Physician Supervised Starvation Diet

sotto_voce
on 12/22/09 2:25 am - Alpharetta, GA
This is a follow up to my post from last week. My boyfriend, Dan, is an Internal Medicine resident at UT Memphis. Currently, he is doing a month of work at an Endocrinology clinic. He got to present the topic of Duodenal Switch to the faculty and residents last week and ended up getting a standing ovation. During the presentation, there is a discussion period where the faculty give their experience with the topic and generally things get off topic a bit.

One of the attending endocrinologists mentioned physician-supervised starvation as a valid weight loss strategy and today Dan got to meet one of those patients during clinic. The attending is having the patients abstain from eating for up to 6 weeks, while completing 1 hour of cardio exercise per day and taking 1 adult multi-vitamin. The patient Dan saw today didn't eat for 6 weeks. He lost 65lbs in those 6 weeks and had his diabetes completely resolve.

My initial reaction was shock and I could not believe that this was an acceptable medical treatment. I brought up every concern that came to mind from hypoglycemia to vitamin/mineral deficiencies, high PTH, etc. Dan had the same reaction and the attending was able to convince him that the starvation diet was an acceptable treatment in compliant patients.

After the patient reaches a desired weight, food is reintroduced at 1800 calories per day. They are having good success with continued maintenance of lost weight. The stomach has shrunk so much in 6 weeks of no food, that the patient reports satiety with 1800 calories/day. Supposedly if the patient can abstain from food for 5 days, they are usually able to successfully complete the 6 week program.

So, my question is this... did any of you have this method of weight loss suggested to you by your physician as a serious treatment plan? I'm not talking about your friends who joke about being anorexic or fasting for a few days at a time. I am talking about multi-week physician supervised starvation.

Thanks, y'all!

Bethany
Atlanta, GA

 
          
(deactivated member)
on 12/22/09 2:41 am

Been there, done that.  I initially lost weight but when they reintroduced the (I think mine was 1600) calorie a day diet, I gained back all the weight and then some. I gained steadily and the Doctor blamed me for non-compliance...He did not believe me or my food journals.. That was the end of that relationship.

Oh, I wasn't totally starved, they let me do liquids that had zero calories.  lol
 

Personally, I think it is bull**** 

Michele

vivimolly
on 12/22/09 6:02 am, edited 12/22/09 6:02 am - Rochester , NY
Sounds completely familiar.  While my doctor never SAID he didn't believe me, I just got that feeling.  It's not as horrible as it sounds, though.  After the first week I was never hungry at all.  But I sure loved cooking certain foods for my family!  Kielbasa cooked under the broiler was one of my favorites - I'd totally hand over the broiler and just sniff, sniff, sniff like a dog!  LOL  And I don't even like kielbasa!

The weight came off just fine until the "maintenance" phase and then the very instant I put food back into the equation BAM!  Back came the pounds.  With friends.

Vivimolly

Dina McBride
on 12/22/09 2:57 am - Portland, OR
Ummm.... NO!  Thank you Jesus!

I just did 9 weeks of NPO (with IV nutrition) and let me tell you:  it sucks!

I can't begin to imagine what it would be like as a pre-op.  My diabetes was out of control - with FIVE medications - I had huge swings from low 50's blood sugars and high 200's low 300's blood sugars - in any given day!

What I want to know is this:  What is the outcome 2 years down the road?  5 years down the road?  7.5 years down the road?

You can't tell me they have kept the weight off for that length of time and maintained resolved metabolic syndrome!

Blessings,

dina
Open BPD/DS July 2, 2002
Revision:  Lap Re-Sleeve November 10, 2008
Dr. Aniceto Baltasar, Alcoy, Spain
www.bodybybaltasar.wordpress.com
Read my DS Blog:  http://livingthedslife.wordpress.com/
metamorphosis007
on 12/22/09 3:13 am
 Yeah, I'd like to see the long term stats for that, too. Ha! 

To me, it's crap like a starvation diet that makes obesity worse in the long run. What is this doing to your metabolism? In my eyes, and I have no medical background, it's just another yo-yo diet. 
You gotta love livin', baby, 'cause dyin' is a pain in the ass.---Frank Sinatra
Elizabeth N.
on 12/22/09 3:20 am - Burlington County, NJ
IMNSHO this should be grounds for malpractice and possibly criminal charges.
MarciRenee
on 12/22/09 3:26 am - IA
Marci       
sotto_voce
on 12/22/09 3:28 am - Alpharetta, GA
But why?

The patient is agreeing to the treatment protocol and can break the treatment at any time by eating.

I was worried about vitamin/mineral deficiencies and so far, those results have not been seen on blood tests, because the obese human body normally has enough stores to be fine for 6 weeks (so the physician says - NOT ME).

I would worry about long term negative impact on the metabolism, especially if this treatment was followed multiple times with relapses, but where is the proof?

Can you think of a specific reason why this would be malpractice? Dan and I were both wracking our brains and can't find anything specific to point to. Peer reviewed journal articles would be helpful.

Bethany

 
          
Elizabeth N.
on 12/22/09 3:43 am - Burlington County, NJ
I will leave it to others with better access to medical/science literature to give you peer reviewed stuff. In fact, I'll send a message to Brandi about this. I bet she'd be happy to weigh in.

Here are a couple of my thoughts about it, which mean nothing on their own but might give you an idea for further research or just plain questions for Dan to ask those morons, I mean physicians who are torturing their patients.

There's reason number one: It's torture. Deprivation of food is an act of torture. Go look at the Geneva Convention stuff. Yes, the patient SUPPOSEDLY signs an informed consent form blah blah blah and can depart the program at any time. But let's think for a moment about the doctor patient relationship. 99.8% of the time this is NOT an equal relationship. The doctor is in a position of psychological power and influence.  In a good therapeutic environment, this leverage can be used to achieve great ends. But the doctors in this scenario are "demanding" that the patients do something painful, unnatural, abnormal, etc. and will then "blame" the patients if they don't succeed, either overtly or covertly.

Reason number two: It is PROVEN that this method does. not. work. There is a LOT of evidence on record that diets have something like a 95% failure rate for obese to morbidly obese people. If doctors insisted on using a treatment regimen with that kind of failure rate for treating ANY OTHER DISEASE, there would be an outcry little short of a demand for a revolution. But nope. The docs keep putting patients on diets and then blaming the patients for being "noncompliant" when it doesn't work.

I had a lovely conversation last summer with the doctor of my childhood, who just turned 90. He went into orthodpedics when I was but a toddler, and has been more or less retired for about fifteen years, so bariatric medicine is an unknown to him. We talked about my lifelong obesity and how I got to the DS and stuff. It was the first he'd heard about this new field of medicine. You should have seen him light up like a Christmas tree when I told him about some of the research and gave him a few things to look up. Ever the fabulously honest, humble guy, he positiviely GLOWED with delight as he told me how glad he was that someone had FINALLY put something in writing about a phenomenon he'd seen ever since he got his MD from Yale in about 1943. He KNEW that his obese/morbidly obese patients would work their ASSES off to lose weight and it almost NEVER worked. He knew that they were generally incredibly active people, for most of them were ranchers who did hard physical labor all day, every day. He remembered MY struggles with weight and how they started when I was scarcely more than a baby, and how his colleague put me on calorie restricted diets over and over again from young childhood, and how every time I lost some weight and then gained it all back plus a LOT more.

He used his mind and said, "Something is wrong with this picture." He quit demanding extreme measures of his obese patients and talked about FITNESS and HEALTH instead of the numbers on the scale. And he didn't have to have a ton of research under his belt to do this. And he saw that his patients did a lot better with overall moderation. He TRUSTED his patients to work at doing things right. We were his partners and he was our servant and friend with advice to offer.

It breaks my heart that he's gotten old :-( . There need to be more docs like him, docs that use their minds and their hearts.
MarciRenee
on 12/22/09 3:25 am - IA
I think that this sounds CRAZY!!  Nor normal.

My first thought is that they are inducing anorexia.  I mean peeps can develop anorexia by dieting and having some success and then taking that too far.  Of course there is a lot of emotional, psychological, mental stuff also going on with developing anorexia.  There's no telling how this is going to **** someone up mentally and emotionally.  Whatever good relationship the peeps had with food is now gone.  They have made food the enemy, which it isn't, necessarily.

My second though is that if dieting and exercising tend to fubar a metabolism - what is totally abstaining from food for 6 weeks going to do to metabolism?
Marci       
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