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Why you need to Add-A-Meal

#1
I noticed this comes up on here every now and again so I thought I'd try and explain the reasoning (as I understand it) behind the Exante recommendations to add a meal on a regular basis.

Basically, there is an organisation in the UK that is part of and linked to the NHS, called the National Institution for health & Clinical Excellence, or NICE for short. NICE look at all sorts of health issues, review scientific studies and issue guidance to health professionals at all levels to ensure that procedures keep up-to-date with new developments and are carried out with patients best interests as their main basis.

One of the subjects that NICE has looked at in some detail and provided guidance on is obesity. I'll give you a link to the pdf of their guidelines later so anyone who wants to can have a browse, but basically the guide tells health professionals (and individuals!) how to recognise obesity and what methods are available and/or recommended to treat it.

You will see if you read the pdf that NICE's main recommendation for weightloss is a reduction in calorie intake to a controlled level, an increase in activity, and regular monitoring. This is basically what happens when you go to a slimming club such as WW, SW etc, but can also be done by your GP, a hospital or a suitably qualified person at a health clinic, specialist clinic or even a gym or health club.

OK so that's the recommended approach, but for a lot of people it just doesn't work for various reasons.

So if a calorie-controlled approach isn't working, the VLCD comes in as a further option. Again NICE have looked at many many VLCD studies and outcomes, and provided certain guidelines for those prescribing them or following them.

The first one is that nobody should follow a VLCD of less than 600 cals per day without clinical supervision. This is why you have to get a sign-off from a doctor before following LL or CD or see a pahrmacist each week if you are doing LT.

For a VLCD of over 600 cals regular health checks are recommended in the guidelines, but are not essential.

The next thing to bear in mind is that VLCDs do have known, documented side-effects because the diet is essentially a starvation one. For this reason NICE also recommends that nobody follows a VLCD of any sort as the sole source of nutrition for more than 12 weeks.

It is up to the diet provider to decide if their literature and advice follows the guidelines of course. On LL and CD you have counsellors to do this, on LT you have your pharmacist. Because other VLCDs (including Exante) are not so regulated the onus is on both the diet provider to ensure that proper advice is given and the dieter to ensure that they understand it!

There are various ways in which the NICE guidelines can be complied with, but the most obvious is to ensure that for at least a short period and at least every 12 weeks the VLCD is NOT used as a sole source of nutrition.

I have to admit I have no idea why Exante have chosen to recommend the add-a-meal week each 5 and 8 weeks into the diet. I do know though that this ensures the diet follows the NICE guidelines, and the VLCD will never be used as the sole source of nutrition for more than 12 weeks.

So that's the reasonong behind it. In a nutshell, following a VLCD only for more than 12 weeks is likely, according to NICE, to damage your health. Possibly permanently.

Only you can decide when you want to add food back into the equation during your own diet. But bearing in mind the research that NICE have studied, to go against their advice would, I think, be extremely unwise.

If you are following Exante with the knowledge of and under the supervision of your GP you can of course turn to them for further advice on this subject, and follow whatever advice they give. But for those of us who are going it alone it seems sensible that if our diet provider is acting responsibly and advising us to follow a plan that falls within the NICE guidelines we should do just that, no?

Here's your pdf link:

http://www.nice.org.uk/nicemedia/pdf/CG43PublicInfo1.pdf
 
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Myr

Still Motivated
#3
I have to admit I have no idea why Exante have chosen to recommend the add-a-meal week each 5 and 8 weeks into the diet.


It was buried deep in the booklet.
So I assume it was intended that one should only follow for a straight 12 weeks if under medical supervision, and for safetys sake only 4 weeks if not. :D

How long can I do this for?
Depends ~ exante follows Government guidelines
concerning medical protocol. If your Doctor signed a
medical form for you before starting a Total Solution,
then you can use Exante meal replacements for up to
12 weeks, then add one meal each day on the 13th
week. If you passed the health assessment without a
medical practitioner countersigning, then you can
use the Total Solution for 4 weeks and the 5th week
becomes the add a meal week. Each cycle can be

repeated until you have reached your goal weight.
 
#4
That makes perfect sense Myr.

So actually if you are not under medical supervision it looks like Exante recommend a 5-week cycle repeated, not a 5-week then 9-week as the literature seems to suggest!

No wonder we get confused, even I didn't pick up on that one and I thought I'd researched the background quite carefully........:eek:
 
#5
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It was buried deep in the booklet.
So I assume it was intended that one should only follow for a straight 12 weeks if under medical supervision, and for safetys sake only 4 weeks if not. :D

Yip.

Buried as it may be, it still diesn't say why, (or even why those weeks specifically) just that to do so means the diet will follow the guidelines.

Meh. Oh well.
 
#6
I imagine cos if the diet recommends more than the minimum advised by the guidelines there is less chance of someone falling ill and subsequently sueing them? :D
 

dezzie1082

EVERY NEW DAY IS A GIFT
#7
:thankyou:What a very informative post....thanks Yambabe.

Shaz x
 
#8
I imagine cos if the diet recommends more than the minimum advised by the guidelines there is less chance of someone falling ill and subsequently sueing them? :D
Heh. ;)

In any event, have sufficient disclaimers. ;)

I've decided never to leave the house again though, just in case my actions, whatever they may be, should cause someone to sue me...
 

mrsblobby38

Silver Member
#10
roll on week 5 I say hmm what shall I have !! thanks yambabe
 

Isis1981

Are We There Yet?
#11
Is it still week 8 as well?

I was thinking week 5 then 4 weeks in between, then another refeed week. Have I got that wrong?
 

Isis1981

Are We There Yet?
#12
Is it still week 8 as well?

I was thinking week 5 then 4 weeks in between, then another refeed week. Have I got that wrong?
 
#13
No Isis you are spot on.

It should actually be 4 weeks TS, 1 week AAM, 4 weeks TS, 1 week AAM and keep repeating til you get to either goal or a bmi of around 25 then either refeed to start maintenance or WS to get you to your goal if it is lower than your bmi 25 point. :)

You could if you wanted have add a meal or refeed earlier than every 4 weeks if you want. When I was trying to be 100% on-plan I usually planned my AAM weeks to fit in with my social life so for example at one point I did 3 weeks TS, 1 week AAM, then 6 weeks TS and 1 week AAM.

Later on I started to add food most weekends rather than having AAM weeks - one of the things I like about Exante is that it's flexible enough for you to do this if you want.

As long as you don't go longer than the 12 weeks without adding some food (specifically protein I believe although the NICE guidelines and the VLCD literature I've studied so far don't specify it) you should be OK.

If you don't do your AAM week within the guidelines you are at much higher risk of the known nasty side-effects of a VLCD such as hair loss, muscle loss, gastric problems etc etc.
 

Isis1981

Are We There Yet?
#14
Thank you :)

You are such a fountain of knowledge!

I would prefer to avoid them side effects. I am glad I am doing my refeed week. I was talking to my other half earlier about the way you said in another thread that you had been doing TS in the week and WS at the weekend. That really appeals to me.

I am very much considering that. I do not feel it is cheating either, as like you said, Exante is flexible enough to do that :)

I feel happier by the minute xxx
 
#16
Looks like that there food is kind of important!

I'm midway through week three and have been supplementing my soups by puting a few king prawns or shellfish in the bottom. I also find that nibling four crab sticks (17 cals each) through the day that the nasty taste in my mouth goes away.

I'm on 3 a day, shake at breakfast, bar at lunch and soup for dinner, so feel that the small supplements would not take me much over 700 cals, so still VLCD.

Looking forward to add a meal, just to prevent the boredom more than anything else! Having hair fall out is a bit alarming!!
 

Isis1981

Are We There Yet?
#17
My hair is thick hair like most black people. However, I also do not like the idea of losing my hair!lol
 
#18
Thanks for this thread.

I've revised my goals now. I think this is a good thing and may help to prevent yoyo dieting.

So my new target is a BMI of 25 followed by further reductions using Exante and introducing real food gradually. Something that I've never tried before.

Cheers!
 

Isis1981

Are We There Yet?
#19
Makes a lot of sense Mojo! I also want this to be the last time I see this fat!lol
 


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