TLC’s hit reality show “My 600-Lb. Life” follows a group of patients throughout their weight loss surgery. The subjects of this docuseries all have class III obesity, meaning they have a body mass index of 40 or higher.
Dr. Younan Nowzaradan, who specializes in vascular and bariatric surgery, helps prep the patients for their upcoming surgery. The Iranian-born, Houston-based doctor has become a fan favorite for his no-nonsense, tough-love approach. He’s been nicknamed by fans and patients as Dr. Now; and interest has grown in Nowzaradan’s Dr. Now diet.
The Dr. Now diet is a highly restrictive low-calorie, low-carbohydrate diet developed by Nowzaradan to help patients prepare for bariatric surgery.
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 Michelle Smallidge, registered dietitian and director of the B.S. Exercise Science Program at the University of New Haven in West Haven, Connecticut.
[See: The Best Diets for Fast Weight Loss.]
What Is Bariatric Surgery?
Bariatric surgery refers to a number of procedures performed on the digestive tract designed to help people with obesity lose weight.
“Bariatric surgery can have a positive impact on your lifestyle practices, provide the opportunity to manage your weight and eliminate underlying health issues,” says Lisa Jones, a registered dietitian based in Philadelphia. “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, including:
— Nonalcoholic fatty liver disease.
You may be a good candidate for bariatric surgery if you:
— Have unsuccessfully tried to lose weight with diet and exercise for a sustained period of time.
— Have been clinically diagnosed with class III obesity (formerly referred to as morbidly obese) or have a body mass index of 40 or over.
— Have a BMI of 35, but you’re experiencing health complications related to obesity.
As a rule of thumb, a good candidate would be within 100 pounds of their ideal body weight, experts say.
“Ultimately, an evaluation by a trained medical specialist is necessary to determine if an individual is right for this kind of procedure,” Jones says.
While bariatric surgery is effective, it is by no means a quick or simple fix. It’s a major procedure that carries the risk of bleeding or perforation, blood clots, bowel obstruction, problems with malabsorption, hernia and other serious side effects.
[READ: Popular and Dangerous Social Media Diet Trends.]
Types of Bariatric Surgery
There are several types of bariatric surgery, including:
— Gastric bypass:Also referred to as Roux-en-Y gastric bypass, gastric bypass reduces the size of your stomach. Surgeons create a small pouch using the top part of your stomach. The bypass involves connecting a small portion of your small intestine, or jejunum, to a hole in this new pouch, allowing food to travel from the pouch straight to your small intestine. Because the pouch is much smaller than your stomach, it makes you feel full after a much smaller amount of food. When your weight loss goal is achieved, gastric bypass is reversible, but your doctor may advise you on whether or not that’s a good choice in your case.
— Sleeve gastrectomy:This type of surgery involves removing about three-quarters of your stomach. What remains is a tube- or sleeve-shaped section, which can only contain a fraction of the food it used to. This procedure is permanent.
— Duodenal switch:Officially known as biliopancreatic diversion with duodenal switch, this approach combines some features of sleeve gastrectomy and gastric bypass. Bariatric surgeons remove part of the stomach and small intestine to shorten the intestinal route food travels through the system. As a result, this restricts your stomach’s capacity to hold food, limits how much your small intestine can absorb nutrients and prevents your body from producing hunger hormones. This procedure is reversible. Although it is the most complicated type of bariatric surgery and, therefore, carries more risk, it is also considered one of the most effective in helping people lose weight and treating related conditions.
— Lap-band:Laparoscopic gastric banding, a procedure also known as an adjustable and removable gastric band, involves the placement of a soft implant that includes an expandable balloon around the top of your stomach. This divides the stomach into two sections, and you can only eat enough food to fill the top part.
Bariatric surgeons consider an array of factors when helping patients decide which option is the best for them.
“Most bariatric surgery practices in the U.S. 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, surgical director of 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.
[SEE: From Fat to Fit: Tips for How to Lose Fat Fast]
How to Follow the Dr. Now Diet
If you’re considering weight loss surgery, talk to your doctor. Together, you two will come up with a meal plan to prepare for the procedure that will probably look a lot like Dr. Nowzaradan’s diet plan.
The Dr. Now diet is based on three primary principles often referred to as FAT: frequency, amount and type.
Here is a breakdown of how FAT works:
— Frequency: Consume only two to three meals a day, with no snacks in between.
— Amount: Calories are limited to 1,200 a day. They can be consumed in two 600-calorie meals or three 400-calorie meals.
— Type: The Dr. Now diet emphasizes consuming fiber- and protein-rich foods, while restricting carbohydrates and fats.
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. These foods include:
— Chia seeds.
— Flax seeds.
— Lean protein sources, including egg whites, lean fish and skinless white meat chicken or turkey.
— Low-carb condiments, such as mustard, with added sugar for flavoring.
— Non-starchy vegetables, such as broccoli, cabbage, cauliflower and spinach.
— Nonfat dairy, such as skim milk or nonfat yogurt.
The Dr. Now diet prohibits certain foods because of their high-calorie content, including:
— Battered and fried meats (fried chicken and chicken-fried steak).
— Certain carbs (crackers, snack chips, popcorn, white rice, brown rice, pancakes, waffles and pasta).
— Fruits high in natural or added sugar (bananas, cantaloupe, mangos, watermelon and fruit canned in syrup).
— Full-fat and sweetened dairy (chocolate milk, full-fat cheese, sweetened yogurt, ice cream and milkshakes).
— Potatoes (including French fries).
Daily Dr. Now Diet Meal Plan
Here is what a typical day of eating may look on the Dr. Now diet, with three meals that provide about 400 calories each:
— Breakfast: 1 cup of skim milk; two pieces of turkey bacon; 1 cup of plain nonfat yogurt; ½ cup of blueberries or blackberries.
— Lunch: 1 cup of tuna salad made with nonfat Greek yogurt instead of mayonnaise; whole-grain pita bread, celery and carrots.
— Dinner: A side salad with 1 tablespoon of vinaigrette dressing and 2 cups of low-fat chicken and vegetable soup.
How Nutritious Is the Dr. Now Diet?
Overall, the Dr. Now diet allows for the consumption of many healthy, nutrient-dense foods.
“It emphasizes lean protein and vegetables and includes high-quality whole-grain carbohydrates, fruits, nonfat dairy and healthy fats,” Jacks says. “The foods that are avoided are mostly energy-dense and higher in saturated fat, such as simple sugars, fried foods and baked goods.”
However, the diet does eliminate some healthful foods, such as potatoes, certain fruits and most nuts and seeds. These foods are incorporated in most healthy diets because they provide vital vitamins and minerals, like vitamin E, niacin, zinc and magnesium. Eliminating them entirely can lead to serious nutritional deficiencies in the long run.
Research Behind the Diet
Proponents of the Dr. Now diet say that weight loss before bariatric surgery can help reduce the risk of post-surgical complications.
In a 2015 study published in the Annals of Surgery, researchers evaluated 22,327 patients undergoing gastric bypass and found that preoperative weight loss was associated with a 13% reduction of complication risks. In addition, a 2020 study published by JAMA Network Open demonstrated that even modest weight loss of less than 5% of one’s body weight before bariatric surgery was associated with a lower 30-day risk of mortality.
However, recent reviews of studies have not yielded conclusive evidence to support the practice, according to researchers of a 2020 paper published in the Cureus Journal of Medical Science. Additionally, a 2021 study published in the Journal of Gastrointestinal Surgery didn’t find a clear relationship between preoperative weight loss and bariatric surgery outcomes, with researchers stating that “preoperative weight loss is not predictive of postoperative weight loss success after bariatric surgery.” The study found that greater weight loss before surgery was associated with only a mild decrease in length of stay, but the findings did not show a reduction in operative time, overall complication rates, intensive care unit admissions or complications during surgery.
Downsides of the Dr. Now Diet
The Dr. Now diet is a risky approach for attaining quick weight loss for people with obesity, says Kaylee Jacks, a registered dietitian with Texas Health Sports Medicine in Dallas. Unless you are preparing to undergo bariatric surgery, the Dr. Now diet is not a good fit for you. Even if you are, this diet should be followed under the supervision of your bariatric dietitian and surgeon.
“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. “This is a medically supervised weight-loss plan and should not be attempted by individuals on their own without the guidance of a physician and dietitian.”
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 to be followed for extended periods of time or by those who are not undergoing weight-loss surgery, experts say.
A diet of only 1,200 calories is by no means sustainable for most people. The Dietary Guidelines for Americans recommend a number closer to 1,600 to 2,400 calories a day for women and about 2,000 to 3,000 calories a day for men.
Additionally, ultra low-calorie diets meant for fast weight loss can have the opposite effect in the long run by slowing down your metabolism.
“Failing to supply your body with adequate calories can lead to fatigue, malnutrition and even a weakened immune system,” Jones says. “Without receiving the right balance of calorie intake, the everyday functioning of the body can be severely impaired.”
If you’re not a good candidate for bariatric surgery but are still interested in shedding some pounds, WeightWatchers, the DASH diet and the Mayo Clinic diet all rank among the U.S. News’ 2023 best diets for weight loss.
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What You Need to Know About the Dr. Now Diet originally appeared on usnews.com
Update 04/25/23: This story was published at an earlier date and has been updated with new information.