TLC’s hit reality show “My 600-Lb. Life” follows a group of patients as they undergo weight-loss surgery. The subjects of this docuseries all have class 3 obesity (formerly referred to as morbid obesity), meaning they have a body mass index of 40 or higher. For example, a person who is 5’7″ and weighs 255 pounds has a BMI of 40.
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.
What Is the 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 Michele Smallidge, registered dietitian and founding director of the B.S. Exercise Science Program at the University of New Haven in West Haven, Connecticut.
[See: 11 Healthy, Low-Calorie Snacks.]
How to Follow the Dr. Now Diet
If you’re considering weight-loss surgery, consult with your doctor or a registered dietitian to develop a personalized meal plan that will help you prepare for the procedure. Your plan may look 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.
— 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.
Foods allowed on the Dr. Now diet plan
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 and flax seeds
— Lean protein sources, including egg whites, lean fish and skinless poultry breast meat
— Low-carb condiments, such as mustard, without added sugar for flavoring
— Non-starchy vegetables, such as broccoli, cabbage, cauliflower and spinach
— Nonfat dairy, such as skim milk or nonfat yogurt
Foods to avoid on the Dr. Now diet plan
The Dr. Now diet prohibits certain foods because of their high-calorie content, including:
— Almonds
— Bacon
— Battered and fried meats (fried chicken and chicken-fried steak)
— Cashews
— 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)
— Honey
— Potatoes (including french fries)
— Sausage
Daily Dr. Now Diet Meal Plan
Here is what a typical day of eating may look like on the Dr. Now diet, with three meals that provide about 400 calories each:
Breakfast
— 1 cup of skim milk
— 2 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
— 1 whole-grain pita bread
— Celery
— Carrots
Dinner
— A side salad with 1 tablespoon of vinaigrette dressing
— 2 cups of low-fat chicken and vegetable soup
[See: What Not to Say When Someone Loses Weight — Especially Now]
How Nutritious Is the Dr. Now Diet?
The Dr. Now diet allows for the consumption of many healthy, nutrient-dense foods. For example, the 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. However, the diet is restrictive and forbids some healthy foods, such as many whole-grain products, potatoes, certain fruits and most nuts and seeds.
These foods are incorporated into most healthy diets — including the Mediterranean diet, which ranks as the top diet on U.S. News and World Report’s Best Diets rankings — because they provide vital vitamins and minerals, such as vitamin E, niacin, zinc and magnesium. Eliminating them entirely can lead to long-term nutritional deficiencies.
[Read: What Happens When You Stop Taking Weight Loss Drugs?]
Pros and Cons of the Dr. Now Diet
Dr. Now diet pros
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. In fact, many of his patients aim to lose 30 pounds in the 30 days leading up to surgery.
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. Although Ali does not recommend that patients follow the Dr. Now diet specifically, he does suggest adopting eating patterns with reduced calories, carbs, and sugar to promote fat loss.
According to Ali, some of the benefits of weight loss before bariatric surgery include:
— Shrinking the size of the liver. This 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. Studies indicate that a low-calorie diet is effective in helping reduce liver size.
— Making it easier for patients to meet weight-loss goals after surgery
Ideally, a patient can lose 5% to 10% of their body weight before surgery to reap the above benefits and reduce risks, he adds. While some dedicated patients are able to achieve this weight loss before their operation, not everyone is successful.
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
Some cons of the Dr. Now diet long term include the potential for:
— Malnourishment
— Rebound weight gain
— Hormonal imbalances
— Gallstones
— Slowed metabolism
— Fatigue
— Gastrointestinal symptoms
— Skin problems
— Changes in heart rate and blood pressure
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.
Even for people preparing for bariatric surgery, extreme dieting can have long-term consequences. Ali does not recommend patients stay on restrictive diets for longer than a month or two before surgery, depending on the individual.
“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.”
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.
After surgery, Ali discourages continuing the Dr. Now or a similar low-calorie diet.
“For patients who are getting ready for surgery, it’s reasonable because it’s short term,” he adds. “After surgery — which is a tool helping them to reduce their intake — we still recommend being careful with carbohydrates and sugars, but we don’t give them specific numbers.”
This is not true of all surgery centers. For example, the University of California San Francisco’s website clearly states that bariatric surgery patients are encouraged to consume between 900 and 1,000 calories daily over the long term. After gastric bypass surgery, your meals are generally no larger than one cup of food, and high-fat or high-sugar foods could cause severe gastrointestinal symptoms for some individuals.
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.
[See: 10 Healthy Habits of the ‘Naturally’ Thin.]
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.
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. Exact recommendations will vary based on your age, gender, height, lifestyle, activity level and overall health.
You can use U.S. News’ calorie counter to estimate the number of calories you need a day to maintain or lose weight. Chances are, you can eat a lot more than 1,200 calories a day and still shed a few pounds.
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. For someone weighing 250 pounds, this translates to approximately 2,500 calories per day.
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. Many, but not all, clinical studies have found that weight loss decreases metabolic rate by three to five percent over the long term.”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.”
“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.”
These diets can also put people at risk for nutrient deficiencies, heart problems and muscle loss.
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.
After bariatric surgery, patients are generally advised to take dietary supplements, including a complete multivitamin, vitamin B12, calcium with vitamin D and iron.
If you’re not a good candidate for bariatric surgery but are still interested in shedding some pounds, WeightWatchers, the Volumetrics diet and the DASH diet all rank among the U.S. News’ 2024 best diets for weight loss.
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. It also greatly reduces the risk of having a heart attack or a stroke and reduces the chances that you’ll someday develop certain types of cancer.
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 or have a BMI of 40 or over
— Have a BMI of 35, but are experiencing health complications related to obesity, such as high blood pressure or diabetes
Note that, citing insufficient evidence, not all surgeons agree with the idea of performing surgery on anyone with a BMI of less than 40, regardless of their other health conditions.
Best bariatric surgery option for you
Bariatric surgeons consider a range of factors when helping patients determine the best option 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, 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. Besides your surgeon, you’ll also likely be meeting with a dietitian, psychologist, nurse case manager and obesity medicine specialist.
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The Dr. Now Diet: Pros, Cons and How to Follow originally appeared on usnews.com
Update 05/02/25: This story was published at an earlier date and has been updated with new information.
