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The Hunger Games

Sunday, April 22, 2012

Date of Writing: 4/2/2012
The meal plan I'm on provides 600 calories a day. That is clearly not enough to sustain a human being, and even though the meal replacements are carefully balanced to provide 100% of my vitamins and minerals, plus high protein and fiber and moderate fat, it's been a struggle to get used to such a limited caloric intake. The goal is to mimic starvation--after four or five days, the body goes into ketosis, in which instead of burning carbohydrate it burns fat, thus resulting in rapid weight loss (and appetite suppression, which is one of the side effects of starvation, incidentally).

Of course this is very radical, and not something that I would normally endorse or participate in. I've always been a believer in moderate, safe weight loss and have never been attracted to severe calorie restriction. In fact, such schemes always smack of quacks, gimmicks, and unhealthy results to me. But VLCDs (very low calorie diet) have been around for years and have in fact been the subject of several studies (which I read from the original journals publishing the research).

Researchers have found them to be not only effective in weight loss, but also effective in reducing diabetes, high blood pressure, fatty liver disease, PCOS, etc. The research shows that for people with a BMI higher than 30 (me), the risks of the program (potential for gallbladder stones being the most prominent) are dwarfed by the positive health impacts when carried out under a doctor's care.

My program is being monitored by a physician (who is also a registered dietitian and board-certified bariatrician). Before I started I was given an EKG, urinalysis, full blood work and labs, and had my blood pressure, body fat, and lean body mass measured. I will continue to go in for checks every week and I will have my blood, urine and EKG monitored to make sure that I'm not developing any complications.

The expectation is that I will be able to lose between 3 and 5 pounds per week. So far, that seems about right, since this first week isn't even over and I've already lost 7 pounds (usually the first week's loss is about double what it will be, given water weight loss).

All this sounds pretty good, right? Safe, fast weight loss? Without being hungry? Without having to exercise? Without having to count calories or points or measure fiber or fat grams? Well, so far, that's all true. Eating a lemon or chocolate shake for every meal is a little repetitious, but other than that the process has been pretty easy. I was crazy hungry for the first few days, but that is abating. The lightheadedness has been the worst symptom so far.

So, what's the catch? Well, the research on the long-term effectiveness of VLCDs is also pretty clear: most people don't keep the weight off. You're more likely to do so if you receive behavioral modification during the process (which I am), but many people just gain the weight right back. It's easy to understand why: you've been off real food so long, the tendency is to gorge; you haven't really learned how to eat properly or what a realistic serving size is; you haven't necessarily changed your exercise habits, and with rapid weight loss lean muscle mass is also lost, which can undermine long-term weight control. It's also possible that your metabolism has been suppressed, though my doctor says that isn't the case with the program I'm on because the fat content of the meal replacements is high enough for it not to happen. But without a doubt, the real battle here will not be getting the weight off but keeping it off.

That's one of the reasons for starting this blog: to have a place to hold myself accountable, once I get to the maintenance phase. In the past when I've lost weight, I've either gotten pregnant and gained it back or lost motivation and gained it back. This time I realize that if I don't want to end up right back where I am now, I'm going to have to be really, really careful to count every calorie and log every morsel once I start on real food again. This is the opposite of my usual M.O., which is to relax once I've lost the weight, throwing caution to the wind. Well, we can see how well that worked!

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