Ottawa Hospital Core Program

Finally, this is getting started. Over the past month I haven’t been fasting. In part because of all the family interruptions, and in part because I had fallen hard in early August and just about broke several ribs as a result (nothing actually broken but severely bruised). The last thing I wanted to do was hinder recovery by focusing on a 200-400 cal per day diet. With this program starting this week (last week was just an orientation), there didn’t seem to be much point.

On the plus side I’ve been very consistent the last 3 weeks in terms of the expected weight gain after fasting. I’ve been fairly steady between 306-308 lbs and 38% body fat and holding. Considering that the major thing that has changed between 5 months ago and now is my walking schedule, that to me is a good thing. I’m hoping its going to set-up for success with the Core Program I’m about to embark on.

Core Program – Meal Replacement Phase

Starting September 20 for 12 weeks, all meals will be replaced with 4 optifast shakes to be taken roughly every 3-4 hours starting no later than 1 hour after waking. That represents approximately 900 calories per day for 84 days. 

Based upon previous fasts, where I have lost up to 1.2 lbs per day on average during steady state, I’m assuming that in the first two weeks there will be about 20 lbs of weight being lost, and then approximately 0.6 lbs per day for the duration for a total of about 60-65 lbs. 

During this time there will be doctor checkups, 2 rounds of blood work, and various workshops including journaling, goal setting, understanding nutrients, stress management, some gym work, and a few other related topics.

Food Reintroduction Phase

This phase will run for 7 weeks (owing to Christmas holidays in the middle of this part) where you are slowly taken off the meal replacement. What I don’t know is whether the goal here is to maintain the 900 cal/ day or run back up to your basal metabolic rate in order to learn how to maintain the new weight.

Meal replacement is removed slowly so that by the end of 5 weeks you are back on solid foods. Workshops focus on food labels, eating styles, seating out and personal responsibility. There is also another 2 rounds of blood work.

Stabilization Phase

This last phase runs for 5 weeks and is mostly all workshops on body image and self confidence, sleep hygiene, diet trends, and long term weight management. 

Throughout all of this are regular doctor visits each week.

Post Core Program

After, apparently there is up to 18 months of support and follow-up based on the patient’s needs wherein you can return to talk to the support personnel or repeat workshops as needed. I didn’t see anything about repeating the optifast. So while its not a drug according to Health Canada (i.e. no DIN associated with the product), and all restriction on the sale are purely a marketing gimmick, it does not appear that they will allow you to go back on it again afterwards.

Also, since the program is a one-shot deal, there is no opportunity to repeat the program once you have been through it. 

My assumption is that the program is supposed to help you get to your goal physical activity level (note I didn’t say goal weight) which was something mentioned as part of the introduction last week which gives me more of a positive feeling about the program and what it is designed to do. Unfortunately there are about a half-dozen other indicators that seem to counter this which I won’t get into unless they can be substantiated. 

What I will say is this – during the pre-assessment period (which ran for over 15 months just to get into the program) there was a lot of pressure to consider the bariatric surgery side of the program, and a lot of pressure toward other drugs before considering other interventions first. I was really not impressed by this and am hoping that this is not going to be a trend throughout the program.

They claim they don’t pressure people in to these types of alternatives but they do, even when you ask them not to. So if anyone is reading that is considering the program just be forewarned. You will get a lot of pressure to consider drug and surgical therapies before changing your lifestyle. While there are research studies backing the effectiveness of these therapies, to me it seems that if you can’t change your lifestyle then all a drug or surgery is going to do is enable a pattern of bad behaviour and provide tacit approval to continue, or increase, those same destructive patterns. 

Trying to change too many things all at once doesn’t work. So, to me, better to focus on getting your lifestyle choices fixed first, before resorting to drugs or surgery. Unless there is a life threatening need to immediately start one of these therapies, if you are in that grey zone of high risk but no actual symptoms, better to fix your lifestyle first and then see what your therapy options are once you have that part under control. 

The Core Program is already going to be a significant challenge. I don’t want to complicate it by going onto a drug program, that I may not be able to stop once I’m on, if diet and exercise will mitigate the program from the need for drugs or surgery. Keep in mind that some therapies are forever. Once you start you are now committed to for life. Especially bariatric surgery which can’t really be undone. That is not something I’m willing to do based on a 10 minute consult with a doctor that isn’t willing to take the time to properly discuss the research, costs, and life implications of the therapy.

At least that is my philosophy on it.

As with everything else on here you really need to discuss with your doctor. If you really don’t want the pressure however you have to be insistent because this program will push you towards those therapies unless you really can show you are committed to a lifestyle change. At least that has been my experience so far.

So – wish me luck because, despite the progress I’ve made over the past 6 months, I’m really scared I’m going to screw this up. 

— Kevin

OHCP - Week 2
R52 Busted

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