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Losing weight too fast does not always hurt

Losing weight too fast does not always hurt

Many people wonder if quick weight loss can be bad for health. And until very recently my answer would be: yes. Losing weight too fast is bad, yes. However, some relatively recent publications have made the scientific community rethink such a response. It is certainly a controversial subject and still without a definitive answer. But some interesting points deserve space here.

As a starting point, I would say that perhaps the problem is the way the question is being asked. It is possible that the best question is not this, but rather: is losing weight too fast making it difficult to maintain the weight that was lost? Or even better: losing weight fast (and not too fast) helps long-term results or harms?

Losing a lot of weight in the first month helps to consolidate results

To try to answer the reformulated version of the title question of our column will begin by quoting a sub-analysis of the look-ahead study. The study evaluated 5,145 patients with diabetes and obesity for approximately 10 years. Some of them received what was called intensive lifestyle intervention, while the rest were only conventionally oriented in relation to diet and exercise.

In one of them, it was shown that the patients who presented the greatest weight loss in the first and second month of treatment were those who reached a lower weight at the end of 4 and 8 years respectively. That is, individuals who lose more than 6% of their initial weight within 1 month are more likely to lose weight consistently in the long run. What it means to say, for example, that for a person who starts his 90-kg weight loss plan, reductions of 5.4 kg or more in the first month of treatment are welcome.

The origin of the myth

We know that a conventional diet produces on average losses of 2 to 4 kg per month. For many years we have heard that rapid weight loss was associated with a worse prognosis in the long run. It's common for the patients themselves to talk to us in the office: "Doctor, I'd rather lose weight slowly because I know that if I lose too much weight too fast then I'm going to recover all over again and I'll still be overweight than when I started "

This concept was overturned in 2013 when an article was published in the New England Journal of Medicine entitled" Myths, Assumptions and Facts About Obesity ". This publication has become a must read among endocrinologists and nutritionists and there is a list of seven myths in the area. Among them, we find fast weight loss as villain. Such misinterpretation comes from the 1960s, an era in which VLCD ( Very Low Calorie Diets diets with very few calories, in free translation) were common. Diets with less than 800 calories per day, but very poorly prepared and therefore nutritionally insufficient. Thus, these diets have produced many adverse events and have been condemned in specialized textbooks and even by public health entities . Thus, during the following decades, they came to be seen as bad options. It is up to us to demystify this issue with patients. VLCDs can be used in the treatment of overweight, but with parsimony, medical guidance and taking care that there is no deficiency of any micro or macronutrient. They should not be seen as an option for long-term use either, since adherence to this type of approach is often very low.

How does this apply today?

In order to facilitate prescription and adherence to this type of diet, some methods have become commercially available in our country in recent years. They are diets with very firm and structured planning, in which the patient mixes water with a powder and produces what should be eaten at each meal.

These are so-called protein diets, that is, with a slightly higher protein content in its composition, but which are not hyperprotein. Low amounts of carbohydrates are used to produce what is called ketosis. That is, in the face of a lack of carbohydrate in the diet, substances known as ketone bodies are formed, in order to overcome the lack of carbohydrate. Such substances are able to act in specific regions of the central nervous system producing an anorectic effect (appetite suppressant).

Thus, the patient is able to follow the diet plan more easily and there is rapid weight loss. It is about six to 10 kg per month (equivalent to 2.5 kg per week). And there are already studies of more than one year of follow-up showing good weight maintenance.

What to do to have a better weight maintenance then?

In this type of diet, there is an urgent need for medical monitoring and a vitamins in parallel to avoid possible side effects. But again we can show that more intensive weight loss can and should be encouraged. Sign of the times ... After all, medicine is the science of transient truths!

In this way, we can conclude that we already have enough scientific evidence to affirm that more intensive and faster weight loss may be interesting for the patient to long term. On the other hand, that does not mean that any intensive weight loss is adequate. There must be always common sense and close monitoring by the health team. Adjustments should also be made according to the response of each patient.

It continues to be our maxim that no treatment can be considered as a panacea, and there are always risks and benefits to be considered by the doctor-patient binomial at the time of the taking decision-making.


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Four cups of tea per day may help prevent type 2 diabetes

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