Crash dieting – is it safe?

Crash dieting, otherwise known as living on starvation rations, is back in the news – but with a twist this time. Coroners reported last week on the deaths of two women who were on a severely-restricted calorie intake diet to lose weight fast. Yet despite these fatalities, doctors and obesity experts are queuing up to reassure the public about the safety of the modern equivalent of eating cabbage soup for a week to get into that little black dress.

This sudden enthusiasm reflects the extent of the UK’s recent wake-up call to the dangers of obesity. One in four of the population is now clinically obese (having a BMI of 30 or more with a waist measurement of more than 94cm for men and 80cm for women) putting them at significantly greater risk of heart disease, some cancers, arthritis and diabetes.

Instead of constant harping on about the dangers of excessive weight loss, a landmark report from the National Institute for Health Clinical Excellence in July 2008 made it clear that our capacity to deny the flab in the mirror poses a far greater health risk. Once we’re over a certain weight, we’re no longer being urged to lose weight slowly but surely. Fat people are more motivated to stay on track the more sensational the speed with which they drop dress sizes. But is it really a good idea to crash diet?

At 17st 7lb, Samantha Clowe, 34, had a BMI of 37 when she went started a very low calorie diet (VLCD) because she “didn’t want to be a fat bride”. She died of heart failure in Leeds last year after shedding 3st, 11 weeks into a diet that allowed a daily intake of just 530 calories in soups and shakes – a quarter of the recommended daily calorie intake for a woman.

Her brother Daniel claimed there was “too much pressure on women to be like skinny celebs”, while the coroner cautiously implied in his report last week that her death “may be related to her low-calorie diet and weight loss”. But doctors disagreed. “Samantha’s death tragically shows the real dangers of being obese,” commented Dr David Haslam, chair of the National Obesity Forum. “The truth is the number of sudden deaths among the obese … is significantly higher than those that occur among people on VLCDs,” said Professor Iain Broom, director of the Centre for Obesity Research at Robert Gordon University, Aberdeen.

The following day, the Derby Coroner’s Court reported on the death of Susan Alderson, 49, a diabetic with liver problems, who used another way to lose weight fast: gastric banding. This involves having a silicone loop tightened three-quarters of the way up the stomach so people feel full after eating relatively little. At 16st, Susan had a BMI of 44 and had been advised to have the operation for health reasons at Derby City General Hospital in January, but died of internal bleeding hours after surgery.

Once again, the tragedy seems unlikely to halt the meteoric rise in the popularity of the procedure, not least since the TV presenter Fern Britton admitted that it was a gastric band that had shifted 5st in 2006. The private sector, which has invested heavily in obesity surgery, can also rightly claim to have made this operation safe: while one in 200 gastric band operations in the NHS are still thought to be fatal, some private sector providers insist they have a zero mortality rate as a result of extensive pre- and post-surgical care.

What really counts, however, is the level of support in changing the way people feel about themselves and the food they eat. The benefit of a crash diet, it seems, is that enforcing a reduced appetite gives a breathing space to people who have obsessed about food for years. With sufficient daily nutrients to keep them healthy, the key to successful and sustained weight loss is the extent to which they use this transition period to develop a healthy diet and a balanced lifestyle, getting used to being thin and active again. Without such changes, the weight will pile back on.

Providing this support is not necessarily straightforward. “People who maintain a clinically obese body weight have a habit of consuming body-builder levels of calories and of course that has to change,” says registered dietitian, Cirian-Marie Beddoes, head of Weight Management Services at The Hospital Group.

“Severe calorie restriction carries risks, particularly if the few calories consumed are low-quality,” explains Beddoes. “You can consume 1,000 high-quality calories and blossom or the same number of calories in junk food and you’ll be ill.” Her team of dietitians provides two years of one-to-one aftercare, with food diaries and telephone consultations to check for symptoms of malnutrition: hair loss, brittle nails, skin pallor, apathy, moodiness or aggression.

The dietitians see it as a priority to provide psychological support, including neuro-linguistic programming and cognitive behavioural therapy. “These people often feel crap about themselves. Our job is to nurture and nourish their love of food, a healthy balanced diet and being socially and physically active,” Beddoes says. “Changing lives requires intensive and skilled intervention.”

Most VLCD companies such as Cambridge Diet provide little support. LighterLife leaves pre-diet preparation to the GP but does provide group counselling post-surgery, run by graduates of a training programme lasting just four weeks. “Before and after” success stories in ads may hide less-impressive long-term success rates.

NHS obesity treatment is largely restricted to occasional surgery, with increasing use of prescription drugs: Reductil tricks the brain into believing the stomach is full, while Xenical, which has its own support phone line, blocks the absorption of fat, causing unpleasant side effects for anyone taking the drug while eating lots of fat. “The failure of the NHS to invest in obesity services, having put all the funds into anti-smoking, makes my blood boil,” says Beddoes, who moved to the private sector last year.

There are signs of changes. The Department of Health launched its Healthy Weight, Healthy Lives campaign last year. And in Scotland, the Counterweight Programme is a dietician-led service. If you’re thinking of attempting rapid weight loss, consult your GP first. It could be some time, however, before we can rely on the NHS to get us into that little black dress.

extracted from [http://www.independent.co.uk/life-style/health-and-families/features/crash-dieting-desperate-measures-1787304.html]

Eating Disorders – The Culprit to Obesity

The current health care debate, when it focuses on food at all, focuses on obesity. Two-thirds of Americans are either overweight or obese. That is shocking, but in the national panic about obesity, we run the risk of making things worse.

More people could get caught in the grip of eating disorders. Already, an estimated 11 million Americans have anorexia or bulimia. Hospitalizations are increasing. Even more worrisome, the American Medical Association found the greatest increases among boys and girls younger than 12, and among adults ages 45 to 65.

We could save a lot of pain, suffering and money by incorporating obesity into the range of illnesses now classified as eating disorders, and by focusing on prevention. Agencies that are working on ways to combat obesity should include experts in eating disorders.

Maybe you didn’t feel fat, just a touch overweight, before the U.S. Centers for Disease Control and Prevention revised the height/weight tables, and now your weight hits the category of “morbidly obese.”

Do you automatically exercise more and eat less? More likely, you feel bad, blame your genes or your lack of willpower, try a new diet, fail, feel worse, eat more.

Practically all disordered eating begins with a diet.

Eating disorders and obesity have increased spectacularly in the past 20 years. How is that possible? Did our genes suddenly change?

No, but our eating habits did. We eat while walking, driving and working. Families have a hard time sitting down to a meal together, and even gas stations sell food.

We eat out a lot more, now spending 50 percent of our food dollar in restaurants. Eating out, it’s hard to avoid sugar, fat and salt. As Dr. David Kessler, former commissioner of the Food and Drug Administration, writes in his bestseller, “The End of Overeating,” “Eating foods high in sugar, fat, and salt makes us eat more foods high in sugar, fat, and salt.”

With food relatively cheap and highly available, we also have more opportunity to eat badly at home.

What else has changed in two decades? While America has become a 24-hour buffet, the pressure to be thin has increased.

Girls, particularly, get the message from movies and fashion magazines that the ideal body type is a wire hanger. But who among us doesn’t obsess about weight? Pounds and body mass index can feel like the sum of our worth. Which means just about everyone gets to feel bad about his or her body.

If agencies attacking obesity aren’t careful, they could inadvertently encourage more disordered eating. Obsessively counting every calorie isn’t hard. Moderation is hard. As generations of dieters know, changing habits is hard.

In the health campaign against fat, we should avoid bashing obesity and idealizing thinness, which only foster the self-destructive thought processes that characterize eating disorders from anorexia to obesity. Anorexics with jutting collarbones think they’re fat. Binge-eaters often think, after eating too much, that they’ve already done the damage so they might as well keep eating.

No eating disorder is a lifestyle choice. Besides the serious, often life-threatening physical dangers, there is shame, loneliness and depression. Our community is lucky to have help for all of this, at the Eating Disorders Resource Center of Silicon Valley (www.edrcsv.org). Its services are free.

Environments can change. Not that long ago, people smoked everywhere, just as we eat everywhere today. The health campaign against cigarettes worked. We can change the way we deal with eating disorders as well.

 

SHEILA HIMMEL is the author, with Lisa Himmel, of “HUNGRY: A Mother and Daughter Fight Anorexia” (Berkeley Trade Paperback, 2009). Upcoming readings include Tuesday at Kepler”s Bookstore in Menlo Park and Monday at the Cambrian branch of the San Jose Public Library. (The full schedule is on sheila.himmel.com.) She wrote this article for the Mercury News.
[http://www.mercurynews.com/opinion/ci_13319172?nclick_check=1]