An increase in fiber intake is also recommended for regulating bowel movements. Other methods of weight loss include use of drugs and supplements that decrease appetite, block fat absorption, or reduce stomach volume. Bariatric surgery may be indicated in cases of severe obesity. Two common bariatric surgical procedures are gastric bypass and gastric banding. Both can be effective at limiting the intake of food energy by reducing the size of the stomach, but as with any surgical procedure both come with their own risks that should be considered in consultation with a physician. Dietary supplements, though widely used, are not considered a healthy option for weight loss. Many are available, but very few are effective in the long term.
The Johns Hopkins Hospital protocol for initiating the ketogenic diet has been widely adopted. It involves a consultation with the patient and their caregivers and, later, a short hospital admission. Because of the risk of complications during ketogenic diet initiation, most centres begin the diet under close medical supervision in the hospital.
The least intrusive weight loss methods, and those most often recommended, are adjustments to eating patterns and increased physical activity, generally in the form of exercise. The World Health Organization recommended that people combine a reduction of processed foods high in saturated fats, sugar and salt and caloric content of the diet with an increase in physical activity.
The same goes for working out in a “fasted” state. Without a ready supply of glucose and glycogen to pull from (which has been depleted over the course of your fasted state, and hasn’t yet been replenished with a pre-workout meal), your body is forced to adapt and pull from a source of energy that it does have available: the fat stored in your cells.
In addition to improving your health, maintaining a weight loss is likely to improve your life in other ways. For example, a study of participants in the National Weight Control RegistryExternal* found that those who had maintained a significant weight loss reported improvements in not only their physical health, but also their energy levels, physical mobility, general mood, and self-confidence.
I’ll share some of my experiences, now doing heavy strength training for 3 years in a fasted state: For my first “fasted” workout or two after starting an IF protocol, it was very weird to not eat before training. However, after a few sessions, I learned that my body could certainly function (and even thrive) during my training sessions despite not eating a pre-workout meal.
In many developing countries, the ketogenic diet is expensive because dairy fats and meat are more expensive than grain, fruit and vegetables. The modified Atkins diet has been proposed as a lower-cost alternative for those countries; the slightly more expensive food bill can be offset by a reduction in pharmaceutical costs if the diet is successful. The modified Atkins diet is less complex to explain and prepare and requires less support from a dietitian.
As chronic obstructive pulmonary disease (COPD) advances, about 35% of patients experience severe weight loss called pulmonary cachexia, including diminished muscle mass. Around 25% experience moderate to severe weight loss, and most others have some weight loss. Greater weight loss is associated with poorer prognosis. Theories about contributing factors include appetite loss related to reduced activity, additional energy required for breathing, and the difficulty of eating with dyspnea (labored breathing).
1 Reference for 5%: Blackburn G. (1995). Effect of degree of weight loss on health benefits. Obesity Research 3: 211S-216S. Reference for 10%: NIH, NHLBI Obesity Education Initiative. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Available online: http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf Cdc-pdf[PDF-1.25MB]External
A study with an intent-to-treat prospective design was published in 1998 by a team from the Johns Hopkins Hospital and followed-up by a report published in 2001. As with most studies of the ketogenic diet, no control group (patients who did not receive the treatment) was used. The study enrolled 150 children. After three months, 83% of them were still on the diet, 26% had experienced a good reduction in seizures, 31% had had an excellent reduction, and 3% were seizure-free.[Note 7] At 12 months, 55% were still on the diet, 23% had a good response, 20% had an excellent response, and 7% were seizure-free. Those who had discontinued the diet by this stage did so because it was ineffective, too restrictive, or due to illness, and most of those who remained were benefiting from it. The percentage of those still on the diet at two, three, and four years was 39%, 20%, and 12%, respectively. During this period, the most common reason for discontinuing the diet was because the children had become seizure-free or significantly better. At four years, 16% of the original 150 children had a good reduction in seizure frequency, 14% had an excellent reduction, and 13% were seizure-free, though these figures include many who were no longer on the diet. Those remaining on the diet after this duration were typically not seizure-free, but had had an excellent response.
People use a ketogenic diet most often to lose weight, but it can help manage certain medical conditions, like epilepsy, too. It also may help people with heart disease, certain brain diseases, and even acne, but there needs to be more research in those areas. Talk with your doctor first to find out if it’s safe for you to try a ketogenic diet, especially if you have type 1 diabetes.
Implementing the diet can present difficulties for caregivers and the patient due to the time commitment involved in measuring and planning meals. Since any unplanned eating can potentially break the nutritional balance required, some people find the discipline needed to maintain the diet challenging and unpleasant. Some people terminate the diet or switch to a less demanding diet, like the modified Atkins diet or the low-glycaemic index treatment diet, because they find the difficulties too great.
Another program called the 5:2 Fast Diet involves eating 5 days a week and fasting for the other 2 days, when women can get no more than 500 calories and men no more than 600. That’s a quarter of the amount you likely eat on the days when you don’t fast. Whether you eat those calories in one sitting or spread them across micro-meals throughout the day is up to you.