Weight loss is a complex journey, and various diet programs promise effective results. The doctor-designed diet program, often associated with bariatric surgeons, has gained attention for its structured approach to rapid weight loss. This article explores the principles, benefits, and potential risks of such programs, providing a comprehensive overview for those considering this path.
Introduction to Doctor-Designed Diets
A doctor-designed diet program is a structured eating plan created and supervised by medical professionals, often tailored to individuals preparing for weight loss surgery or those with significant health risks due to obesity. These diets are typically restrictive, focusing on low-calorie and low-carbohydrate intake to promote rapid weight loss. One notable example is the Dr. Now Diet, popularized by Dr. Nowzaradan from the TV show "My 600-Lb. Life."
The Dr. Now Diet: Principles and Guidelines
The Dr. Now Diet is a very restrictive low carb, low calorie diet. Dr. Nowzaradan is a Houston-based bariatric surgeon who specializes in weight loss surgery for people with morbid obesity. He gained fame on “My 600-Lb. Life,” which documents the lives of his patients who weigh more than 600 pounds (272 kg). The show follows their journey before, during, and after weight loss surgery. He encourages his patients to lose weight prior to weight loss surgery using this diet.
Dr. Now’s book explains the three main principles of his diet approach using the acronym “FAT”:
- Frequency: Dr. Now recommends eating two to three meals per day with no snacks.
- Amount: Limit calorie intake to 1,200 calories or less each day, divided evenly - so 400 calories for each meal 3 times daily, or 600 calories for each meal twice daily.
- Type: Strictly avoid sugar and choose low fat and low carb foods while increasing the protein and fiber content of each of your meals. Protein and fiber can help make your meal more filling.
Dr. Now says that when you begin, make a list of all of your favorite foods, and then remove all the sugary, high fat, and high calorie foods from the list. What remains should be a regular part of your daily meals while you’re doing the Dr. Now program - that way, it’s easier to stick to. He also says to focus on minimally processed food and choose small portions, which will help make it easier to meet the restricted calorie count. This diet is designed for short-term use in the lead-up to bariatric surgery, so don’t follow it for longer than a month or two.
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Always make sure you’re under close medical supervision while you’re on this diet.
Foods to Eat and Avoid on the Dr. Now Diet
The Dr. Now Diet emphasizes high protein, high fiber, low calorie, low fat, and sugar-free foods. It restricts several nutritious foods due to their calorie content, including oatmeal, olive oil, nuts, and eggs.
Foods to Eat:
- Lean protein sources: egg whites, lean cuts of meat, chicken breast, turkey breast, beans, tofu, fish
- Fats and oils: cooking spray, small amounts of oil for cooking
- Lower sugar fruits: all whole fruits, except watermelon, cantaloupe, banana, and mango
- Most vegetables: all vegetables, except potatoes
- Certain nuts and seeds: flax seeds, chia seeds
- Nonfat dairy: plain nonfat yogurt, skim milk
- Whole-grain carbs: wheat bread, wheat or corn tortillas, whole-wheat pasta in moderation
- Zero-calorie sweeteners
Foods to Avoid:
- Some sources of protein: high carb or sugary protein shakes, high fat meats, processed meats (like hot dogs, bacon, sausage), battered and fried meats (like fried chicken), eggs
- Some fats and oils: butter, olive oil, vegetable oils
- Fruits higher in sugar: fruit juices, fruit canned in syrup, fruits that have more natural sugar (watermelon, cantaloupe, banana, and mango)
- Potatoes: includes French fries
- Most nuts and seeds: peanut butter, peanuts, almonds, cashews, pistachios, sunflower seeds
- Full fat and sweetened dairy: sweetened yogurt, sorbet, ice cream, milkshakes, chocolate milk, full fat cheese
- Certain carbs, especially refined products: crackers, chips, popcorn, white rice, brown rice, waffles and pancakes, white bread, pasta
- Sugar-containing sweets: cookies, candy, cakes and pastries, ice cream, honey, syrup
Sample Menu for the Dr. Now Diet
Here’s a sample menu you could follow for 3 days on the Dr. Now Diet. Since there are no snacks allowed on the diet, you’ll only see breakfast, lunch, and dinner suggestions below.
Day 1
- Breakfast: 2 ounces (57 grams) egg whites with spinach, mushrooms, and 1 ounce (28 grams) part-skim mozzarella on 2 pieces whole-wheat toast, ready-to-drink low carb protein shake
- Lunch: 3 ounces (85 grams) grilled chicken, salad with 2 tbsp. (30 grams) vinaigrette dressing
- Dinner: 3 ounces (85 grams) broiled salmon with asparagus
Day 2
- Breakfast: 1 cup (245 grams) plain nonfat yogurt with stevia and 1/2 cup (75 grams) blueberries, 1 cup (240 mL) skim milk, 2 pieces turkey bacon
- Lunch: 1 cup (238 grams) tuna salad made with nonfat Greek yogurt instead of mayo, whole-grain pita, celery, and carrots
- Dinner: spiralized zucchini with 4 ground turkey meatballs, marinara sauce, and 1 ounce (28 grams) part-skim mozzarella
Day 3
- Breakfast: fruit smoothie with 1 cup (240 mL) skim milk, 1 scoop protein powder, 1 cup (150 grams) strawberries, 1/2 avocado
- Lunch: 1 cup (240 grams) broccoli stir-fry with 3 ounces (85 grams) tofu
- Dinner: 2 cups (478 grams) low fat chicken and vegetable soup, side salad with 1 tbsp. (15 grams) vinaigrette dressing
The above meal plan details 3 days of meals that provide approximately 400 calories in each meal and stick to the foods allowed on the Dr. Now Diet.
Benefits of Doctor-Designed Diets
- Rapid Weight Loss: This strict, low calorie diet plan does result in fast weight loss, especially in people with higher body weight. Dr. Now encourages many of his patients who weigh more than 600 pounds (272 kg) to try to lose 30 pounds (14 kg) in just 30 days, and many of them are successful.
- Preoperative Weight Loss for Bariatric Surgery: In fact, the 1,200 calorie diet is commonly used for preoperative bariatric surgery patients, not just in Dr. Now’s practice. Doctors often recommend preoperative weight loss for people undergoing bariatric surgery because it appears to help reduce complications after the operation. One study looked at outcomes in more than 480,000 people who had bariatric surgery. The researchers found that weight loss prior to surgery helped reduce the risk of death within 30 days of surgery - even when people lost less than 5% of their body weight. Studies have also found that when people were required to lose weight before they were approved to have weight loss surgery, they tended to have more successful weight outcomes after surgery.
Potential Risks and Considerations
The Dr. Now Diet plan isn’t a good choice, except for those who need to lose weight to have a safe operation. The 1,200 calorie limit is excessively restrictive for most people and therefore not sustainable. In fact, long-term extreme calorie restriction might make it harder for you to lose weight.
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That’s because your body adapts to calorie restriction by slowing down your metabolic rate, meaning you burn fewer calories. Low calorie diets may also affect your hunger hormones, making you hungrier than normal. Research shows that many of these diets lead to rebound weight gain because of these metabolic changes. As a result, this and other crash diets aren’t a good choice if your goal is long-lasting weight loss.
Additionally, very calorie-restricted diets often provide inadequate amounts of nutrients, even if they’re rich in nutrient-dense fruits and vegetables. For example, one study noted that a high protein, low carb, 1,200 calorie diet - similar to the one Dr. Now recommends - came up short on thiamine, vitamin D, vitamin E, calcium, magnesium, and potassium. While these gaps may not pose immediate health risks, they could lead to complications in individuals following the diet for more than a short-term basis of a few weeks.
Restrictive diets also cause changes to the gut microbiota, the beneficial bacteria that populate your large intestine. Maintaining a healthy balance of these gut bacteria is crucial for optimal health and digestion. However, restrictive diets may reduce both the overall population and the diversity of the bacteria present.
Finally, don’t attempt the Dr. Now Diet without medical supervision, especially if you have any medical conditions or are taking medications. If you’re looking to try this diet, be sure to speak with a healthcare professional beforehand.
Alternatives to the Dr. Now Diet
For individuals seeking sustainable weight loss, several alternative programs offer a more balanced and comprehensive approach. These programs focus on long-term lifestyle changes, incorporating balanced nutrition, physical activity, and behavioral support.
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- WeightWatchers: The WeightWatchers Points Program assigns every food a “Point value” based on calories, protein, added sugar, saturated fat, unsaturated fat and fiber. Foods higher in protein, unsaturated fat, and fiber will be fewer Points, while foods higher in calories, added sugar and saturated fat will be more Points. All members receive a personalized Points Budget, calculated based on their individual metabolic rate, determined by age, height, weight, sex assigned at birth and goals. Participants need to stay within their points budget to lose weight.
- Mayo Clinic Diet: The Mayo Clinic Diet focuses on eating healthy foods by teaching how to estimate portion sizes and plan meals while increasing physical activity. By consuming generous amounts of foods that are high in bulk but low in calories, such as vegetables and fruits, people can feel satisfied yet consume less calories. The diet is divided into two phases: The first is called “Lose It!” and the second is called “Live It!”
- Mediterranean Diet: The Mediterranean diet emphasizes fruits, vegetables, whole grains, legumes, nuts, seeds, and olive oil. It also includes moderate amounts of fish, poultry, and dairy products, while limiting red meat and processed foods.
- DASH Diet: The DASH (Dietary Approaches to Stop Hypertension) diet focuses on reducing sodium intake and increasing the consumption of fruits, vegetables, low-fat dairy, and whole grains.
The Gut-Health Connection to Weight Loss
Maintaining a healthy gut is crucial for overall well-being and can significantly impact weight management. An imbalance of gut bacteria, known as dysbiosis, can lead to various health issues, including digestive problems, inflammation, and weight gain.
- Dysbiosis: An imbalance between the beneficial and harmful bacteria in the gut is known as dysbiosis-the opposite of symbiosis, which describes coexistence in a state of harmony. Dysbiosis can make you feel nauseated, cause belly pain or bloating, or make you gassy (very gassy). Bowel movements change-you might have to “go” too much (diarrhea) or too little (constipation).
- Leaky Gut: If the intestinal lining is damaged, the holes get bigger. All sorts of undesirables-bacteria, viruses, yeast, undigested food particles-literally leak out of your small intestine into your bloodstream. The condition’s formal name is “increased intestinal permeability,” but it is more commonly known as leaky gut. Leaky gut can also lead to low-grade, body-wide inflammation and digestive issues, skin problems like psoriasis, and autoimmune diseases.
Integrating Ancient Wisdom with Modern Medicine
Traditional medicine systems like Ayurveda and Chinese medicine offer valuable insights into digestive health and weight management. Ayurveda emphasizes the concept of "agni," the digestive fire responsible for converting food to energy. A strong agni promotes a healthy metabolism, while a weak agni leads to a buildup of "ama," undigested food that forms a toxic sludge within the digestive system.
- Agni and Ama: In Ayurveda, the digestive fire is called agni. It’s responsible for absorbing the nutrients the body needs while burning off waste products. When agni is strong, your metabolism hums, your body systems (digestive and others) work well individually and together, and you feel physically and mentally well, strong, and calm. A weak agni means an unbalanced body and mind. You feel sluggish, your mood takes a nosedive, your systems begin to malfunction, your skin and hair grow dull, and your metabolism slows considerably, leading to weight gain. A weak agni is caused by a buildup of ama-undigested food that forms a toxic sludge within your digestive system. Ama is thought to lead to disease over time.
Similarly, Chinese medicine views the stomach as a cooking pot and the spleen as the fire underneath the pot. Proper digestion is essential for creating "qi," natural energy, and maintaining overall health and vitality.