Confused

Ok, as some of you might have read, I am new to the forums(been around a few weeks) and had asked for suggestions/advice and read A LOT of these threads and thought I understood it.

You want to create a deficit of daily calories by counting your calories and cutting some out, through exercise, or a combination of the two.

You do not want a daily deficit of more than 1000 caloriers per day for an extended amount of time because your body could go into starvation mode and could cause serious consequences to your body in addition to no loss.

Well, I was waiting to speak with my doctor before I got real serious about anything just to so I'd know what was ok for me and what wasn't.

I saw him yesterday, he suggested these  things:

1) No weight bearing exercises. Do cycling or water exercises.

2) Eat 5 times per day like clockwork.....do not skip ANY meals, eat anything I wanted, don't count calories, BUT eat only 1 cup of food at each meal.

In addition he prescribed me a appetite suppresant. (I really dislike pills)

Said that this would shrink my stomach and help learn portion control.

I was so looking forward to doing the low calorie. I don't understand how eating only 5 cups of food per day will be sufficient and what about the major calorie deficit. One website or this one(can't remember which) says I need 2650 at sedentary to maintain. So, I need at least 1650 with no exercise to not go over the 1000 calorie deficit.........possible to get this from just 5 cups of food? And he doesn't even want me to keep track of the calories.......don't understand. I didn't get to finish my conversation with him as he got called on an ER call. I go back Monday for some blood test. He thinks I could have Type 2 Diabetes and some hormone problems.

So, guess I'm not a CC anymore.

 

I've read a lot of posts about doctors' recommendations to lose weight and some of them sound absolutley crazy. Including this one. Eat 5 cups of anything?!?!? Especially if you have diabetes. I don't know much at all about diabetes, but don't you have to be careful what you eat?

Counting calories is a mathematical certainty. I don't see how people do it any other way and see long-term results. It teaches you portion control and it also teaches you about whats in what foods. And I'm also not a big fan of pills at all. Any kind. Whether they're diet or any other kind.

Since you do have some medical issues such as diabetes and hormone problems, I would get a second opinion. Go see a nutritionist.

By the way.... what are your stats?

I hadn't weighed myself for 3+/- years before the doctor visit. I had guess I weighed around 350, I was off  I actually weigh 410. I am 27, 5'5ish.

His thinking behind the "eat whatever you want" is......if he tells me NOT to eat something, I am gonna want it and it will be harder.....his goal is to teach me how to make good choices. He says if I want to use 1 of those cups to eat a cup of ice cream, go ahead.....but he is certain I will not do that again after I realize the ice cream doesn't fill me up or keep me from being hungry for very long. He thinks I will learn to make better choices by only being allowed to have 1 cup.

This is my first time with this doctor, as my family doctor moved his practice to another town.

I was talking to my mom today and she said that he lovesssssss to order test for anything imaginable.

He asked if I was diabetic. I said no, but I have been tested before, especially when I was pregnant and the test were always ok. He said well I'm telling you that you do have diabetes. I can tell by looking at your skin and your history and stats. And you've never been tested with the test I am going to do. I did not list any symptoms or problems, b/c I have not had anything, my appointment was only for a check up and consult about low calorie lifestyle. Now, I notice nothing wrong with skin. But I'm not a doctor. He hasn't even done the test for diabetes yet. I am almost certain it is going to come back ok.

As for the hormone balance problem, he thinks this because I have acne....but like I told him, it isn't consistent and it isn't like it is covering my whole body or my whole face. Only along my lower cheek/jaw bone. Only after periods of stress, after certain foods, and around my period time do I have acne.

I have really thought about going to another doctor. Although, he was the first doctor who has ever taken the time to sit and talk to me. We talked for a good 30-45 minutes before he had the ER call.

I am going to try this 5 cup a day deal and see how this works. Just wondered if anyone else had heard of it or what others thought.

Edit: When I made my first post on this thread....I had been up for 24+ hrs and forgot to mention......he said when a patient wants to have lapband surgery, he(or all drs, can't remember which) makes them stick to this 5 cup per day deal to shrink their stomachs and lose weight before having the surgery. I am hoping that after I go back Dec 12th, we will switch to just low calorie.

FYI- I do NOT want to have lapband or gastric bypass or anything like that. Him and I discussed gastric because I had looked into it, but I told him I didn't want it.

If I was you, I'd go find a different doctor... I've heard of all sorts of crazy things, but that beats them all. I don't see how you could possibly have any kind of balanced diet on five cups of food a day. (but then, if it's 'practice' for a gastric bypass that's about as much as you'll get after the surgery... maybe it's a test to see if the person can survive on that little food?!)

Testing your hormones is a very good idea though, because there are lots of things that affect your weight... I hope he's doing a thorough blood panel and not just testing for diabetes. He's probably doing the HA1BC (I think) test that tests your blood-sugar levels over a long period, not just for one reading. Based on your weight and age I'm not surprised he thinks you're diabetic - it's the first thing that leaps into their mind... and I'd also think that he thinks you've got PCOS or hypothroidism. Any of which are possible so it's a good thing to find out. 

Doctors always assume that an extremely large person has medical problems... DH is 400 pounds and they're always 'certain' that he must have diabetes and heart disease etc etc but he doesn't... he's that large because he's eaten too much and moved too little over a very long period of time. (and we'd like to do something about it...)  

He is doing 4 different blood test........The ones I remember is CBC(Complete Blood Count), DHEA-S( I think it was) , and can't remember what other 2 called.

What does your instinct tell you? Is is saying, "yeah, maybe he's onto something"... or is it saying, "what the hell's wrong with this quack?!?"

1 cup of anything 5 times per day. Well, hmmmmmm... that just about covers the lettuce ONLY that I use in my salads. And I really don't think that's going to fill me up. So should I go with one cup of chocolate instead??? I mean, hey, I can food process a LOT of that into little slivers to fit into a cup!

Doctors are not nutritionists or dieticians. Get a second opinion before going with anything besides a balanced, calorie appropriate for you diet. And run, don't walk, to do that.

Ok, I think it's a little quackish for people on this site to start bashing doctors.  Unless you have a PHD in medicine?  Then, feel free to speak up.

I'm not a doctor, but if I understood you correctly, it sounds like what your doctor really wants is for you to "shrink your stomach" and "lose a little weight" so that you can have surgery done.  It might be a good idea for you to talk to him again, and make it clear that you don't want the surgery.  Or, perhaps, reevaluate whether perhaps you'd like to have it done after all. 

 I agree with others that the 5-cup a day plan does not sound sustainable over a 250 lb weight loss because it would be difficult to get the right amount of vegetables and still meet your calorie requirements-- unless you ground them up very small.  That is why it seems to me that the doctor does not intend for you to follow this plan throughout your entire weight loss, but only to prepare you for surgery.  It's important that you talk to him and make sure that you're both on the same page.

kajikit---

Yes, he thinks I have PCOS. Very likely he is right, when I was 17 it was discovered I had ovarian cysts, I've had surgery for sleep apnea(when I was 11), I recently went 6 months with no period, when I do get my period it is very abnormal, oily skin, and I just had a skin tag removed from my neck when I saw him that day. All of these are symptoms.  Luckily, I was able to have 2 beautiful children.

eringilbert & sarahrnorton

My instinct tells me that there is no way I can do the 1 cup 5 times per day for a very long period of time. A short amount of time I will attempt and try my very hardest.

I'm conflicted about how I feel about him. Like I said before he actually took the time to talk to me. The only thing is.....maybe him and I crossed wires somehow. I explained to him that it was time for a lifestyle change. I didn't want to try whatever new rad diet is out there. I wanted to make a lifelong change. I would like to do a low calorie diet and was just really wanting to get advice/clearance to follow this lifestyle. I explained to him that I had read up about gastric bypass and couldn't justify putting myself at that risk, I felt I gained the weight w/o surgery or pills, so apparently I could most likely lose it w/o them. I thought low calorie was best for me and would be the one most likely that I would stick with.

He then told me how he NEVER suggest anyone having gastric bypass b/c of the risk and that he recommends lap band, if any WLS.

Then we began discussing what he thought was wrong with me, what test he wanted done, what exercises he thought I should do, and he told me about the 5 cup a day.

It was later when he told me about how they have lap band patients do this before the surgery to shrink the stomach and lose weight, b/c if they can't do this before the surgery then they won't do it after, so no point in having the surgery. (in his opinion)

Shortly after this, is when he had to go.

He did say that he expects to see significant results when I return in  1 month. The pills he prescribed he won't authorize refills unless you see him every month. Which is fine, I don't even want them.

So, I am not sure if he put me on this regimen to jump start everything and see how things go for the next month or because he misunderstood and thought I would be interested in lapband.

One thing I feel confident about (kind of) is that if it wasn't safe to do this for at least a month, he wouldn't have me doing it. I hope anyhow. So, as of now, my plans are to ask to speak to him Monday when I go in for my blood test and if not able then I will follow for the first month, but ask him to re-evaluate the decision at my appointment.

I definetely do NOT want to have the surgery. Main reasons are, (in my opinion) it is still a lifestyle change, the surgery only speeds the weight loss up. It make take a bit longer to lose the weight, but I'll be healthy and achieve the same results in the end with a much lower risk of complications.

 

I agree with everyone who says get a second opinion.  The simple fact that you've come on this forum looking for advice or confirmation shows that you have your own  doubts about his treatment recommendations.  You should see a nutritionist and tell them what your doctor said and see what they say about it.  I'm also 5'5" and 27 years old, and I started counting calories because that's what my doctor recommended.  She said to limit my calorie intake to 1500 calories a day.  As a result, I've gone from 220 pounds to 169 (and that includes maintaining for the last 3-4 months).  No, counting calories isn't going to get you to a healthy weight in a month, but it's the safest way to lose weight.  Any faster with dramatic diets (or surgery) will take a horrible toll on your body.  And it's quite possible that if you lose weight the healthy way, some of your other health problems will fade away with your weight.

A thought:

If you do feel, once you've gotten into it, that the 5-cup-a-day plan is hard for you to stick to, instead of abandoning it entirely, I would suggest incorporating an extra cup or two of salad -- not with your other meals, as this would not be helpful in the stomach shrinking and portion control plan, but separately.  It will enhance your nutrition and won't make much difference in your calorie intake.

Some people respond well to limits and some don't -- perhaps the doctor's idea is just what you need to regulate yourself, and perhaps it isn't.  Only you can judge that.  If, after several months, you find yourself thinking "I can't do this for the rest of my life," you should probably consider trying other options.  I like CC because I get to decide when and how much I eat. 

Also, I wanted to point out that if you can prove to your doctor and yourself that you are capable of making the lifestyle change, then you can have both that AND the lapband.  It can be like one of those 401Ks where your employer matches your contribution every month -- You lose the first half by lifestyle change, and the second by surgery.

 

Original Post by sarahrnorton:

Also, I wanted to point out that if you can prove to your doctor and yourself that you are capable of making the lifestyle change, then you can have both that AND the lapband.  It can be like one of those 401Ks where your employer matches your contribution every month -- You lose the first half by lifestyle change, and the second by surgery.

I know without  a doubt I can make the low calorie lifestyle change. I am having trouble doing the 5 cup a day and it's only the 2nd day. By the end of the day yesterday I was so hungry that I ate an apple sliced with peanut butter on it, a container of sugar free pudding, a slice of swiss cheese with 8 ritz crackers. And I was still hungry, so I just went to bed. ugh so discouraging.

However, even if I manage to stick to this 5 cup a day I don't want lap band.

I have to get a referral from him in order for my insurance to pay for me to see a nutrionist. Then only under certain circumstances will the pay. My mom told me last night to go to her doctor. I'd like to go ahead and get these blood test done on Monday before switching doctors.

I am not sure, I just see calorie counting working for so many people here and it gave me such hope and seemed like a reasonable change I'd be able to make and follow. Maybe I shouldn't discredit his advice and try my best to follow/make myself follow and see how it works.

I know you are getting tons of advice, much of it conflicting (I'm sure mine will be also, lol) -- 5 cups of food per day is a very low calories diet.  Unless you ate 5 cups of fat (pure fat, not ice cream/chocolate) -- you will be eating very few calories.  I would be eating almost all whole grain/high fiber foods....  A cup of raw oatmeal (equals 2 cups cooked, but...), throwing in ground flax seed, measuring a cup by weight instead of volume, etc

Personally, I don't happen to agree with his directives or advice -- but I didn't go to school for 7-10 years to learn about it, either.  He sounds like a bariatric doctor -- he is supposed to know what he is doing (I realize there is no guarantee).  His theory is valid -- 5 cups of food per day will certainly result in stomach shrinkage -- unless you are having to fill up excessively on water to quench your appetite.

You may wish to try to get a referral for the nutritionist by couching your request as a desire to know WHAT to eat for those 5-cups that will give you the most bang for your buck and provide you with the nutrients you need each day. 

You should also consider a second opinion if you are covered for it -- and any doctor who gets upset at the idea of a second opinion is not a doctor worth having -- they should welcome the idea of validation. 

Keep us posted on how it's going 

 

If your doctor is testing you for diabetes, you should check out these sites.  There are a lot more sites. 
If you are diabetic, your doctor should send you to a nutritionist.   My SIL was just diagnosed and has to take classes.

http://www.diabetes.ca/Section_About/nut

american diabetes association

Might be a better choice to follow these guidelines.

My husband(he is my main support, not sure what I would do without him besides fall apart) and I discussed what the doctor had to say. We sat down and talked indepth about everything. Personally, I don't feel comfortable restricting my body this way, even if was to change me over to just counting calories/exercising after my next appointment. I want to get set in one change and stay there. My husband is not comfortable at all with this plan the doctor ordered. I am really really uncomfortable using the pills. I HATE taking pills for any reason and especially for this reason.

What my husband and I have decided is that I am going to go ahead and go Monday for the blood testing, it's already ordered and won't cost me anything(such as co-pay, etc). I don't want to delay getting that done.

I am going to ask the nurse when she is doing my blood test if I could speak with the doctor for a few moments. Then I am going to ask for a referral to a nutrionist and ask him if we somehow misunderstood each other somehow. Even though I mentioned I had considered gastric, I said that I have decided that I do NOT want it, no type. And say to him that at the end he mentioned the 1cup, 5x a day is what they put lap band patients on to prepare for the surgery and it got me thinking that maybe he thought I was interested. And then I'm going to ask him how long he plans on leaving me on this schedule. I am also going to tell him that I am going to try not to use the pills.

I looked up on my insurance to see what they will cover and they cover 2 visits per year to a nutrionist, under certain circumstances. I think I could qualify. 

Original Post by coach_k:

A cup of raw oatmeal (equals 2 cups cooked, but...), throwing in ground flax seed, measuring a cup by weight instead of volume, etc

He never mentioned whether to measure raw or cooked, by weight or volume

Original Post by coach_k:

He sounds like a bariatric doctor -- he is supposed to know what he is doing (I realize there is no guarantee). His theory is valid -- 5 cups of food per day will certainly result in stomach shrinkage -- unless you are having to fill up excessively on water to quench your appetite.

He is actually just a family practice doctor-general doctor- whatever you wanna call it. He also never mentioned anything about liquids. Something else my husband and I was discussing, would it be ok to drink the protein shakes or anything like that to get the nutrients I am not getting from those 5 cups.

spoiled_candy- Thank you for those links. Was nice of you and appreciated it. I will check them out.

Well, I had the blood test done. I also started the phentermine and am doing the eat 1 c. of food, 5x per day, well kind of.

Today, in the mail, I get a copy of the paper from the lab the doctors office sent my blood to. The paper had something circled and written on it.

So, I called the doctors office. His receptionist said that it said Metformin and that she would call it in if I told her what pharmacy. I asked what it was for, as he done several test on the bloodwork. She said sugar. I said ok and told her where to call in it at. She said it would be Monday before she could b/c he was out of office and she wasn't allowed to call anything in when he was out.

Here is what I don't understand:

Obviously, as he suspected, I have type 2 diabetes. This is something new to me. Should he not call me back in and discuss this issue and what I need to do/not do? I mean just calling in a prescrip and no further education about it? Doesn't seem right. I had an appt already scheduled for Dec 12th. So I could understand waiting until then to discuss the results and give me the meds, but not just giving me the meds and not discussing anything with me.

Here is my problem:

Since I have started the 1c. 5x per day and the phentermine, I am never hungry. I eat my 1c. of food at breakfast and then SOMETIMES dinner. That's it. I tried making myself eat on Sunday, but it made me sick. However, I have been really sick with the flu and am almost over it. So, I don't know for sure if it's the meds or the flu that was making me not hungry.

But I read that eating every few hours will get your metabolism moving. So, even if I am eating less and not hungry, I won't lose because I am only eating twice per day, therefore my metabolism isn't working very fast, right? wrong? I don't know. So confused at this point.

Should I try making myself eat, even if I'm not hungry?

I read on other post here about people who have taken phentermine and they talk about all the energy they had after taking it, I still have no energy.

I just don't know what to do at this point.

I want to live a healthy lifestyle, I want to lose this weight and keep my diabetes under control. I was barely out of the range on the blood test, so maybe there is still hope that I can take a hold on things before the diabetes gets out of control.

For some reason, I have more motivation and desire to change and lose this weight than ever before, but I want to do it the right way.

The doctor puts me on this medicine and "eating plan" and him being a doctor I should trust him.

However, reading everything on here and reading about the min 1200 calories and the "starvation mode", it makes me wonder which to trust.

Obviously, I am not doing both, what he suggested and what this site suggest, and don't know which to trust.

Sorry for this being so long, just kinda venting and seeking explanations all at the same time.

It is really weird that he would just give you the prescription for diabetes without talking to you about it first.  He seems to be eerily uncommunicative -- I'm sure that he knows what he's doing, but it would be really nice if YOU knew what he was doing, right?  Also, because it seems that you are worried, confused, and nervous about the appetite suppresant and the diet he has you on, I would REALLY suggest you go see another doctor for a second opinion AND see a nutritionist.

Two cups of food a day is really not enough.  I hope you find yourself able to eat more when you are over your flu.  If not, well ... you need to eat in order to function, that's all there is to it.  So, there is yet another reason to talk to your doctor.

Phentermine is not a risk-free drug. It is a central nervous system stimulant (controlled substance), similar to amphetamines, and it can be habit forming.

As a medical student I am wary (and I am being taught to be wary, by my professors) of doctors who prescribe such medications too liberally.

The metformin is medically necessary. It's for your diabetes. The phentermine is only given to "enhance compliance" with your eating plan. (Wikipedia has pretty amazing medical info BTW, we students use it all the time!) Nobody should tell a patient that a pill is for "sugar" - it's for diabetes!!! Patients aren't stupid, they will understand if you take the time to explain things properly. I find it patronizing of them/us to dumb down the language that much.

Counting calories does make a person learn portion control, the hard way (you measure your food!) It's important to be accurate and complete in your counting, and it's important not to let it make you obsessive, but it is a demonstrated way to lose weight without risky meds. If you can't stick to a diet plan on your own, maybe the meds would be indicated... but it's weird that this doctor tells you NOT to count calories. Counting isn't possible or doable for everyone, possibly, but you won't know till you try.  You say you are doing the 5c a day thing, "well kind of" - what do those three words mean, by the way?

I would recommend that you get a second opinion - develop a plan that you think you can live with (1650 healthy calories a day would be a good example), and see what they think. And make sure you stick to that plan - your health and future depend on it.

(And for what it's worth, if you have no energy - even on amphetamines! - and have had appetite changes or sleep changes or feelings of hopelessness or sadness, you may want to talk to a doctor about the possibility of clinical depression, which I suspect is quite common in obese people...)

Also, the frequency/timing of meals has a minimal effect on weight loss - overall intake is the real factor that matters (timing/frequency can help some people stick to their eating plans though!). You do need to eat a minimum amount, so that your body doesn't go into conservation mode, but 1650 calories would be fine. 

Original Post by trustwomen:

 You say you are doing the 5c a day thing, "well kind of" - what do those three words mean, by the way?

 

The "well kind of" part means that I am certain to not eat more than 1cup of food at a time, but I am not eating 5x per day.

I just got off the telephone with my mom and she never says much about what I am doing/not doing, but after talking to her about what the doctor has advised/done she asked me to go see a different doctor.

After all the debating I've done with myself, I am going to go ahead and get a 2nd opinion, even if all it does is put me at ease with everything, it will be worth it and $40 well spent. Stressing over what is right/wrong certainly isn't going to help with weight loss that is for sure.

Thanks for your post and information. I'll read up on clinical depression.

 

Original Post by sarahrnorton:

It is really weird that he would just give you the prescription for diabetes without talking to you about it first.  He seems to be eerily uncommunicative -- I'm sure that he knows what he's doing, but it would be really nice if YOU knew what he was doing, right? 

Ya, I thought it was weird to prescribe the meds without discussing anything with me. I mean he told me at my appt that he suspected I had diabetes, but that was the extent of discussing it.

I mean, from what I've read, there is certain changes you should make being diabetic.......the ones I know of, I know because of online research, not from him.

You're right, it would be nice if I knew what he was doing with MY body.

Since, I do seem to have diabetes, my insurance will pay for a nutrionist, so I am going to ask for a referral to one.

Thanks for your reply.

A few solid links about diabetes (type 2):

Canadian Diabetes Association fact sheet

Wikipedia page

American Diabetes Association fact sheet

You probably know most of this stuff already but just in case (and for any lurkers who might be interested!)