Preventive Medicine Column
Dr. David L. Katz
I thought weight loss common sense couldn’t go any deeper into a coma than believing that pregnancy hormones were the reason a 500kcal diet was causing weight loss (i.e., the ‘HCG diet’). But I was wrong. Common sense, it seems- along with medical ethics- has come off life support altogether with the advent of the “K-E diet.”
“K-E” stands for ketogenic enteral nutrition. A better, more descriptive term for the new diet is the nasogastric tube diet. The K-E diet involves inserting a feeding tube into the nose, down the esophagus, through the stomach, and into the duodenum, and then infusing a high-protein feeding solution continuously.
This is done in the hospital routinely for people who can’t eat. But that’s not what the K-E diet is about. It’s about brides-to-be who want to lose ten pounds or so in a hurry to look good in a wedding dress.
This ‘diet’ is little short of lunacy on the part of any such bride-to-be; colossally misplaced priorities on the part of any groom-to-be watching it happen; and as profound an abrogation of professional ethics on the part of doctors peddling it (for $1500) as I have ever seen.
Everything about this is appalling. Not so much because of the risk of metabolic complications from a ketogenic diet over a period of just ten days. These are real, and include stresses on the liver, kidneys, and skeleton- but for people healthy at the start, such concerns are both minor and remote. Bone loss will occur, but will be inconsequential if limited to a ten-day span. Constipation is the one complication that will occur almost without fail. A ketogenic diet is used in medical practice to treat intractable seizures- but that’s a case where the inconvenience and adverse effects of the diet are the lesser of two evils, because the alternative is uncontrollable epilepsy.
What makes the K-E diet truly appalling is that it transforms a medical therapy into the indulgence of a short-term, short-sighted, vanity-driven whim. It opens up a whole new world of shockingly bad ideas:
Why not chemotherapy induced nausea and anorexia for weight loss? If you don’t need a medical condition for a nasogastric tube, why should cancer be required for chemotherapy? Why not a medically induced coma/anesthesia for weight loss? Or perhaps a serious metabolic stress to melt off the pounds- such as -why not medically controlled anaphylaxis?
If self-induced vomiting after meals constitutes an eating disorder, what, exactly, is infusing liquid formula through a tube into the duodenum without medical indication? If the K-E diet survives a while- and I sure hope it doesn’t- I bet it will come to be defined as an eating disorder in its own right. I fully appreciate the frustration many people feel when trying to lose weight (see www.newlr.com) – but if bulimia is not the right answer for that problem, neither is this!
A nasogastric tube is an unpleasant, undesirable medical procedure we impose on sick patients who can’t eat. It carries with it a risk of aspiration pneumonia, which can be fatal. Ladies, not to put too fine a point on it, but: do you really want to marry a guy who stands by while you risk your life to lose ten pounds? If my then-wife-to-be had proposed any such thing (not that she would have), my answer would have been equally emphatic and immediate: over my dead body!
In terms of quick weight loss, this dangerous nonsense is a guarantee of quick rebound with interest, since it involves no useful behavior change whatsoever. It has nothing at all to do with health- and basically endorses the notion that weight loss by any means is acceptable. If that is so, why not a 10-day, pre-nuptial cocaine binge? It will work as well or better, and almost certainly be more fun, than a nasogastric tube.
As for the doctors involved in peddling this travesty, I condemn their actions. The job of physicians is not to come up with any way to satisfy a patient’s whim no matter how fundamentally at odds with health.
Our professional mission is to promote and protect health- and to serve the patient in that context. In that context, the patient is the boss- and we are, or should be, at their service. But we are abdicating our profound responsibilities and most sacred pledges when we renounce a commitment to health, and adopt an “oh what the hell” approach to make some extra money by exploiting a patient’s faith in us, and their desperation. On behalf of my profession, I am ashamed.
This is weight loss lunacy. Resuscitate your common sense while there’s still time. Love the skin you’re in- ten extra pounds and all- and marry a guy who does, too.
Step away from the nasogastric tube- and one less person will get hurt.
Dr. David L. Katz; www.davidkatzmd.com