Lately, I have had many inquiries from patients about weight loss. In the vast majority of cases we decide upon a gradual program that aims at maintaining a new disease free state. However, sometimes weight loss can be used as the primary way to achieve the new disease free state, ie, weight loss can be used to treat certain conditions. In these cases, we are interested in more rapid weight loss.
There are many weight loss approaches that patients have encountered, and in reality, if a patient can stick with one particular program they are likely to have success.
Conventionally, there are three components to the success of any weight loss program:
- caloric control
- increased physical activity
- behavioral modification
Many internists will note that that if a patient incorporates all three aspects into their approach, they will likely lose weight. Unfortunately, after 6 months, this weight loss typically stalls, no matter how much the patient has lost. If the weight loss is more rapid, the stall period can come earlier. This is when doctor and patient typically become impatient.
My own favorite weight loss approach for those that are generally healthy has been the use of AMP (also called myoden) injections in conjunction with diet and exercise. The AMP helps to keep the energy up, control hormones associated with weight gain, and keep appetite down (behavioral component). This approach has been described here and here.
However, sometimes a more aggressive approach can be used, which incorporates a supervised very low calorie diet.
A typical weight loss for patients who create an energy deficit of 500 calories will be 1/2 to 1 lb a week for patients who are overweight. A deficit of 1000 calories per day may be needed to create the same weight loss for someone more obese. Over time, typical weight loss programs create a loss of 18-19 pounds over 20-24 weeks.
A more intensive, very low calorie program can create weight loss of 44 lbs in about 12 weeks. This type of an approach gives a dietary allowance of less than 800 calories and needs to be done under supervision. Typically a liquid and controlled diet is used, which is composed of high quality and high availability (high biological value) protein. Electrolytes and uric acid are monitored weekly in the blood.
The goal of such rapid weight loss would be an increase in the quality of life, and an improvement in conditions such as hypertension, diabetes, elevated cholesterol, and cardiovascular disease.
Conventional very low calorie diets tend to fail in the long term for three reasons.
First, they may never get off to a good start because the caloric restriction is too difficult for the patient due to fatigue or hunger. This is the most important. Naturopathically, we prevent this with weekly to twice weekly Myer’s nutritional IV injections. We will also typically use nutritional supplements to decrease appetite and maintain normal energy levels (amino acid therapy).
Second, conventional very low calorie diets fail because rapid weight, and particularly fat, loss can release large amounts of stored toxins into the blood stream, such as PCBs. This is also theorized to be part of the reason why patients on a standard diet tend to plateau. The PCBs inhibit beta oxidation (burning) of fat, and thus limit the amount of energy that can be burned in metabolism. They also make patients feel fatigued. Naturopathically, we increase the liver’s ability to metabolize and detoxify these released chemicals, as well as increase excretion into the stool to prevent this problem.
Third, patients tend to relapse if they go back to their regular eating and lifestyle habits. So long as we incorporate proper lifestyle choices, and do a full internal work up every 4-6 weeks after achieving an ideal weight, this can be avoided as well.
Edit: December 18 2008
Myoden no longer available. Only B12 and MIC.
