Is weight loss surgery the easy way out?

No, no it isn’t. If you opted for weight loss surgery, don’t ever let anyone tell you that you took the easy way out. If you know someone who opted for it, realize that the decision was most likely made after hours and hours of intense thought and discussion amongst family members and key medical providers. It involves drastic lifestyle changes with a serious commitment to habit alterations. But it’s lifesaving and as I said in my recent post, it is often the best decision that person has ever made for their health.

My goal for this post is to explain the options in the simplest way possible and drive home the fact that, although weight loss surgery may be the most successful end point for weight loss known to date, it certainly is not the easy way out. It’s only a tool, but a damn good one at that.

So here we go, let’s start with the laparoscopic banding procedure. Nothing is changed from your inside anatomy. So you still have your full stomach and intestines intact. The band is purely a restrictive procedure and is just what it sounds like, a band (think of it like a bracelet even) that is placed around the top portion of the stomach. At first, it’s just a fancy expensive bracelet. Shortly after surgery, it can be filled with a salt solution, called saline, to tighten its grip around the stomach, by injecting the fluid through a port that runs from the band to just under your skin. Think of it as blowing up a doughnut ring….that hole in the middle is gonna get tighter when it’s blown up. Problem is, this procedure doesn’t work. I know, that’s a bold statement for me to say, but in the ten years I’ve worked with bariatric surgery candidates, I only saw maybe three patients (out of hundreds) lose the expected 20-25% of their initial starting weight and maintain it off for more than one year. And guess what? All of them eventually had to have their bands removed due to complications and/or weight regain. Luckily, their bands were converted to the sleeve gastrectomy and they were able to continue their lives with a more permanent option.

People see the band as the “noninvasive, less risky” choice. However, that’s just not true. When you have a foreign object placed in your body, it doesn’t like it. The band can slip out of place, corrode, grow into the stomach, get infected, flip over and out of place, the port tubing can get a hole in it and leak, and the possibilities go on and on. Most often, one of two things would happen. I either saw people throw up over and over because food just wouldn’t go down where the band was and eventually their esophagus above the band placement would dilate, or get bigger, and they would end up with essentially two stomachs to fill. Think of it like an hour glass, one on top and one on the bottom….endless hunger. Or I saw them give up and live on liquid, soft foods that slid through the band into the stomach easier…..so milkshakes, pudding, ice cream, jello, mashed potatoes, and even fried foods. It’s not uncommon for someone to even gain weight after this procedure, as you could imagine. Some facilities have smartened up and don’t offer the band anymore. In my opinion, if a surgeon recommends the band to you, run the other way.

The sleeve gastrectomy has gotten lots of attention over the past five years or so for those who have a lot of weight to lose but may or may not have any major health problems. It is a purely restrictive procedure as the surgeon removes around 75-80% of the stomach in a vertical fashion, leaving a banana shape left. Don’t be mistaken, though, your stomach ends up smaller than a banana. Think “man’s index finger” size. It is very restrictive, but what I think helps people out the most is that the part of the stomach that gets removed is also the part that produces the hunger hormone, ghrelin.

So, yea, you may fill up on the same amount of food your two year old niece just ate, but you weren’t really hungry to begin with. And if you have read or listened to any of my content before, you may have heard me talk about how ghrelin increases in production in response to massive weight loss. It can’t with the sleeve gastrectomy. That’s a big plus. I do caution people against choosing this procedure if they have problems with stress or emotional eating or what I call “grazing.” If you don’t eat because of excessive hunger and you have a habit of nitpicking all day long out of boredom or stress, this procedure doesn’t do anything to stop that….you can still eat a small amount of food every couple of hours or so. You can’t, however, sit down to a large meal and finish it in your normal ten minutes. It’s going to take at least twenty minutes to finish off a 1/3 cup of ground turkey. Talk about eating to live! Expected weight loss is anywhere from 25 to 35% of your starting weight. This is life changing for the vast majority of those that are are successful at it.

The last procedure I’m going to talk about here is the roux en y gastric bypass. This one has gotten a bad rep for years which is why I believe there are so many new procedures constantly up and coming, like the stomach stapling at one time, then the lap band, now the sleeve, and the up and coming “balloon” (that’s for another post). But this one has stood the test of time for the last forty years now and remains the gold standard of weight loss surgery. Is it drastic? Yes. Does it involve a huge lifestyle change? Oh yes. Does it work? Yes. I’ve seen lives absolutely change for the better and people leave the hospital off their diabetes medications after having this surgery. There was no waiting period for weight loss, it was immediate. When we talk about this surgery, we are talking about a metabolic operation that changes the body’s hormones with some major rerouting of your digestive system. So, like the sleeve gastrectomy, hunger is no longer an issue. Nothing is actually removed, like in the sleeve, but the part of the stomach that produces the hunger hormone, ghrelin, no longer comes into contact with food. The major difference is that a large portion of the small intestines is rerouted to create a “Y” shape with the new, smaller, egg-shaped stomach and connected lower down the digestive tract which results in calorie malabsorption. Not only are you not hungry and restricted in how much you can eat in one sitting, but you also don’t absorb all the calories you eat at one time. Lastly, high sugar and high fat foods are a no go. You run a high risk of getting sick with the shakes, diarrhea, and breaking out in sweats if you eat even just one small bite of the wrong thing. Interestingly enough, lots of people who have had this surgery experience a change in their taste preferences anyway.

Since expected weight loss is closer to 35% starting weight, I recommend this procedure for the stress eater, person with a slow metabolism, chronic yo yo dieter, and most importantly, anyone with a serious health condition who requires massive weight loss to improve. This would include cardiovascular disease, obstructive sleep apnea, or diabetes.

This is your life, and if someone told you there was a cure for a known disease that you have, would you take it? In 2013, the American Medical Association recognized obesity as a chronic disease. At that point, health insurance companies began expanding their coverage for weight loss surgeries. A chronic disease is something that never really goes away. If you have been struggling with your weight, you know what I’m talking about. You succeed at a weight loss attempt temporarily, but the weight always finds its way back, somehow. I know that this is not for everybody and you may note even qualify.

If it is something you are considering or if you are in a place where you don’t quite qualify, but you’d like some help with your weight, feel free to reach out to me at the below links.

P.S. If you’re looking for online support with like minded moms striving to live a healthier lifestyle, you may be interested in joining my free online support group here.

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Jillian McMullen, RDN, CSOWM, LDN

Does your stomach really shrink when you eat less?

As a specialist in weight loss, I hear this phrase a lot, “I just need to shrink my stomach so I can get used to eating less.”

In reality, throughout life, the adult stomach stays about the same, which is the size of a football. However, the stomach is a muscle that can be stretched temporarily to fit more in should the occasion occur. How much we eat tends to be more dictated by habit and hormones rather than size, however.

A little anatomy for you. (I promise, just a little.) There are three very basic parts of the stomach: the top (the fundus), the middle (the body), and the bottom (the pylorus), which is where food empties out into your intestines. The the fundus, is the stretchy part that can expand a bit to allow more food to fit if necessary. It is not likely that the entire body of the stomach is going to expand to allow more food. Back to the football, if you can visualize how much chewed up food that would really mean, it’s quite a lot. However, our body regulates our appetite with hormones that send signals to our brain to tell us whether we’ve eaten enough or not – this is independent of how full the stomach is. Those hormones play a very big role in weight regulation and can be easily over-ridden by outside cues (i.e. the food tastes really good, it’s Thanksgiving, etc.)

Now back to the fundus. This upper muscle is why there’s always room for dessert, but maybe not another immediate meal. It takes about two full hours for the meal to completely empty down to the lower  stomach, out and travel into the small intestine. If you overdo it by eating too much too fast or adding some dessert at the end, that fundus is going to allow for some extra room. For those that habitually overdo it, the tolerance is going to grow over time for allowance. For those that don’t, it’s gonna be more uncomfortable and you’ll be less likely to keep doing it. When you go on a diet and purposely under eat for a couple of weeks, that fundus will become less stretchy and you’ll feel like your stomach has “shrunk.” But it really hasn’t. Weird, huh?

Competitive eaters use this to their advantage and train that muscle over time to allow them to eat a lot in one sitting without puking. I’m not suggesting you do that since I’m assuming you read my blog for help with weight loss, not competitive eating.

In someone who has had weight loss surgery, the body and possibly the pylorus of the stomach has been removed or bypassed, leaving about the size of an egg left. That’s not a lot and it creates some massive restriction. Because this part of the stomach is a muscle and can still stretch, it doesn’t stay that restricted for good. However, the tolerance for over-eating is much less, so the individual usually never gets back to having a football size stomach and still experiences permanent food restriction. If you know someone who had weight loss surgery and regained all or some of their weight because they “stretched their stomach back out,” this may be what’s going on. That’s for another blog post, though.

Hope you found this helpful and enjoyed a little weird science today!

P.S. If you’re looking for online support with like minded women striving to live a healthier lifestyle, you may be interested in joining my free online support group here.

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Jillian McMullen, RDN, CSOWM, LDN

Why it’s not risky to have weight loss surgery

Although I have never personally been overweight, I am an advocate for those who are. It’s not because I watched a family member struggle or have some heart wrenching personal story to share with you. Circumstances ten years ago just lead me to a position working with people who do struggle with weight.

Through that time, I have gotten to know hundreds, if not thousands, of individuals and their personal stories, and why there is so much more to weight loss than “eat less, exercise more.” I’ve helped a lot of people make the scary decision to pursue weight loss surgery, get their habits (and their mind) right on the way there, and I’ve been there that amazing day when they became a literal new person. So much so, I couldn’t even recognize them standing right next to me as I called them into my office for that two month post surgery check up.

I’ve cried with clients, done happy dances with them when the scale hit a certain number, and held the trash can when they needed to vomit because they ate something they shouldn’t have (yea, sucks to do that in your dietitian’s office.) I’ve been the first person to weigh someone after years and years of avoiding the scale. I’ve been the last person to see someone drink a soda before they chucked it in the trash can for good (carbonation isn’t allowed after weight loss surgery if you were wondering.) I’ve also been the first person to find out they’re going for it, for realz. It’s scary, it’s exciting, it’s terrifying, and it’s truly life changing.

Here’s the deal though, I don’t want to hear that “bariatric surgery is high risk” from people who know nothing about it other than that their brother’s coworker’s aunt’s mother in law had that “stomach stapling” procedure back in the 80s and died. Don’t ever take the excitement away from someone by telling them it’s too risky. 

I do get it. I’ve worked with two or three people out of hundreds that had the surgery and it went terribly wrong. They can’t eat food anymore because they had a rare complication. They get to live on a feeding tube for the rest of their life. I’ve gotten to know a couple of individuals who died months later because their health problems before surgery were against them and weight loss surgery didn’t fix it. It sucked. But they were exceptions, more on this later.

But I’ve also seen people get out of wheelchairs, off their diabetes medications, go on vacations again, and live life out of the house again because of this surgery. And that “stomach stapling” or “risky gastro procedure” everyone is so scared of, was actually life saving to someone that used to spend their entire life dieting without success, counting pills, administering injections, and going to doctor visits because their body became a prison.

If you think it’s about eating less and exercising more, think again. Obesity is not a lifestyle choice. If it was, there would be zero obese people in this world trying to lose weight. Everyone would wake up, cherry pick their dream weight and get to it. But if you’re reading this, you probably know that’s not true.

Here are 5 well meaning reasons why I’ve heard weight loss surgery is an unsafe choice and why they are false. If it’s something you’ve been considering but have been convinced it’s a “last ditch effort,” I want to give you some peace of mind to make a rationale choice. I’m not here to tell you to go do it, but I don’t want you to not go do it out of fear, either.

  1. You could die. Obesity itself is the number 2 cause of preventable death (aside from smoking) in the United States today. In this analysis of 13,871 morbidly obese patients from a national registry between January 1996 and January 2006, the risk of death within 60 days following any weight loss procedure was 0.25%, making it a rare event. A main reason for this is because modern day procedures are typically done laparoscopically, meaning only 5 small incisions about one inch in length each are made to perform the procedure rather than a long vertical incision as used to be made. Medicine is always evolving!
  2. It’s a cop out. And you could die. Okay, this is kind of a continuation of the first, but I felt needed more clarification. Bariatric surgery is emerging as a powerful weapon against severe obesity and type 2 diabetes mellitus (T2DM). Numerous studies confirm that weight loss surgery, particularly Roux en y gastric bypass surgery is more effective at bringing those with T2DM into disease remission than those who were undergoing conventional medical therapy. Some studies that back this up include this one, this one, this one, and this one. But there are several more available in case you need more proof. As a reminder, complications of long term, uncontrolled diabetes include: kidney failure, often requiring dialysis, neuropathy leading to toe and/or foot amputations, and heart disease. Not one of these are known complications of weight loss surgery.
  3. You’re going to throw up a lot. Well, yes, if you don’t follow strict dietary guidelines. I get it, this is not a lifestyle for everyone. It requires consuming adequate amounts of nutrition, 5-6 times/day, when you’re barely hungry. It also means you will be preplanning your meals every day, for the rest of your life, including the small details like quantities, calories, and protein grams. You will also need to be picky about what restaurants you choose when and if you decide to eat out in restaurants. Be prepared to eat slower. A lot slower. And chew well. Choose your food wisely. No room for fillers here when your stomach is the size of an egg. So no air swallowing habits either, like chewing gum or soda. Eat the wrong food item and you may be sorry for hours or days following.
  4. You’ll have no energy. Actually, if you’re frame has been carrying an extra 50-100 pounds it’s not supposed to be carrying and all of the sudden, in a very short person of time (say, 4-6 months?), you lose it 50 plus pounds, just like that? Wouldn’t ya think the opposite would be true? Think of it more like this: you’ve been carrying a 75 pounds back pack for a few years and I just took it off. How would that feel? This doesn’t really matter what your starting weight is, either. 75 pounds is 75 pounds.  You will also be forced to eat better with surgery, that’s part of what the surgery is for. Run through the drive through with some friends and a cheeseburger real quick and you’ll be running to puke. It’s just what happens when you’re digestive system is rearranged and shortened. Better diet = more energy.
  5. You’ll just gain it all back, so why bother going through that? Not true. Statically, 20% or 1 in 5 individuals who have weight loss surgery will regain all of the weight lost following surgery. But that also means 80% or 4 in 5 will maintain that loss. Those who do not have surgery? If your body mass index is above 30, the sad and terrible truth is, statistically <1% of individuals will maintain any weight off. I know….

In case you haven’t figured it out by now, I’m a pretty big proponent of weight loss surgery. This may surprise you, but like I said, I’ve worked with lots of people and I know their struggle. I’m also a big proponent of taking control of your own life, whatever that may mean for you…and I’m here to help you on that journey. I’ve got a ton of posts for the non-surgery folk too, so look around!

There are various types of surgeries, but the two most effective and common choices available today are the laparoscopic roux-en-y gastric bypass and the laparoscopic sleeve gastrectomy. If you want to know more about them, I encourage you to talk with your doctor. This post would go on forever if I described them here, but certainly feel free to reach out to me for resources if you want to know what they are.

P.S. If you’re looking for online support with like minded moms striving to live a healthier lifestyle, you may be interested in joining my free online support group here.

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Jillian McMullen, RDN, CSOWM, LDN

This is why slower is better (even though it feels sucky)

When we make positive changes in our lives to reach a goal, it’s human nature to want results overnight or, even better, YESTERDAY. You know what I’m talking about if you’ve been on a healthy eating kick. I mean, who wants to plan their meals diligently, grocery shop and cook those meals, eat less than normal, feel hungry, drink a bunch of water, ditch the sugar and fried food, say no to the tv snacks, and get rid of the chocolate stash just for a couple of measly pounds after a entire week of faithfulness to this plan? Not many.

In life, we want a big payoff, or return on investment, when we make a decision to change. Want to make $10K a month? Who doesn’t? It takes time. Want to lose 80 pounds? It takes time. And here’s the deal – most people will get discouraged when they don’t see results fast. In fact, some may argue that diets offering quick results early on equal higher success rates because they spark high motivation. But what they don’t mention is the long term maintenance of said diets. And to me, that’s a failure. Anyone can lose weight. If you’re reading this, you’ve probably done it a dozen times yourself. That isn’t your problem. Your problem is maintaining that weight loss. So my challenge for you is to RESIST the urge to crash diet because crash dieting is no different than what you’ve done before.

In fact, losing weight quickly is a red flag that you will regain that weight quickly.

Why? Because physiologically, the body doesn’t adapt well. We are designed to be protected from starvation. Losing weight in general causes a decrease in the production of the hormone leptin, which signals the brain to say “hey you’re full, you can stop eating now.” It also causes an increase in the hormone ghrelin which tells the brain, “hey you need calories, eat!,” and that means you’re gonna be hungry. Losing weight also means a slower metabolism, because smaller people naturally burn less calories. If there is less of you, you are going to need less calories the smaller you. Make sense?

This creates a problem for the chronic dieter. You have a slower metabolism, but you’re hungrier than ever. Tack on an unrealistic diet you followed to get the weight loss you achieved (say, a low carb diet, an 800 calorie diet made up of all protein shakes, or a cabbage soup diet, you get the point) and well, you don’t stand a chance. Stay with me, there’s still hope.

If you are losing weight slower, say one half to two pounds per week, it can actually be a sign that you are likely to keep that weight off. Why? Because you are probably doing something that you can continue doing long term (i.e. you aren’t on the latest and greatest fad diet of the season). Think about it this way – if you are looking back at the last four weeks and you’ve lost two pounds, I completely understand that it may be really frustrating and you probably feel like you’re getting nowhere. But in one year that equals twenty-six pounds lost. Twenty-six pounds you will keep off for good. Isn’t that better than twenty-six pounds in say, two months that will ultimately result in thirty pounds regained over a year’s time? I know you know what I’m talking about here because you’ve probably experienced something similar.

What is an optimal rate to lose weight?

-If you weigh <250 pounds = 5-10% over six months (so a 200 pound person might lose 20 pounds by the 6 month mark)

-If you weigh >250 pounds = 10-20% over six months (so a 300 pound person might lose 60 pounds by the 6 month mark)

Bottom line, keep at it. Even if your wins don’t seem like much, they are actually a really big deal. Losing weight fast usually means it won’t stay off. I’ve seen it more times than I can count. On the flip side, when people lose weight at a slower pace consistently, I’ve almost never seen them regain it. So let that be an encouragement to you today to stay the course!

P.S. If you’re looking for online support with like minded moms striving to live a healthier lifestyle, you may be interested in joining my free support group here.

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Jillian McMullen, RDN, CSOWM, LDN

How to end weight cycling (and beat that plateau!)

If you’re reading this, you’ve probably experienced yo yo dieting, or more technically referred to as “weight cycling.” Simply put, dieting to successfully lose a significant amount of weight in a fairly short amount of time followed by weight regain and often additional pounds.

Have you ever wondered just how many times you can repeat this process before your body has had enough? Or if it’s even a healthy thing to do? Sure, you know that extra weight isn’t a good thing, but you also know that regaining large amounts of weight isn’t, either. And why bother going on a diet if you know the end result will be a number on the scale much higher than when you started? But what other choice do you have?

Eventually there will be a quitting point for your body. You’ve probably already noticed with each dieting attempt it’s becoming more difficult to lose weight – you don’t lose as much or lose it as fast. And no, regaining large amounts of extra weight is not very good for your body at all, it increases your fat to lean tissue ratio and in recent studies, it’s tough on your cardiovascular system, too.

When you lose weight, it’s inevitable that you will lose some of your muscles mass. This equates to a slower metabolism in the long run since fat burns a lot less calories at rest than muscle does (and as a wild guess here, I’m assuming you aren’t hitting the gym when you’ve stopped following your diet, so your muscle gets replaced with fat when you start regaining the weight.) So in this case, it would have been better for you to have never tried losing weight in the first place.

The fact is, statistically 90% of dieters who lose weight WITHOUT bariatric surgery will regain their weight loss within the following year. Discouraging, I know. But some of this starts with having realistic weight loss expectations to begin with. So let’s start there.

A realistic rate of weight loss is, on average, 1/2 to 2 pounds per week. If you weigh closer to 300 pounds or more, than it’s 1% of your body weight weekly (so 3 pounds a week, 4 for 400 pounds, etc.) And most will begin to see a weight loss plateau around a 5-10% weight loss. What does this mean? It means you will begin to see a dramatic slowing in weight loss results or even a complete halt sometime between there. Those who have more to lose (if you are over 300 pounds to start with) may not see this plateau until you’ve lost closer to 20% of your initial weight. But rest assured, it’s coming.

What do you do when that happens? Realize that your efforts to lose weight worked and that your body is responding in the way that it should.  And then accept that you may only see the scale drop by a pound or so per month for a while instead of per week like you are used to. Unfortunately, this is when most people begin to get frustrated and feel like what they are doing is no longer working and so they throw in the towel. That’s a dangerous place to be because you are at high risk to regain the weight to begin with. Your body is in a bit of a metabolic mess and very prone to weight gain because it has not had time to adjust to the new, lower weight you. Throwing in the towel on healthy eating habits and exercise is the worst thing you can do. Instead, do these four things and you will end the yo yo cycle while continuing to see results:

1. Consider lowering your carbohydrate intake to 130 grams per day if you are not already following a low carb diet.

2. Be sure you are consuming plenty of protein at all of your meals – 30 grams is the magic number for most.

3. Exercise a minimum of 45 minutes daily. This is the absolute minimum requirement as recommended by the American College of Sports Medicine for prevention of weight regain. (Don’t shoot the messenger!)

4. Be sure you are drinking a minimum of 8-10 cups of water per day.

Lastly, if you are doing the above things and you can’t get out of it, try keeping track of your food intake for a few days using an online record keeping system like sparkpeople or myfitnesspal (both free and easy to use) to get an objective take on what you are consuming. I once worked with a woman who swore up and down she was only consuming 1200 calories per day. When she finally decided to track it, she was mortified to find out she was actually consuming 2400 per day. That’s twice as much!

You can also consider a weight loss aid, such as an appetite suppressant. I talk about your options in a previous post here, available through your doctor and natural options that you can contact me about if interested in learning more.

Once you understand that this is a lifelong effort, you will begin to understand that there is no such thing as going “on” a diet (because that means eventually you are going “off” a diet) but rather, changing your lifestyle.

P.S. If you’re looking for online support with like minded moms striving to live a healthier lifestyle and lose weight, you may be interested in joining my free support group here.

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Jillian McMullen, RDN, CSOWM, LDN

Is a very low calorie diet right for me?

Have you ever considered going on a very low calorie diet, aka VLCD, to lose weight? Maybe you don’t even know what it is – rest assured, you probably have heard of them just not by this term. Some of you remember (or at least heard about) when Oprah melted before her audience’s eyes in the 80s after following the Optifast plan. More recently, you or someone you know is probably following the HCG diet plan. Both of these are VCLD plans. So let’s review them.

There are several types in existence on the market today – some with fancy names like the ones mentioned, but they all have one thing in common – they involve consuming 800 calories per day or less. Their means to achieve this intake vary from consuming meal replacements to following strict meal plans and some include taking supplements, injections, and/or appetite suppressants. Their calorie ranges typically go from 500 to 800 per day. The goal is to create rapid weight loss in a short period of time. As you can imagine, these types of diets can be very effective.

I am very familiar with the concept as I personally worked with clients in group and individual settings following a VLCDs for seven years. Our chosen modality was Optifast meal replacements because it is a product that can only be purchased at a clinical facility and a diet like this really needs to be followed under medical supervision. On this program, dieters get a choice of high protein shakes, bars, and soups totaling 800 calories per day. Some required appetite suppressants, but that was determined on an individual basis.

I will mention the HCG diet here too because it is the most common VLCD that I hear about in recent days. Simply put, it’s a 500 calorie strict meal plan paired with injections of human chorionic gonadotropin (HCG), a natural hormone that the body produces during pregnancy. Yea, sounds weird to be used for a weight loss diet, huh? Well, according to the website, “HCG releases stored fat to ensure the growing fetus during pregnancy receives the nutrients it needs to grow and develop normally. When HCG is taken in non-pregnant women and men, the body still releases the stored fat. Because there is no fetus present, however, the body uses the stores for energy or eliminates the rest. This enables the body to release stored toxins and fat. Abnormal fat is lost, leaving normal or structural fat and muscle tissue. This means you lose weight in those stubborn areas–hips, thighs, buttocks and upper arms!” 

Unfortunately, this just isn’t true and there is zero scientific backing that it actually works. In fact, if you look at the fine print directly on the website, you will find this little gem of an FDA statement: 

“HCG has no known effects on fat mobilization, appetite or sense of hunger, or body fat distribution. HCG has not been demonstrated to be effective adjunctive therapy in the treatment of obesity. There is no substantial evidence that it increases weight loss beyond that resulting from caloric restriction, that it causes a more attractive or “normal” distribution of fat, or that it decreases the hunger and discomfort associated with calorie restricted diets.”

I don’t like to be the bearer of bad news, but I will tell the truth, even when it hurts. So why do people lose weight on this diet? Because it’s only 500 calories.

During my seven year tenure with the Optfast program, I had the privilege of being a part of some fantastic success stories. People losing 50-100 pounds or more in just twelve short weeks. It was amazing and a true honor to see such transformation in the lives of people who would start the program feeling totally defeated from a lifelong history of yo yo dieting and failed attempts at exercise programs, demoralized by what they saw in the mirror, the number they saw on the scale, and horrified by the clothes they had to wear. Some of them would come because it was their one last big try before considering anything permanent like weight loss surgery. And I would watch them literally melt away before my eyes and go out and do things they never thought they could do again – tandem skydiving, mule rides in the grand canyon, mountain hiking, cross their legs, and tie their shoes.

But after seven years, the program needed to be ended because more than 75% of the success stories became another yo yo story. Almost every single person regained all of their weight back and then often more. It wasn’t for a lack of guidance to a gradual transition back to real food. That was provided along with weekly support. But they had to choose to participate and most didn’t.

Why is this? Because while you are in the weight loss phase, it’s fun, exciting, and you feel on top of the world. The maintenance part is where the real work begins. On a VLCD there is no planning or thinking involved – “eat this/drink this, move on with life and watch the pounds melt off.” In maintenance, you have to deal with real food choices and decisions between fried and grilled chicken, an extra bite of birthday cake, running through the drive through on a busy day, pre-packing lunch for work, and the normal weight fluctuations that come along with it. Exercise is more important than ever, something that is restricted while on the plan. The American College of Sports Medicine recommends those maintaining significant weight loss exercise 45-60 minutes most days.

So in summary, do I recommend VLCD as viable method of weight loss? Yes and no. They are extremely effective when safely monitored by a trained health care professional for getting the weight off and doing it quickly. If someone requires this for a lifesaving surgical operation, say they need to lose weight to repair a life-threatening hernia, remove a cancerous tumor, or it is a precursor to weight loss surgery itself – then it is a fantastic option. Nevertheless, I’ve seen some people have massive success and maintain it off in the long term. But those are the exception and are the rare, dedicated types that follow all of the rules. They calorie count, rarely go off their meal plan, exercise the recommend 60 minutes daily, live an active lifestyle overall, and eat breakfast daily, drink plenty of water, and keep themselves accountable with the scale on a daily basis. They also see their health care providers regularly for outside accountability.

Lifelong weight management is just that – it’s lifelong. No matter how you get it off, it is something that will always have to be at the forefront of your mind. Unfortunately, VLCD plans are too much of a “on the diet, off the diet” approach to create those necessary habits for sustained success.

P.S. If you’re looking for online support with like minded moms striving to live a healthier lifestyle and lose weight, you may be interested in joining my free support group here.

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Email: contact@jillianmcmullen.com

Jillian McMullen, CSOWM, RDN, LDN

Your body is going to fight you on this

I know if I could just get on the treadmill (which, by the way is making a fantastic clothes hanger currently), I would lose the weight I want to. So why can’t I?

My problem is, I can’t stick to a diet. I like food too much.

I don’t have enough discipline.

I don’t have enough willpower. 

Any of these sound familiar? I know there are a lot of other reasons that lead to weight loss failure over and over again. But the above are not valid. In fact, they are just different versions of you blaming yourself and beating yourself up for a physiological response that frankly, you have zero control over. What angers me though, is that the dieting industry capitalizes on this and continues to throw it in your face with more programs, gimmicks, books, pills, exercise equipment, blenders, vitamins, injections, and lies to make you think it’s easy, if you’d just have enough willpower and get over yourself.

Here’s why I’m calling them out:

Our bodies are uniquely designed to promote weight stabilization. This means even though our food intake may vary from day to day, generally speaking, our weight does not vary widely on a day to day basis. Thus, in times of extreme calorie deprivation (i.e. meal skipping), our body will compensate by slowing down the metabolic rate to conserve calorie expenditure. This is why skipping meals are usually ineffective at causing weight loss. But our body also signals us with hormones to tell us when it is time to eat and when we’ve had enough at each meal. These hormones, called ghrelin and leptin, are responsible for appetite regulation. When we override our body’s signals (i.e. leptin is produced to tell us we are full) because a food is tasty by overeating, that’s when weight gain occurs. Especially when we are doing nothing to burn off the extra calories consumed.

But here’s the thing. In several studies, including one in 2002, when blood plasma levels of ghrelin were taken in obese subjects after a 17% initial weight loss, they found a 24% increase in ghrelin levels. Translation: they were HUNGRY. Hungrier than when they started. Why? Because their body was fighting them to put all that hard earned weight loss back on!! What’s even more disheartening, when you lose weight, there is less of you to maintain, and this means a slower metabolism (i.e. you are burning less calories in spite of feeling like you are starving to death.) So if you feel like you gain weight just by LOOKING at that slice of pizza, you probably are.

Sounds crappy, huh? Because it is. The world of weight loss is very grim. To date, weight loss surgery is the only long term strategy that yields weight loss even close to what most people have set for their goal. This includes not only a number on the scale (when asked, most people desire to lose around 50% of their initial body weight), but also health-related such as resolution of diabetes, heart disease, and sleep apnea. For someone who has these serious health issues and their body mass index is above 35 and especially if their body mass index is above 40, it is something to seriously consider. Weight loss surgery usually results in a 25-35% initial weight loss that stays off long term. Why? One reason was demonstrated in the same study referenced above. Gastric Bypass resulted in a 77% reduction of ghrelin production. Translation: they weren’t hungry!! While the study didn’t include those who had Sleeve Gastrectomy, the results are similar as it does remove the part of the stomach that produces ghrelin. (As a side note, the laparoscopic adjustable band does not have this affect at all as the stomach remains in tact.)

But what if you’re not a candidate for surgery? Or you aren’t ready to take that step in your life yet? It changes every aspect of your life, after all. You could go on a crash diet, you’ve probably done it before. I’ve met many of you who have lost at least 50-100lbs at one time or another in your lifetime. But how are you going to keep yourself from gaining it all back this time? Biology is not on your side.

For starters, get a plan to fight back when your body starts resisting your efforts. It’s going to fight you every step of the way. One of the best pieces of advice I was ever given was to find people who are in places of life that I want to be in and do what they do. For the person wanting to maintain significant weight loss off long term, the ones to follow have registered themselves on the National Weight Control Registry and recorded their daily habits. YES, it’s that easy for you to see what they are doing!!  Here are some common behaviors, according to the registry findings:

  • 78% eat breakfast every day
  • 75% weigh themselves at least once a week
  • 62% watch less than 10 hours of TV per week
  • 90% exercise, on average, about 1 hour per day

Second, don’t be afraid of appetite suppressants. But I’m going to suggest if you choose to use some of the synthetic ones available on the market, that you choose one that can be recommended and prescribed by your doctor who is knowledgeable in this subject AND you use them sparingly during the weight loss phase. You will need them more during your weight maintenance phase when your ghrelin levels are in overproduction and you are starving. If you use them too early on, you risk becoming tolerant of them and then they are useless to you when you really need them.

If you are interested in a natural option that can be used during and after, I have seen amazing results with the use of essential oils such as grapefruit, peppermint, lemon, ginger, and cinnamon in combination with each other. The benefit of natural options is that they work to bring the body into balance and are always working with the body in it’s ever changing state, something you need during times of significant weight loss. For more information, be sure to contact me and I would be happy to discuss more with you to see if it’s a right fit for your goals.

Lastly, realize that this is a journey and you need to be flexible with not only your expectations, but yourself. Weight loss is challenging and the dieting industry capitalizes on the self doubt and guilty feelings that many of you feel. In short, it actually doesn’t matter how you lose the weight. What matters is that you have a good plan in place to keep it off.

P.S. If you’re looking for online support with like minded moms striving to live a healthier lifestyle and lose weight, you may be interested in joining my free support group here.

Follow me for daily livestreams on Facebook

Instagram: TheOilRD

Email: contact@jillianmcmullen.com

Jillian McMullen, CSOWM, RDN, LDN