Question #2 October 2014
Several of the studies in this meta-analysis used Very Low Energy Diets (in one study participants consumed 400-500 kcals/day for two months). As an RD, would you encourage Very Low Energy Diets or liquid diets as weight loss techniques? Do you believe these techniques are realistic for long-term weight management?
posted by Caroline Moss @ 4:12 PM
15 comments
15 Comments:
This is tricky and a lot of factors weigh in but one thing is for sure, I would absolutely not attempt this with out the guidance and recommendation from a physician. These types of dieting can often be dangerous and its important to do them right. That being said, I believe these methods are only truly appropriate for extremely obese individuals as a means to jump start weight loss. This should not be a life long change; at some point a healthy diet and relationship with food would need to be explained and practiced by the client to achieve life long healthy weight maintenance.
I do not believe that an extremely low calorie diet meets adequate nutritional needs long-term. It's not realistic to expect a patient to maintain this type of diet and I also don't think it's healthy physically or mentally. A physician would definitely need to be monitoring the patient's electrolyte status, vitals, weight, etc. If losing weight is something that needs to immediately happen in order for the patient to improve their current condition than it may be appropriate. However, they would need weight loss education after the restricted calorie diet in order to lose/maintain weight in a healthier manner. Drinking shakes and taking supplements is not ideal for most people. Learning how to eat in moderation and enjoying food would be a better plan in my opinion.
That is something I should have mentioned as well. I don't think that during the trial with extremely low calorie dieting clients should be expected to go about their day like normal. I fully believe they they will not be functioning to the best of their ability and restricting should only be done for a short period of time to avoid any long term damage.
I agree with both Jessica and Haley about how a physician should regularly monitor a patient if they are on a Very Low Energy Diet or liquid diet. I also agree that nutrition education and the components of a healthy diet should be explained to the patient. I think too many people use liquid diets as a "quick fix," and they do not change their eating habits after they stop the liquid diet. Then many people eventually gain back any weight that they lost.
In general, I would not recommend "very low energy diets" or liquid diets for weight loss. Bottom line, and I think we all agree, is that these techniques alone are not true lifestyle changes and therefore not practical for more long-term change. If I am helping someone lose weight, I want to help them develop skills and practices that they can sustain well into the future: how to choose healthy foods, how to put meals together, how to eat a healthy breakfast in a hurry, how to cook for themselves, etc.
These techniques are only a starting point for long-term weight management if and only if you are dealing with a patient that has a solid knowledge base in eating a healthy diet, a dedication to staying active, and a real understanding that that a VLED/liquid diet is only small step one in a lifelong process. Even then, it's still something I would hesitate to recommend. It is not for everyone.
Good point about learning to enjoy food, Haley. I know there might be some medical rationale for these diets at times, but feel like these extreme plans can create some complicated relationships with food. We've got to help them to keep enjoying food and not see it as something that always has to be restricted and feared.
When I think of these "liquid diets," I think back to high school when girls were doing the Master Cleanse diet just drinking lemon juice with cayenne pepper and they lost a ton of weight in just three minutes. It caught on quickly based on everyone's "rave reviews" about the cleanse, but everyone doing it felt awful and 99% of them never completed the full time because they couldn't function normally just drinking cayenne water (surprise!) I completely agree with Brady and Haley that it can set you up for some complicated feelings about food and we should aim to teach about a healthy lifestyle that you can maintain in all settings and occasions. With that being said, there may be an appropriate use of a Very Low Energy diet when under the supervision of a physician, but for most people I think we would all agree it's not an appropriate approach for healthy, sustainable weight loss.
As many others have pointed out, these VLCD are not safe with out the guidance of a physician, and even with the guidance and supervision of an MD trained in such a specialty, the jury is still out in regards to the long term effectiveness of these diets. As Brady pointed out, it's not for everyone.
Also as many have pointed out, our job as Dietetians is to focus on lifestyle changes, or the changing of habits for the long-term, not neccesarily for the short term. While our skills may be warranted along with the skills of a supervising MD in administering such diets in certain situations, our goal as nutrition professionals must be to create an eating plan that is sustainable, enjoyable and healthy...and none of these three adjectives come to mind when talking about VLCD.
I would be very hesitant to ever recommend such a diet myself and if I were to recieve a notice from an MD ordering such a diet for a patient, I would be sure to ask the MD why this is the best course of action to get him/her to critically think as to why this is indicated. If they have clinically researched answers or it's of absolute clinical importance, then I'm not one to argue with that,but if it's a "just because" kind of thing, I'd hopefully be able to reason with them and try an alternative route first to see if we can go the balanced route with more moderation and sustainablity. This is a perfect example of why it's so important to develop rapport with the MDs where you work, to get into their ear and let them know what the RD can do to help facilitate weight loss in a healthful mannner. At BroMenn, the RDs have a great relationship with the MDs and it's great to see them interact and work collaboratively.
I remember diets like that too Sammy! I dated a gal in high school who would consume nothing but 3-4 carnation instant breakfasts per day (and this was during track season...) because she read online that she could lose a ton of weight doing it. I always looked at her like she was crazy, and was very discouraging with it, but there was no stopping her. I think it lasted about a month, and then she couldn't do it anymore because she became too lethargic and weak (surprise!).
Brady, great point about plans like VLCD creating a complicated relationship with food. If we prescribe such diets to people, what are they supposed to think? They may begin to fear whole food or think that it's "bad" for them and that their path to success & happiness is through consuming shakes everyday. Also, what about having a social life while on one of these diets? Imagine going into Olive Garden with friends/family, sitting there not ordering and then busting out a 200 calorie vegetable based shake. Uh...
Balance and moderation are just so important. That's what we've got to preach...
In general, I don't think encouraging clients to lose weight quickly is a great plan of action. Since most of these people didn't put on the weight overnight, I think they need to learn that it will take just as long to take it off. If we encourage "healthy" weight loss of just a few pounds per week, we should be making recommendations to make small changes to their current diet and decrease their calories by about 500 a day. Very low calorie diets make me nervous, since our bodies typically require more calories than that just to function every day, so I would be wary to recommend them to a client - especially since as most pointed out, it wouldn't be safe to recommend without a physician's approval. Weight loss is possible through small dietary changes and physical activity, and I think this is the message we should be pushing. People need to realize that quick solutions to weight loss don't last, and lifestyle changes should be the goal.
Sammy, you used a great example by describing the Master Cleanse diet. I have had several complete strangers ask me if "cleanses" work after I tell them I am in dietetics. Then I just tell them to eat real food! Another great example was what Arthur brought up about the girl that only drank breakfast shakes because she read online they would make her lose weight. It's crazy the influence that the media and the diet industry has on the public. This just shows how much we need to encourage lifestyle changes and eating real, healthy foods.
Brady said what I am thinking in a great way. There may be a time and place for these low calorie diets, but they make me nervous to endorse. Ultimately, these diets are not sustainable, and they don't help with our message of making healthy lifestyle changes.
I completely agree with Haley that low cal diets do not meet long term dietary goals. It's impossible to get everything you need for your body to function when you're only eating 400-500 calories per day. I think that's not safe, could cause them to develop an eating disorder, and people would not be able to maintain that weight loss. Quick weight loss, as we all know, consists of lean mass as oppose to more fat mass. The chances of them gaining it all back and then some are higher because their body will try to make up for that.
However, I do think that in some extreme cases, partial liquid diets may be necessary and could help give that initial push for people who are really struggling to lose weight. I would recommend there be a psychologist, dietitian, and physician be involved to ensure good health for the clients. I would not recommend staying on a liquid diet for a prolonged period of time because you don't know what that could do to your body. Your body needs real foods and fuel.
Susan and Tina,
You two brought up very good points about very low energy diets. I was curious about your opinions on this topic since you two both did internship rotations at the DMH Wellness Center that endorses a liquid diet plan to their clients. So I was curious if your experiences there would make you more supportive of these types of diets. However, I like how both of you discussed that quick weight loss typically doesn't last and that we should focus on teaching people to make long-term diet changes.
As Brady said, there might be some medical rationale for these diets, but I would not want to recommend them. I think a VLED/liquid diet that does not meet a patient's nutritional needs would have to be monitored by a physician. One thing I am learning during my clinical rotation is that lots of patients (even overweight or obese patients) are at risk of malnutrition. A clear liquid diet is considered inadequate nutrition, and if a patient's diet cannot be advanced beyond a clear liquid diet in 7 days and does not appear to be moving in that direction, in most cases, we recommend tube feeding or TPN to prevent malnutrition. These diets are definitely not reasonable for long term weight loss and being on them for any length of time could lead to really poor eating habits.
Post a Comment
<< Home