The Dr. Now diet, popularized by Dr. Younan Nowzaradan of TLC's "My 600-Lb. Life," is a very low-calorie diet plan designed to help individuals with class 3 obesity lose weight rapidly before undergoing bariatric surgery. Dr. Nowzaradan, known as Dr. Now, is an Iranian-born, Houston-based vascular and bariatric surgeon. His no-nonsense, tough-love approach has made him a favorite among fans and patients alike. This article will explore the details of the Dr. Now diet, its benefits and drawbacks, and its sustainability.
What is the Dr. Now Diet?
The Dr. Now diet was designed “for rapid, effective weight loss, most notably to assist obese patients to drop weight prior to weight-loss surgery,” explains Michele Smallidge, registered dietitian and founding director of the B.S. Exercise Science Program at the University of New Haven in West Haven, Connecticut. The diet is detailed in his book, “The Scale Does Not Lie, People Do.”
How to Follow the Dr. Now Diet
The Dr. Now diet is characterized by three main principles, summarized by the acronym "FAT":
- Frequency: Dr. Now recommends eating two to three meals per day, without any snacks in between.
- Amount: Calorie intake should be limited to 1,200 calories or less each day, divided evenly between meals (e.g., 400 calories per meal for three meals, or 600 calories per meal for two meals).
- Type: Focus on consuming low-fat, low-carb foods while increasing protein and fiber intake. Avoid sugar strictly. Protein and fiber can help increase satiety.
To stick to the diet, Dr. Now advises creating a list of favorite foods and eliminating those high in sugar, fat, and calories. The remaining foods should form the basis of daily meals. He also emphasizes choosing minimally processed foods and controlling portion sizes to meet the calorie restriction.
The Dr. Now diet is designed for short-term use, typically one to two months, in preparation for bariatric surgery and should always be followed under close medical supervision.
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Foods Allowed on the Dr. Now Diet
People on the Dr. Now diet can consume a few basic types of foods, says Lisa D. Ellis, a registered dietitian in private practice in Manhattan and White Plains, New York. The Dr. Now diet emphasizes lean protein sources, specific whole-grain carbohydrates, non-starchy vegetables and nonfat dairy, while avoiding foods that are often high in calories, sugar and saturated fat. The diet allows for high-fiber, high-protein, low-fat, and sugar-free foods, including:
- 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 on the Dr. Now Diet
Dr. Now provides his patients undergoing bariatric surgery with a list of foods to avoid on the diet. The list includes foods you would expect, like cookies and French fries, but also some surprising foods, like oatmeal, popcorn, and peanuts. His reasoning is that oatmeal is high in carbs, popcorn is often doused in fat, and peanuts are high in calories and easy to overeat. The diet restricts or prohibits foods such as:
- 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.
Dr. Now encourages avoiding several nutritious foods due to their calorie content, including eggs, olive oil, nuts, and seeds. In addition, Dr. Now suggests limiting whole-wheat bread and other whole-grain carbs, although they’re not totally banned from the diet.
Daily Dr. Now Diet Meal Plan
A typical day on the Dr. Now diet might look like this:
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
Pros and Cons of the Dr. Now Diet
Dr. Now Diet Pros
- Rapid Weight Loss: The primary benefit of the Dr. Now Diet is its ability to help bariatric surgery patients lose a significant amount of weight in a relatively short period. Many patients aim to lose 30 pounds in the 30 days leading up to surgery.
- Reduced Surgical Risks: Dr. Mir Ali, a bariatric surgeon and the medical director of the MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California, often encourages patients to lose weight before surgery to reduce the risk of post-surgical complications.
- Shrinking the Liver Size: A low-calorie diet is effective in helping reduce liver size, which is important because doctors have a harder time operating on people with larger, fatty livers, as the liver can block the view of the stomach.
- Improved Surgical Outcomes: Studies indicate that a low-calorie diet is effective in helping reduce liver size. Ideally, a patient can lose 5% to 10% of their body weight before surgery to reap the above benefits and reduce risks, he adds.
- Reduced risk of complications: Some, but not all, research studies have found an association between preoperative weight loss and a reduction in the risks of complications and even death following the surgery.
Dr. Now Diet Cons
- Not Sustainable: Unless you are preparing to undergo bariatric surgery, the Dr. Now diet is not a good fit for you. A diet of only 1,200 calories is by no means sustainable for most people. The Dietary Guidelines for Americans recommend a daily intake of approximately 1,600 to 2,400 calories for women and 2,000 to 3,000 calories for men.
- Potential for Nutrient Deficiencies: Following a restrictive diet like this long term can increase the risk of nutrient deficiencies, as well as lead to disordered eating patterns,” explains Erin Palinski-Wade, a registered dietitian based in Sparta, New Jersey. These diets can also put people at risk for nutrient deficiencies, heart problems and muscle loss.
- Social Difficulties: These types of diets also make socialization difficult, as even the most discerning dieter will find it challenging to find acceptable choices on the average menu or buffet table.
- Metabolic Slowdown: Ultra-low-calorie diets can cause weight gain in the long run by slowing down your metabolism. Many, but not all, clinical studies have found that weight loss decreases metabolic rate by three to five percent over the long term.
- Health Implications: Because rapid weight loss can have health implications, consulting health care professionals is crucial before undergoing a restrictive diet, says Lisa Jones, a registered dietitian based in Philadelphia. Failing to supply your body with adequate calories can lead to fatigue, malnutrition and even a weakened immune system.
Is the Dr. Now Diet Effective or Sustainable for Weight Loss?
The Dr. Now diet is a very restrictive, low-calorie meal plan that is not designed for individuals who are not undergoing weight-loss surgery, experts say.
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The American Academy of Nutrition and Dietetics recommends that patients with grade 3 obesity consume 22 calories per kilogram of body weight - there are 2.2 pounds in a kilogram - to lose weight. In addition to being unsustainable in the short term, ultra-low-calorie diets can cause weight gain in the long run by slowing down your metabolism.
To determine if you qualify for this diet, Ellis emphasizes the importance of consulting your medical doctor. "This diet is so restrictive that it is important that they be medically stable and have no vitamin and mineral deficiencies," she says.
What Is Bariatric Surgery?
Bariatric surgery refers to a range of procedures performed on the digestive tract to regulate the amount of calories patients can consume and absorb.
"Bariatric surgery can have a positive impact on your lifestyle practices, provide the opportunity to manage your weight and eliminate underlying health issues," Jones says. "It seeks to reduce the volume of the stomach and, in turn, restricts how much food you can consume. By changing what, when and how much you eat, bariatric surgery can lead to long-term positive outcomes for patients."
Successful weight loss from the surgery can improve chronic conditions associated with obesity, such as sleep apnea, nonalcoholic fatty liver disease and joint and back pain.
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Gastric Bypass vs. Sleeve Gastrectomy
"Surgeons perform either gastric bypass or sleeve gastrectomy, and the decision is one that should be mutually decided upon by the surgeon and patient together," says Dr. Erik P. Dutson, chief of minimally invasive and bariatric surgery at the Center for Obesity and Metabolic Health at the University of California, Los Angeles. "The overwhelming number of patients will do well with either operation. However, a smaller number of patients should not get one or the other based on medical conditions."
For example, he says, larger patients, patients with diabetes in more advanced stages and patients with gastroesophageal reflux disease - a disorder in which stomach contents come back up through the lower valve of the esophagus - tend to do better with the gastric bypass.
Patients taking immunosuppressants - whether for cancer, organ transplantation or autoimmune diseases - tend to do better with sleeve gastrectomy.
"Ultimately, an evaluation by a trained medical specialist is necessary to determine if an individual is right for this kind of procedure," Jones says.
In general, individuals with gastrointestinal diseases, severe heart or lung disease or substance use disorders will be disqualified from having the surgery.
While bariatric surgery is effective, it is by no means a quick or simple fix. It's a significant procedure that carries the risk of bleeding or perforation, blood clots, bowel obstruction, problems with malabsorption, hernia and other serious side effects.
According to some estimates, approximately one-quarter of all bariatric surgery patients will require emergency department (ED) care within three months of their operation. Of these ED visits, 10% will result in readmission.
For many individuals, though, bariatric surgery is truly life-saving. In fact, 90% of bariatric surgery patients lose and keep off about half of their excess weight. But no one should expect to have their surgery and then return to their previous lifestyle.