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 – 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;