I've been meaning to post this for a while. When I joined here and was talked out of my low calorie diet, I went in search of the studies to back up that advice and I couldn't find them**
What I did find were studies like DROPLET (Doctor Referral of Overweight People to Low Energy total diet replacement Treatment - someone doesn't understand how acronyms work 😁)
It's worth looking at closely. 238 obese people in Oxfordshire were randomised between whatever care the practice usually offered for weight loss, or a 12 week very low calorie diet with a further 12 week followup. It was a commercial Total Replacement Diet (TDR) of 810kcal per day, with real foods introduced in week 9. The difference in the results were dramatic. Those on the TDR had lost an average of more than 10kg, compared a little over 3kg for usual care after 12 months.
More of the TDR people returned at the end of 12 months (78% vs 69%). If I was at or above my starting weight, I would not turn up for the follow up. I suspect the results would be more dramatic if 100% could be followed up.
You can see the relative satisfaction with the diets, as 9% of the TDR people paid for extra food after the 24 weeks, and 27% were "still in contact" with the food provider. But while 73 of those on usual care were still trying to lose weight, only 4 of them were still following the advice they had been given at the start of the of the trial. 🤨
I think we should stop telling people eating less than the NHS recommendation that they need to eat more. The science doesn't seem to support this. The NHS's usual care seems to only lead to 3kg weight loss per year. We may see more here, but most of the 100,000+ people who join here never post at all, and most disappear without completing the journey. The only people following standard care on here will be those that are succeeding at it.
I'd be happy to be enlightened by the contradictory studies that are guiding the admin team's advice.
**We can exclude The Biggest Loser and similar studies. Going thousands of calories in deficit every day for 30 weeks will destroy your metabolism. So, don't do that.
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Subtle_badger
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Thanks. Let me edit my post. In fact, I will change it to TDR, which is the study's term.
(The low calorie diet I was on was also low carb. This has dropped my blood pressure, which is something there wasn't much change in the the DROPLET trial.
Thank you for posting Subtle_badger and as I have said before, I’m sorry if you feel that the forum doesn’t support Very Low Calorie Diets. As a peer to peer support group we are here to help and encourage everyone to lose weight and become healthier in what ever way they choose. However, when we see so many members fall by the wayside by following the traditional restrictive eating Monday and Tuesday, then overeat on a Wednesday, perhaps you can understand why we encourage eating as much as you can whilst still losing weight 😊
For myself, I can only offer my own opinions, and anecdotal results, which was that by being allowed to eat more than on the previous 600 and 80 thousand million ‘diets’ (ok, slight exaggeration 😂) I lost weight and kept it off.
You are right that the forum sees many, many members join and not post, or even return, and any suggestions about how we retain New Members is most welcome.
As a newish member I think this forum is great. I don't think there is anything else you can do to retain members personally. I think that there are different topics to join in with - interesting posts with videos and plenty of more experienced members who have had weight loss success and share their wisdom..
Perhaps it's a case at times of what you put in you get out. I find by engaging with the community and listening to others I'm learning lots which is helping retain me as it's useful things that I can apply. I'm a kinaesthetic style learner and pragmatic so if it didn't work for me I'd probably have left.
Perhaps for some people a virtual forum doesn't suit them, or they find other places for support..
If you had the time (unlikely as you're all volunteers) you could do a survey of new members and set up an exit survey for folk who leave / general survey for people who stay to get feedback?
However - you all have plenty to do outside of your volunteering time doing this so maybe not
I find this topic very interesting, particularly the balance between calorie intake and LCHF.
My own diet, which started in August 2019 was stalling by December 2019 after good monthly weight losses on LCHF of 3-5 kilo per month I had pretty much plateaued.
So I continued with LCHF (Yoghurt/Alpen/Cream breakfast, Meat/Fish & Veggies main meals plus usually 2 small snacks), but started calorie counting as well as a way of limiting portion size of the healthy LCHF food but not reducing calories to the point where I was unsustainably hungry, only a bit rumbly before meals (listen to your body) and followed TRE 14:10 breakfast to dinner eating window.
If I had followed the NHS advice I would have eaten "Recommended daily calorie intake:
2351 - 3023 kcal". On LCHF with less hunger and consumption of healthy fats, my calorie intake (measured every day 1st Jan to 30th June) was an average of 1,200 calories daily (varying 1,100 to 1,400). I certainly wasn't suffering on this plan.
For the next 6 months weight-loss returned to a pretty consistent average of 4kg per month. I'm now tinkering with portions sizes as I head into maintenance. The result over 11 months was a more or less pretty consistent 2 pounds/week loss for 49 weeks (102 pounds total).
Upshot:
My own experience (sample of one) leads me to believe that going below the recommended calorie limits can be effective over the longer term as part of a 'blended' approach if combined with LCHF to reduce hunger and when not carried out with the 'stronger' versions of these techniques (Fast800 or keto). I'm sure Time Restricted Eating (TRE) 14:10, Couch to 5k and closing my 30 minute exercise Apple rings daily (8,000 steps per day) were also helpful in the mix.
I fully appreciate the advice to not lower calories to the point that the body goes into 'starvation shock', but unless that point has been reached (which I think a blended approach prevents) I'm not sure how useful the blanket 'eat more food to the NHS lower calorie recommendation' is, because it kind of 'depends' on other factors and other techniques.
My 2 cents as my American friends would say. 😄
Evening Subtle badger
I found your post and the trial very interesting - thanks for sharing.
For me - most days I'm under my BMI recommended range (lowest number is 1551). I'm usually 1100 / 1200 on occasions been 900.. If I drink alcohol or eat a Brownie that ups it. I'm genuinely full though - and that includes with the exercise I do such as 5k, shorter runs and yoga. I can't imagine ever getting to mid or upper range (1994)..
I think that as long as people are eating healthily and aren't making themselves ill mentally or physically to achieve much lower calories - its OK. Its also about a sustainable lifestyle change..
Out of interest - after the 12 weeks and in the 4 weeks reintroduction - did the sample group gradually increase calories? Or was the idea to continue to keep it low?
Hi S_b, thank you for posting, it is an interesting read. I would like to see a study comparing VLCD and LCHF directly. Personally speaking I have counted calories for yrs, sometimes while attending Slimming World as well. My weight has yo-yo'ed for the last 30yrs. Read about LCHF since joining this forum, early days yet , so not sure how I will get on. Am finding the advice and support very helpful though.
I am a variation of the Droplet thing, in that I used total meal replacements, but used enough packets to have my calories around 1,200/day. I could not (and still can't) imagine me only taking in 600 cal/day and still functioning. 1,200 was quite low for me, as my starting BMI was nearly 54. I had watched a couple of documentaries about it, and read a lot as well, so I didn't just jump into it as a plan. I lied on the daily diary saying my GP approved it, because I didn't want lectures from people. It worked for me, kick started my second phase of dieting, and I'm now up to 1,800/day, still losing, and eating 'normal' food.
My feelings about this forum, which I have shared on it now and again, is simply take what you need and leave the rest -- find something that works for you and do until it doesn't work, then try something else. Easy for me to type and follow, but maybe not for everyone who comes on the boards.
I think being a host must be very difficult and I applaud the admins for being willing to support the rest of us in what ever ways they do it. However, I also worry that initial advice and statements are percieved as Facts, and Scientific, and You Can Only Do It This Way... by people who are so desparate to find anything that will help them lose weight that they don't notice the alternatives that others on the forum are using that work just as well.
There are no easy answers to this, or other challenges around obsity. The fact that so many people are so unhappy with their weigh, and yet can seemingly do nothing to address it, means the NHS powers that be need to re-think its entire strategy around weight loss. For me personally it is far far FAR more complex than 'eat less, move more'.
Good post. I mostly agree, except that there are some hard scientific facts involved, and although there are some complexities (which revolve mostly around human psychological foibles) it helps enormously if your diet plan is consistent with known biochemistry. It it isn't, your results will inevitably be mediocre.
I'm not going to berate badger (or you) for using a VLCD approach, because clearly it turned out fine for you in the end. I get the feeling that, for some people, weight loss has to hurt, or it must involve some dramatic intervention; otherwise, they can't muster sufficient belief in the remedy. If that's what it takes to get them on the right road, so be it, but it disturbs me to see people here who get stuck in that rut and descend down and down into a deadly embrace of self-recrimination, self-loathing, and further weight gain, simply because they can't be talked out of the idea that they're eating too many calories.
Hi TAT, I was one of those people who, like you say, ‘got stuck in the rut’ desperately bingeing and starving, putting more and more weight back on, hating myself more and more after each binge. I am not very scientifically minded, but the explanation involving insulin sensitivity, built over years of yo-yo dieting, makes sense to me. I only know that when I started eating LCHF food, for the first time in months, I didn’t have to battle with cravings for sweet foods, followed by feeling out of control, then bingeing again. I slipped up around my birthday because I couldn’t let it go by without alcohol and cake. This led to several days of binge eating and weight gain. I have now come out the other side and am back on track, eating LCHF food again, that I enjoy. Like people have stated, everybody is different and there is no one size fits all. Am just glad that I found this site for the range of information discussed and the support offered by like minded people.
The more interesting bit, to me, is the control arm (ie., 'go home and eat less/exercise more'), which basically doesn't work. 3kg loss, for an obese patient, has no clinical significance (as stated in the box). But we knew that already, because there's a ginormous amount of literature that describes the same result.
As for the intervention arm, it'd be worth watching the Zoe Harcombe video for a bit more context around those results, I reckon. The problem is the reintroduction of a "normal diet", which will of course be the Eatwell plate - the diet that made them fat in the first place. That means the weight will go back on again, and by month 24 (a very reproducible result) most people who do any form of low-calorie diet are right back where they started, as shown in the video.
Of course starving the poor patients for 8 weeks results in weight loss (plus half of them reporting that they don't like it). A body doesn't have any choice in those circumstances. But it drives me mad that doctors think that weight loss is the be-all and end-all. Surely, reaching a healthy weight and staying there foreever is the goal? Surely fat loss (as opposed to combined muscle+fat loss) is important? Surely good health counts for something?
This study doesn't demonstrate that they've achieved anything useful with VLCD ("results do not support conclusions"). Example: if you're enrolled as a 5'5" female at 85kg (BMI=31) then you're still seriously overweight (BMI=27.5) at 12 months. Since we're not told if the subjects' weight is increasing, STS, or still decreasing at the end of the study, we can't even guess what the long-term prospects are.
I agree with the posts above that the results would be more interesting if compared with the most effective known intervention, ie., LCHF - or as I prefer to call it, healthy eating.
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Ok - I'm outta here...
Losing weight with physical illness.
Very confused !
Give up the YO-YO
12 Week NHS Diet Plan Success?
