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Thursday, November 27, 2014
Obesity and Weight Management
Hi, I’m a RD. I have a client that is in the starvation mode. I know you are supposed to not change the amount of calories consumed but help them to eat differently. I am not sure what this means. I have not had a client like this in the past. Also, I know it will take about 6 months for this client to regain an appetite. The client states that they are not hungry. I’m out in an area with not a lot of access to information. I hope you can help me to help them. God Bless.
Thank you for your question. Many people think that starving themselves will lead to fast weight loss. A starvation diet does not mean the absence of food. It means cutting the total caloric intake to less than 50% of what the body requires.
The body responds by using its own reserves to provide energy, and these reserves are not just the body's extra fat. Initially, glycogen stores are broken down for energy. Glycogen is the storage form of carbohydrate in our body. There is little glycogen available so this energy source is depleted during the first hours of starvation. When glycogen is used, water is released which is noticed as a drop in weight on the scale. These labile stores are quickly replenished when feeding is resumed which is noticed by an increase in weight.
The individual's initial weight when starting a starvation diet will dictate to what extent fat is lost. Those individuals who are not obese (Body Mass Index (BMI) < 30) will tend to lose their lean body mass more easily and quickly than those who are obese (BMI > 30). It is dangerous for these smaller individuals to go on a starvation diet because the lean mass that is lost may come from organs such as the heart. In the 1970's there were several deaths resulting from starvation-type diets. Death is a rare side effect, though.
The more common problem resulting from starvation-type diets is the resultant weight regain. Weight is typically regained because there has not been a change in the lifestyle that led to the original weight gain. When the starvation diet is ended, the individual returns to the same old habits. The scale will indicate the weight regain, but it will not identify the composition of the added weight.
When weight is regained, it is fat. When fat replaces the muscle mass that was lost during starvation, the metabolic rate (the number of calories needed to maintain the current weight) is decreased. The frustrated individual typically initiates another starvation-type diet only to continue this cycle.
To help an individual break this cycle, begin with a diet history, and help the client make some small changes. The goal should be 4 - 6 small meals/snacks that result in a balanced intake. Also get the patient started exercising. Weight training will be important for rebuilding the lost muscle mass. Increasing muscle mass and increasing aerobic exercise will help increase the appetite appropriately.
Don't forget to help the client identify a realistic weight loss goal. That goal should never exceed 10% of initial weight in a six-month period. After six months, the client should try to maintain the loss for a few months before considering further weight loss.
Shirley A Kindrick, PhD
Former Team Leader of Comprehensive Weight Management
College of Medicine
The Ohio State University