My friend posted a picture from a church event the other day on facebook. We only knew one person, my friend, in the picture. While the picture was just them smiling and waving to the camera, all my wife and I could notice was the morbidly obese man who was sitting in a wheel chair with them. He was part of the event.
Anyway, I felt really bad for him, as is my usual reaction. He might be rather embarrassed of his weight/appearance and I it got me and my wife talking about his options.
We’d estimate he weighs at least 500 lbs.(maybe more) and it looked like he was wheel chair bound due to weight. I know a 350 lb. man who walks around pretty well, and this guy was quite a bit heavier.
Anyway, what would happen if he reduced his diet to 1500 calories per day? Other than losing weight, would his body go into shock? Could the same amount of calories I could survive on kill him due to the sudden change? Or would he just rapidly lose weight and be otherwise OK?
I know this is an unnecessary side note, but in case you are wondering, the wheel chair had no arms so the man could sit on it. Just in case you are trying to picture it.
At that level of obesity, it’s really best to do extreme calorie restriction as an inpatient, connected to heart monitors. Yes, it could cause heart arrhythmias which could be fatal. This is why they have doctors on the set of The Biggest Loser and similar programs.
I ran some numbers, assuming he’s indeed 500 pounds, 50 years old, male and average height (5’10"). He needs 3139 calories a day assuming NO physical activity at all - just basal metabolic rate of a person that size laying in bed all day, not gaining or losing weight. 3767 calories for maintaining that weight with “little/no exercise”, meaning we let him get up to go to the bathroom, fix a meal, watch TV. A fat loss diet would recommend 3013 calories per day, and an “extreme” or “fast” fat loss - recommended for someone of this size who is trying to lose weight as rapidly as possible - should be done with no less than 2260 calories per day. Of course, as he loses weight, these numbers change downward. At just 10 pounds lighter, he needs to reduce another 30 calories to keep losing fat slowly, or 40 calories to keep losing weight rapidly. This is one reason why dieting is so frustrating for very obese people. Every time you get used to eating less and think, “hey, I can do this!,” your allotment gets lowered even more.
You can play with the calculator yourself here, if you like.
Most generally healthy people can go for a few weeks without food and survive as long as they have water. For a morbidly obese person there might be health issues that would kick in with little food intake, plus being tired and hungry all the time.
Restricted calorie diets are a common weight loss plan for the morbidly obese. But there are dangers and it should be done under medical supervision. These are for calorie counts as low as 800/day.
There is an extreme case of calorie restriction in the British medical literature from the 70s - been posted on here before IIRC. A morbidly obese guy ate nowt for a year - nothing - under medical supervision. He lost a lot of weight, obv, but the interesting thing is how nothing was needed in the way of intervention. I think it really was a case of nothing at all was administered in the way of vitamins / minerals etc during the fast, so the complete opposite of the body going into shock. Obv a N=1 sample, but an interesting one. I’ll try to find the reference.
Another reason for slow calorie reduction is very low calorie restricted diets can cause muscle loss in the heart as well as gall bladder inflamation. Both are life threatening.
Isn’t the OP pretty much describing life after a lap band procedure? There’s a sudden reduction in calories. They are monitored by doctors but the weight comes off very steadily.
Yep that was my thought - we call it a gastric band op.
What’s really fascinating about that op is the Law of Unexpected Consequences. I’m no expert but the documentary I saw described how people who have this operation often report being released from a kind of addiction - that is, they no longer feel hungry all the time.
Something to do with HFCS coating receptors … so the message to the brain saying you are full isn’t received and so you keep eating, and eating. Cut off the main/top/first stomach and somehow the hungry message stops… I dunno, it’s early days fro research but hugely interesting.
What would happen is that he would lose weight, moderately quickly at first, then slowing down. By 6 months weight loss over the whole time would average out to be a bit under 2 pounds a week (about 0.8kg).
See[here](http://onlinelibrary.wiley.com/doi/10.1038/oby.2001.134/full\) for a review of randomized controlled trials, especially tables 1 and 2. 800 KCal/day or 400 KCal per day, no signifiant difference: first six weeks losing over 2 kg/week but by 5 to 6 months all having averaged 0.8 kg/week. First two weeks most of the loss is fliud and glycogen, not fat. After that, assuming adequate and high enough quality protein 75% fa loss and 5% muscle mass loss. At least 50g per day of carbohydrates, enough essential fatty acids, and of course vitamins and minerals are advised.
The calculators do not reflect the reality of how bodies dynamically respond to caloric restriction.
As to the other impacts besides weight loss, the article summarizes as follows:
If you lose weight too rapidly, regardless of how or what your baseline weight was, you lose muscle mass in addition to fat, and that’s not good for anybody.
When I worked in hospitals, the “biggest” diet I ever saw ordered was 4000 calorie ADA (American Diabetic Association) because the person weighed over 500 pounds and the doctors wanted her to lose weight, but not too rapidly.
It takes about 10 calories per pound per day just to keep an adult alive, so even with no physical activity, she would have had a 1000-calorie-a-day deficit, and lose several pounds a week if that’s all she was eating.
There is a TV show on ABC called extreme weight loss. A lot of participants start at around 400 pounds, then radically alter their lifestyle. The show goes in 3 month intervals, and obviously in the first 3 months the weight loss is much faster. A lot of people lose over 1 pound a day during the first 3 months, so a 100+ pound weight loss is not impossible. Granted those people are radically lowering caloric intake and increasing activity, so a 4000ish caloric deficit per day is realistic for someone who weighs 400 pounds doing several hours of activity a day (at that weight, even walking at 3mph should burn about 700-800 calories an hour) and cutting their caloric intake to 1200-2000 or so. The more weight you lose, the more your biochemistry changes to make further weight loss harder and makes it easier to regain the weight. But at first, biology is not fighting back too hard and people lose 1+ pounds a day.
I don’t have the science on me, but going on a total starvation diet is a bad idea. I don’t remember why, but something like 800-1500 is the minimum you should eat because lower than that and you run a higher risk of things like organ damage. Plus like DSeid said, you need a certain level of protein to reduce the amount of lean tissue lost during a fast.
I thought you were going someplace somewhat different with the Law of Unintended Consequences. People who have bariatric surgery may be released from one kind of addiction, but they have problems with another kind of addiction: alcoholism. A study found that alcohol problems increased significantly in the second year after bariatric surgery.
I have a friend who’s worked in substance abuse treatment centers, and she’s said that it’s not uncommon for some other addiction to take over when people stop drinking or using drugs. Men and women become religious fanatics or hypersexual in about equal numbers; men are more likely to gamble, and women are more likely to have eating disorders. I also saw someone on TV who had started hoarding instead of eating.
They don’t talk about calories much. In fact, I just spent some time looking through a dozen different hospitals’ information packets, and not a single one mentioned calories before 5 weeks (and only one mentioned them at 5 weeks, and said to check with your dietitian to see if you should be on 1000, 1200 or 1500 calories at 5 weeks). The general gist post operatively is to not think of calories, but to focus on adequate liquid and protein, and slowly, very slowly, adding in one food at a time and testing for tolerance.
But, again, rough guesstimate number crunching, and it looks like 500-800 calories a day the first few weeks - all liquids, shakes or purees.
ETA: Oh, and most band patients have to go on a physician monitored 800 calorie or less diet *before *surgery, to reduce the size of the liver. Kind of fois gras in reverse…
It’s also possible for the person who’s undergone gastric-related surgery to ‘overcome’ the limitations imposed on them, depending on the surgery involved, etc. The person I met who I most thought could use some kind of weight-reduction surgery… turns out she’d already had it a few years back. Ouch.
Milkshakes and chocolate. Some of your fancy frappacino type drinks as well. They are extremely calorie dense and easy to nip at for hours on end, allowing you to consume all the calories and dodging the volume restrictions of the surgery.
There is a weight loss center in St. Petersburg, FL. They offer the 3 choices – gastric bypass, “the sleeve” (involves removing about 2/3 of the stomach) and lap-band. Regardless of the option one chooses, if approved you begin with 2 weeks on Optifast (800 cal/day) before the surgery and after the surgery it’s 800 cal/day clear liquid for 2 weeks. Then it’s full liquid, 800 cal/day for another 3 weeks. Then slow introduction of solid food. Until the target weight is reached it stays at the 800 cal/day. I’ve had a few people I know who have gone through the program. They claim an 85% success rate. Along with the surgery and diet there is a requirement for pre-surgery counseling and post surgery attendance of “group” sessions.
You don’t get to be morbidly obese overnight and the “cure” requires a commitment or its just a waste of time and money.