Question 1
In
the largest randomized trial stated in the study, the lifestyle intervention
group was instructed to reduce their calories to 1000-1200/day if base weight
was <200lb and 1200-1500kcal/day if
>200lb. The article also states that rapid weight loss (>2.5lb/week)
often worsens steatohepatitis or results in liver cirrhosis or failure. Do you
agree with the calorie levels recommended for this group? Please state why or
why not. If you do not agree, what calorie range would you suggest?
posted by Jamie Smythe @ 10:17 AM
34 comments
34 Comments:
I think that for many individuals this would be a drastic decrease in calories, setting them up for a rapid weight loss. For this reason I am going to disagree with these calorie ranges. Ideally it would be nice to have a baseline for participants so you know what they are currently consuming and can decrease from there. It may be more beneficial to decrease a certain percentage from current calorie intake to work your way down to a range. This would however be more time consuming for the researchers.
I disagree with these calorie ranges.Reducing and preventing further fatty build up in the liver and addressing other factors like diabetes, obesity and hyperlipidemia can be achieved with slow and steady weight loss. These calorie ranges are setting the participants up for drastic weight loss and then dramatic weight gain furthering their condition. I agree with Stephanie when she says that baseline calorie intake would be beneficial to start with and then decrease but unfortunately very time consuming.
I'm so glad you brought up this question because I was so shocked when I read these calorie levels! Every person has different caloric needs and I think for most of these people limiting their calories so severly will set them up for even more problems down the road. As Stephanie and Molly said, I think a baseline caloric intake should be determined for each individual. From this information, the researchers should decrease their intake to a standard percentage for the whole group.
After reading this calorie levels in this trial study, I immediately thought, “those calorie levels are too restrictive”. I feel that the lowest any calorie level should go would be 1200 calories, but even that is quite extreme. We’ve learned that there will be negative consequences with intakes that restrict too much (such as a decrease in metabolic rate). I also think it is ridiculous that they put someone on a 1000 calorie diet and tagged it with the title “lifestyle change”. There is no way that an individual could stay on a diet that restrictive for the rest of their life. They would always be hungry and would not be getting enough nutrients because they are eating so little.
I do not agree with a veil of calorie ranges in any individual. Each unique individual has their own set of calorie needs that allows them to reach their own needs and goals based on their specific set of instances. Without looking at the individual as a unique individual you could be setting them up for further harm.
Molly,
I completely agree with you that this would often lead to dramatic weight loss only to be followed by weight gain. This would only worsen their condition which would negate the purpose of the study. Though it would take more time I think it would be much safer and ethically sound to at least create more diverse calorie levels.
I think that the amount of calories would be a large decrease for most of those pt's and it would be difficult to see wight loss maintenance. Most pt's would complain of hunger and would become frustrated and quit following the diet. At the hospital we frequently recommend low calorie diet (1200-1400) calories for pt's who need wt loss. At DMH we use Mifflin and subtract 500 for wt loss, which gives you the low needs. I agree with calorie range but I do not think you can just expect some one to just switch from a 3000 calorie diet to a 1200 calorie diet. There needs to be some middle ground.
I think that the amount of calories would be a large decrease for most of those pt's and it would be difficult to see wight loss maintenance. Most pt's would complain of hunger and would become frustrated and quit following the diet. At the hospital we frequently recommend low calorie diet (1200-1400) calories for pt's who need wt loss. At DMH we use Mifflin and subtract 500 for wt loss, which gives you the low needs. I agree with calorie range but I do not think you can just expect some one to just switch from a 3000 calorie diet to a 1200 calorie diet. There needs to be some middle ground.
Without reading any other research, I would agree with this statement as this calorie range would probably meet the needs of at least 50% of the individuals in the trial. From what I briefly read about this disease, it appears individuals already carry an excess amount of weight in the form of fat on their bodies. While it seems like a very low calorie range, it's important to remember that you do not want to "feed the fat". I question if there are also dismetabolism issues with disease similar to those with PCOS. It sounds like a lot of you agree that 1200 should be the lowest level of calorie needs; however, this may be for the normal healthy population and not for special disease states.
The participants in this trial may also have seen greater successes with weight loss due to the macronutrient distribution as described. Satiety levels are increased when one increases fiber, protein, and healthy fats in the diet while decreasing calories from carbohydrates.
Amanda, you bring up some great points. I agree with you in the fact that we don't want to feed the fat and we do need to remember that these are individuals in a disease state.
I do not agree with the calorie levels recommended. Although an individualized plan based on each participant's energy needs, disease state, activity level, etc would be best, I can see how it would be inconvenient or even impossible in this research setting. So, I think it would be a good idea to separate participants into more categories, rather than just 2 (one for those <200 lb and those >200 lb). These categories could account for things like disease state and activity level. Then calorie ranges could be given to each (more unique) group. Hopefully they would be more realistic than they were when putting such a large number of participants, all with different needs, in the same calorie needs category.
Jordan-
I agree with your comment that restricting calories so much would probably lead to increased hunger and eventually lead to participants quitting the program. We can't expect someone to make a lifestyle change by restricting so many calories
Amanda-
I also agree about your comment that we don't want to feed the fat. If we restrict calories too much the body will just hold on to everything that is taken in.
I am torn on this question. I feel like when you are working with large groups of people like in this study you do have to make broad categories like this for them to lose weight and as the article said these people did show some improvement over the control group. I also think 2.5 pounds of fat weight is a lot of weight to lose for someone and while maybe the first week or two the pt may lose slightly more than this I don't think that they would maintain weekly weight loss higher than this. So I would say I agree with the use of this calorie level in this study, however, with clients out in practice I feel like we need to take the time to make an individualized plan to foster the appropriate amount of weight loss per week.
Brooke, after reading your comment I do have a small change of heart. I do feel like 1,000 calories is too restrictive and that the minimum should be 1,200 calories. Even those in the worst clinical shape never go below this level. However, I really don't think a person who is not used to diet or exercise will hit these levels consistently enough to maintain weight loss levels greater than 2-3 lbs a week.
Very tricky question, while I believe that 1,000 kcal are too low, the sample size was much too large to assess each patient's specific calorie requirements. I think the researchers took a safe approach to ensure that weight loss would occur. However, it was a risk recommending kcal that low, especially with liver cirrhosis and/or failure being the consequence. Are there any published recommended kcal/kg for NAFLD patients?
I agree with Nate, this was picked for a reason. If the range was 1200-1400 kcal, some patient’s needs to maintain weight may have fallen in that range which would have not produced weight loss. Don't forget any who has been to DMH and to the individuals who have not been there the liquid diet is in the same kcal range to start with and they see favorable weight loss results.
In general, I think the calorie recommendations are too low. I agree with Brooke that 1200 should probably be the lowest amount of calories that an individual should consume on a daily basis. However, 1000 up to 1200 calories may be appropriate for certain individuals. I think that calorie needs should be assessed on an individual basis instead of giving a general calorie range for everyone. If everyone were to adjust their calories to this range, I am certain that rapid weight loss would occur which has been proven to worsen these liver conditions.
Nate, I like that you brought up an individualized plan for each person. I think this is a key point! Think of the difference in needs of a 6'2" male versus a 4'10" female. There is no way the 1000-1200 calories a day would come close to meeting the male's nutrient needs. Weight loss plans need to be based on the needs of the individual.
Emily,
I agree that participants should be categorized in a different manner (instead of just <200 and >200) in order to account for different needs within the population.
I agree that calorie levels may be too restrictive. The article states that weight loss is the most effective treatment for NAFLD, but that rapid weight loss can cause further liver damage. Would an alternative be to liberalize calorie ranges and include an exercise component? I would think that weight loss maintenance would be an important part of determining the success of the intervention.
I agree that this would be a dramatic decrease in calories for many people. I would suggest calculating needs based on adjusted body weight. I also feel that it is odd that this approach was taken since drastic weight loss was shown to worsen the disease state. If healthy gradual weight loss was what the study intended, using these classifications for calorie needs could cause drastic weight loss with some participants
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Kathy, I like your suggestion to liberalize calories and add exercise into the intervention. Exercise is such an important aspect of weight loss and I am not sure that healthy weight loss includes a large restriction on calories.
These calorie ranges would definitely make someone lose 2.5 lbs/week or more but this could be a dramatic decrease in calories for some and a steady decrease in calories may be a healthier route. I do not disagree with the 1200-1500 calorie range; however, I feel that anything below 1200 is very restrictive-especially if they are claiming it as a “lifestyle” intervention. It is apparent that these ranges worked since the intervention group had a 9.3% weight loss. I think that after the study it could be very difficult for many of the participants to maintain these calorie ranges and their weight may rebound. I think that personalizing realistic “lifestyle” calorie ranges for the participants would have been a better option, also, decreasing their calories slowly until their goal range is met.
I felt that this degree of calorie restriction is pretty drastic. For some people, this might be close to a 50% reduction in overall consumption and would make it extremely difficult to do, at least starting out. Why not do a more gradual approach, such as 25% reduction and work your way toward 50% reduction? However, to support this drastic approach, some people are motivated when they see results right away. Maybe getting rapid results is enough of a reward to keep people interested whereas the slower approach would make them lose interest. There are pros and cons on both sides.
I agree with Brooke and others that it is ridiculous to call the methods in this study a "lifestyle change". If you are going to change someone's lifestyle approach, you have to make it manageable for them. Sure, in the short-term you will see great results but I believe it is more effective to give the pt/client a flexible long-term eating plan. I do believe rigorous exercise is also key, but again, it has to be practical and doable for the person.
Considering that they aim to combine diet and exercise, I think 1200-1500 kcal/day is too restrictive. While strict calorie control seems to be a somewhat effective intervention for this disease, that low of an intake may not produce as favorable of results as a slightly higher intake.
I think the calorie intake levels are very restrictive and would contribute to rapid weight loss which, as is stated, could worsen the disease state. While I understand that for a large study it would be impossible to create a custom plan for each participant, I think a better criteria than simply body weight could have been used. Perhaps it could be combined with BMI to come up with a better indicator of caloric needs. Given that exercise was a component of the lifestyle intervention, I think using the defined ranges as a net of calories in - calories out might be appropriate.
I do not agree with these calories recommendations because it's such a drastic decrease from the way that most of these participants current lifestyle. The article also states that rapid weight loss seems to worsen their symptoms and by decreasing their calorie intake this much, that is most likely what will happen. I believe that each person's calories needs are different based on a variety of factors and the best way to accommodate this would be to figure out each person's needs and then find an average range based upon that data.
I do not agree with the 1000-1200 calorie diet for those <200 lbs and 1200-1500 for those >200 lbs. This is an extreme decrease in calories, especially considering these individuals are currently overweight. This diet would produce drastic weight loss but it would be difficult to follow through with for an extended period of time, which could cause additional weight gain over the course of the study. As Molly said, I also think there should be a baseline calorie intake based on current intake and then decrease as progress is made. Overall, individual goals should be set based on weight, current diet, and severity of condition.
Emily,
I completely agree with you, I think that the participants need to be grouped into more categories. Also I like the idea of accounting for disease state and activity level. Because this is such a large group it would be very difficult to individualize for every participant but this would still allow more accurate ranges.
Emily-
I like your idea about separating the participants into more categories than just those >200 lb and those <200lb. First, this is a wide range of weight, and second the study may be more successful in grouping the participants by common goals, activity levels, or interest.
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