Extreme Weight Loss: Desperation Reflects Misinformation

It has always been thus.

People wiring their jaws shut to prevent them from overeating. Long lines at the bariatric surgeon's office, where guts are re-routed and stomachs cut in half. The usual parade of ear beads, hormone shots, B12, herbal stimulants, and electrical belts that shock muscles into painful contraction. There has always been weight loss desperation, but we may be descending to a new and even more depressing low.

Today's online Science Daily discusses a method for quick weight loss, an 800 calorie diet via feeding tube. It seems that some doctors (can we call them that, really?) are placing feeding tubes and giving patients the same treatment that hospital patients would do pretty much anything to avoid-- a nasty, painful plastic catheter down the nose. Seems that this particular treatment is becoming a fad for brides who want to shed pounds quickly and has been around in Europe for awhile. See an ABC news article on the same topic, published yesterday.

Physicians take an oath to "do no harm". It's a promise that we are not particularly good at keeping. Sometimes the calculus is difficult. Is an invasive test more harmful than ignoring a little abnormaility you find on an x-ray, for example? But where we do a particularly poor job in my estimation is in matters of basic health counseling. Here, we err on the side of potentially harmful treatments such as multiple blood pressure meds, diabetes drugs and statins rather than exhorting and inspiring patients to make deep and meaningful dietary changes. The latter are risk free. Far from doing harm, they do immeasurable good.

The problem is misinformation, not malintent. Doctors believe what the general public does. That weight loss is pretty much impossible and weight maintenance unattainable. They also have little idea about good strategies for creating weight loss. They are loathe to exhort patients to lose weight because they have nothing to offer except the suggestion. This often causes patient resentment. Can you imagine if your doctor's entire response to your diabetes was, "You've got to get rid of your diabetes?"

Diets that lower insulin to very low levels and are higher in protein are appetite suppressants. No one needs a feeding tube to create this effect. Simply go on the Atkins diet (no carbs) or eat lean meat, fish or chicken and salads for a few days and you will have the same experience. The only thing that the feeding tube accomplishes is that it makes you squeamish about swallowing whole food while it's in. At the same time, the possiblity of irritation or ulceration of the esophagus and stomach is very real. 

Weight loss requires significant calorie restriction, not cutting back 100 calories per day—another misinformed strategy we hear alot about. This technique is not only ineffective, it is impossible to do since the diet varies from day to day. Try eliminating 100 calories and keeping everything else EXACTLY the same for more than one day. The body must believe there is a food emergency if it is to have any urgency about burning stored fat. This food emergency can be accomplished by following pretty much any good diet that is low in carbohydrate (100 grams per day or less and no processed carbs, just fruits and vegetables). The trick is to find a diet which suits you so that you can be fully (as in 100 percent) compliant. 

Long term weight loss will continue as long as the amount of carbohydrate in the diet stays at the same level as it was during weight loss. In other words, you have to keep doing your weight loss diet but with the addition of greater volumes of none carbohydrate foods to keep weight stable. Some men and some younger women will need a small amount of additional carb to avoid continued loss. But most won't. This piece of the puzzle is the source of most misinformation. Eating "moderately" will not keep weight off.

Ancient diets and their modern modifications (like my Primarian suggestions) are the best way to avoid regain. They cut out not only excess carbs by eliminating grains, breads, pastas, potatoes and sweets, but they also eliminate processed foods. The additives in processed foods, or even their packaging — who knows? —may be contributing to insulin resistance and disruption of other endocrine factors that are required for weight balance. 

More extreme forms of weight loss treatment reflect increasing desperation with our nation's greatest health concern. Desperation, though, reflects misinformation... the fact that we've done a poor job of educating people about what actually works. The reason for the knowledge gap? Most doctors (and in my opinion, dieticians) are still in the dark. 

To read more by Dr. Berkeley, follow her at www.refusetoregain.com or on Facebook at Refuse to Regain: Barbara's World.

Would you resort to a feeding tube to drop pounds for your wedding day? Tell us in the comments!