they're given with an expectation of non-compliance or only partial compliance - almost to go overboard to some presumed perfect ideal, and think "well at least if the patient tries and get close that's better than nothing." For an exacting person like me that's a recipe for anxiety, especially if I feel like there's some psychological game being played rather than just trusting me with good information.
Based on the other info you've provided I agree with other posters that you should stick to what was working for you. Take the doctor's recommendations into account, for sure, but don't think it isn't worth it, and give up, if you can't adhere 100% every day.4 -
cmriverside wrote: »Do what works. Full stop.
You listened to the doctor and you're struggling. The low carb thing works for SOME people but it is difficult to do, for sure.
I think any weight loss clinic is trying to sell you something. Either their services, a surgery or a supplement or meal delivery plan.
Do what works for YOU.
To thine own self be true.
This. You know what the problem is, you know how to solve it, you've been seeing success in that front. Keep it up. It's working.3 -
. Like discouraging eating bananas instead of other options etc.
WHY?
unless you have a health issue involving potassium or were eating a silly amount of bananas per day why would any other option be better??7 -
Maverick6714 wrote: »No specific health conditions being addressed with the diet other than weight control/obesity. The doctor is focused on the Body Composition Scans and the amount of lean mass and body fat. I understand his intent to increase lower body fat while maintaining muscle mass. My problems with the eating is not the 1800 calories, because that is about where I was prior to his appointment. My struggle is more putting together meals with 45 grams of protein and less than the 30 grams of carbs, especially quicker breakfasts and lunches.
During my weight loss prior to the appointment, my typical day of eating might have been:
Breakfast - During week: Yogurt (was starting to be more greek yogurt than regular), banana or two clementines On the weekend: two scrambled eggs (no milk) and 1/4 cup of turkey sausage crumbles
Morning Snack - 150 calories cereal bar
Lunch - Lean Cuisine or Smart Ones Meal, Crystal Light Beverage
Afternoon Snack - 150 cal Kind Granola Bar
Dinner - Hello Fresh meal of baked chicken, roasted green beans, and roasted potatoes
After Dinner Snack - Under 200 calories, typical either half a Lenny and Larry's cookie, small dole whip, turkey/cheese, or wheat thins
I really appreciate all of the advice and comments!! Helps keep my head up a little and work through this.
Given protein minimums, WHAT you eat won't have much (if any) effect on your body composition - how much weight you lose and muscle you retain/gain will.
A diet to which you will comply and thus create a calorie deficit and weight LOSS will have a positive effect on your body composition while one to which you cannot adhere and thus GAIN weight will have a negative affect.1 -
I can kind of understand the recommendations. But, these should viewed as loose- manageable and flexible enough for you to adhere. I’d view these as goal, which you expect to hit a majority but not all of the time. I’m assuming the protein at meals is minimum not absolute goal as well, but you won’t have much room for snacking if you exceed too far.
I’m about an inch shorter than you and I shoot to get approx. 170 grams of protein ( minimum) per day. This is based on wanting 1 gram protein per lb of lean body mass. (I weigh 200. 170 is higher than my LBM but what I want it to be).
The doc probably figured 185 grams protein per day for you, as you likely have more muscle than I do. This means 740 cals worth of protein. With 1060 cals left, doc wants 3 x30 cals worth of carbs at mealtimes. That’s approx 360 cals leaving 700cals for the day. Meals will include fats maybe taking out 250-350cals.
snacks are built into the plan, fruit, protein type snacks etc. Here you can get more carbs if you want them (should also not exceed 30 g carbs per snack).
My guess is once you find a way you will be able to stick to this. It takes some experimenting to find what you like that makes you feel satiated.
For instance a meal with meat or fish, a potato and heaps of veggies will have about 37 g carb from the potato and carbs from the veggies (but very few net) - close enough! A sandwich might have 30 g carbs but 27 net from the bread and some from lettuce/tomato etc.
I lost weight (down from 308 to about 200 now) on a plan similar to what you were doing before doc recommendation. Lost it pretty fast and I’m glad I lost it. But my one regret is not getting more protein in the beginning to keep my muscle. Large people have lots of muscle too. It’s much easier to try to keep this muscle than to lose it and get it back. Body fat percentage v. Absolute scale weight - which is more important to you? For me it was scale weight but now I want low body fat percentage.
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Maverick6714 wrote: »penguinmama87 wrote: »
When do you follow up with the doctor again? Did you go over what you were doing with him before and what did he have to say about it?
Not sure where you are, but it's very common here to be able to call the office for quick questions and clarifications from someone on staff, or to make a phone appointment with the doctor. That would be my first step if it's still a while until your next appointment.
We did go over what I have been eating and he had a few critiques and information on a few of the items I had been eating. Like discouraging eating bananas instead of other options etc. Then quickly went to providing the plan I am on now.
My follow-up appointment is mid June. I will take your advice and check into if I can contact him with questions. Thank you.
All too often, it seems like Keto (low carb, high fat) seems to be the default doctors recommendation without much consultation with the patient.
Keto can definitely work for weight loss, but it is a very specific way of eating that is not for everyone. 🙋🏻♀️ I’d ask why your doctor put you on this particular diet. If there is no health-related basis beside weight-loss, I’d point out your success in losing weight prior to being out on the new restrictive diet.
You had terrific results and they can begin for you again. Please don’t let this temporary set back discourage you, you’ll be back on track in no time! 💖
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I’m just going to throw this out there. You do not have to go to the weight loss center if it isn’t helpful for you. It was something your doctor strongly recommended but I’m assuming the bottom line recommendation was to lose weight. There are lots of ways to do that. Many people need a program for the information and structure it provides.
You were successful with what you were doing. Food plans are not one size fits all. If the concern is maintaining muscle mass, incorporating strength training into your schedule. It doesn’t have to be hardcore pumping iron. It can be body weight routines you can do at home.
I find that when I take the advise of others on a food plan and replace what is working for me, I not as successful. Or even worse, I stop trying and revert to my old ways. In my current journey I am working on what is sustainable and have learned a lot. I am naturally eating less carbs because I am focusing on eating more protein. If I don’t try, I never come close to hitting my protein macros. And the carbs I am eating are usually vegetables and fruits rather than grains.
Please don’t continue to force yourself to do something that isn’t working. ❤️12 -
I’d keep doing what you had success with. After losing 90 pounds, my dr told me how I should be doing it. She also told me to stay away from bananas. I gained 5 pounds the first month doing it her way. Went back to what I’d been doing originally and went on to lose a total of 140 pounds. Next appointment she congratulated me on success. I told her I had to go back to what I had original success with. She looked at me skeptically. My markers were all good. Sometimes doctors don’t have the best plans and you really know yourself best. As long as you’re getting proper nutrition, take charge.13
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missysippy930 wrote: »I’d keep doing what you had success with. After losing 90 pounds, my dr told me how I should be doing it. She also told me to stay away from bananas. I gained 5 pounds the first month doing it her way. Went back to what I’d been doing originally and went on to lose a total of 140 pounds. Next appointment she congratulated me on success. I told her I had to go back to what I had original success with. She looked at me skeptically. My markers were all good. Sometimes doctors don’t have the best plans and you really know yourself best. As long as you’re getting proper nutrition, take charge.
i guess im lucky, when i asked my doctor what i should eat (diagnosed as type 2), she basically said 'i didn't go to school for that, talk to a registered dietician'. im glad i did, as i heard her say in passing that it's impossible to lose weight if you don't eat breakfast -_-
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Congratulations on embracing a lifestyle change and losing 30 pounds.
Weight loss happens when at a caloric deficit. The composition of those calories really doesn’t matter for weight loss.
Higher protein and lower carbs are often suggested for weight loss to:
A) maintain muscle mass
feel more satisfying — feel full longer.
I find 45 grams of protein difficult to get at each meal.1 -
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.4 -
Interesting thread. The plan given by the good doctor sounds like hard core keto. i have done something similar, a pretty tough keto regime for a year until April this year. it can be effective but strict keto is clearly not for everyone. These 'rules' and numbers of keto, what you can or can't eat or how many grams of carbs or proteins are allowed I always considered merely 'suggestions going in the right direction'. For me there was never really a daily limit on macros, it is frustrating and I found it impossible to follow. Instead I tried to be as close as possible to the suggested limits, if I went over no big deal i tried to calculate a weekly average that allowed me some room to maneuver. Not all keto diets are the same, it is not an absolute. Ultimately one wants to lose weight, do what works, make adjustions if needed or re-arrange macros completely to make them sustainable.
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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.1
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Thank you everyone for your advice, comments, and support. Since starting this thread, I have worked to add more protein and less carbs into what I was doing. Trying to get as close to the clinic's plan as possible without killing myself. I have started to lose weight again, weighing in this morning at 331 pounds for a total loss of 40 pounds and a loss of 7 pounds since my appointment (plus the weight I had gained in the days immediately following the appointment). Having these forums and community has really helped me work through this and stay on track. Thank you!13
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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?2
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