Answer provided by Deborah Horn, DO, MPH, MFOMA
Please note: Before starting any weight-loss program, please consult with your primary care physician.
I am committed!
I am starting today!
I want it off by TOMORROW!
Almost everyone who struggles with their weight has had this mental conversation. It may have taken years or decades of abnormal physiology and struggling with good choices to put weight on, but once we are committed to change, we want it off now! Similar to the fast-paced technological world we live in today, we want the scale to move at lightning speed. But does rapid weight-loss work? And is it safe?
Many promises of rapid weight-loss are a result of mass marketing and commercial approaches – the ones you see on infomercials at 2 am or read about as the latest Hollywood “secret.” Do any of these sound familiar?
“Drop a dress size in 7 days.”
“Lose weight fast – no exercise required.”
“Boost your metabolism!”
These diets make unproven promises. They often claim to increase your ability to burn fat, simply block the fat you eat, “rev up” your metabolism, or provide a miracle pill composed of “newly-discovered compounds.” Components of these diets often include gimmicks and unproven approaches such as:
While you might lose weight with these gimmicks initially, this is typically due to a severely decreased caloric intake. Most of these diets promise weight-loss without the need for physical activity – and frankly, on such a low-calorie intake, you don’t feel well enough to exercise anyway. Without medical monitoring from a healthcare professional, these options can lead to serious health risks. Additionally, most of these rapid weight-loss approaches are not sustainable – and once stopped, the weight will most likely come right back.
There are two medically monitored and proven options for rapid weight-loss:
Both of these options are very different from the gimmicks on page 14 in that they have proven results, known side effects, and they allow you to work alongside your healthcare provider to optimize your response.
Option 1: VLCD’s
Medically-monitored VLCD’s are typically diets of less than 800 calories. The plan is often built around a nutritionally complete protein-based meal replacement in the form of a shake, although it can be done with regular food as well. This rapid weight-loss approach focuses on high intake of protein and decreased intake of carbohydrates. Whether protein is built into a shake or taken separately, these diets require an adequate intake of vitamins, minerals, electrolytes and fatty acids. VLCD’s have been shown to demonstrate not just faster weight-loss, but also greater weight-loss at one year than dietary interventions which did not include a VLCD component.
Option 2: Bariatric Surgery
Bariatric surgery can include gastric bypass, gastric sleeve and the gastric band. There are also intermediary procedures available such as the gastric balloon. All of these are currently FDA-approved and create rapid weight-loss in most patients. The rate and total amount of weight-loss can vary widely from person to person.
So, there are some proven and some unproven options for rapid weight-loss. Let’s come back to our initial question. Can losing weight too fast hurt me?
Yes. There are potential negative effects of rapid weight-loss. For this reason and many others, it is recommended that you team up with an obesity medicine specialist, a bariatric surgeon or other experienced healthcare provider with expertise in the treatment of overweight and obesity. Together, you can reduce the risks and optimize the benefits if you choose a rapid weight-loss strategy.
Most Common Rapid Weight-loss Risks:
Medications like insulin and a group of medications called oral sulfonylureas are particularly important to follow under medical supervision. Diabetes medications often need to be decreased before starting the intervention – or at a minimum, quickly decreased in the very beginning and throughout your weight-loss journey.
Discuss this with your doctor. If you still have your gallbladder and you have a history of gallstones and/or acute gallbladder disease, you may consider a medication called ursodeoxycholic acid. Studies show that this medication, when used during rapid weight-loss, can decrease gallstone formation from 28-32 percent of individuals to only 2-3 percent of individuals.
Blood pressure medications often need to be adjusted at the beginning or very early on in a rapid weight-loss plan in order to avoid these risks. Your doctor can help you manage these changes appropriately.
Make sure you are working with your doctor to monitor your muscle mass as you are losing weight. This is done by frequently measuring your body composition. Getting adequate protein in your diet and stimulating muscles with physical activity may help decrease this loss of lean strong muscle. Scientists are still determining how this may affect your metabolism long-term, and it is likely to be different in different people.
Drink plenty of fluids. If you are on medication for high blood pressure, this may need to be adjusted sooner on a rapid weight-loss plan as some of these medications work by decreasing your total body fluid. With a change in nutrition and weight, you may need to consider a lower dose or the discontinuation of these medications.
Any very low-calorie diet or bariatric surgery intervention should include regularly scheduled labs to check these electrolytes and provide supplementation as needed. Your obesity medicine specialist or bariatric surgeon can help you monitor these at appropriate intervals.
A few additional symptoms of rapid weight-loss to watch for include:
Rapid weight-loss is just like other health decisions we try to make. It is a matter of weighing the risks versus the benefits. If you and your doctor decide together that you can manage a VLCD or surgical intervention, and that you can maintain follow-up with your healthcare provider, these options are tolerable and the adverse side effects can usually be managed appropriately.
Here are some key points to remember as you consider all of your options:
It’s not your fault – it’s your physiology. Chronic disease requires chronic management and this is where it does become YOUR responsibility to seek care and partner with your doctor to manage your health. Together, you can plan for active phase and maintenance phase treatments that are individualized to you and optimize the benefit versus risk ratio. With many pathways to achieve your goals, the most important thing is to start the conversation today!
About the Author:
Deborah Horn, DO, MPH, MFOMA, is the President of the Obesity Medicine Association and Clinical Assistant Professor in the Department of Surgery at The University of Texas McGovern Medical School at Houston. She is the Medical Director for the UTHealth Center for Obesity Medicine and Metabolic Performance. Dr. Horn was also the recipient of the OAC’s Healthcare Provider Advocate of the Year award, an award given to a healthcare provider who is a tireless advocate for patients, the OAC and the cause of obesity.
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