Brief Answer:
Suggestions given

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone carefully through your query and understand your concern. Trying to scale down from 284 pounds to 170 pounds requires you to be systematic and to remain under the follow up of an instructor. It requires you not only to adhere to a strict diet plan but also to have a customized exercise regimen.

Cutting 500 to 1,000 calories per day from what you eat to maintain your weight yields a 1- to 2-pound weight loss per week. A doctor or a dietitian can help you determine what is a safe -- and not too radical -- calorie intake for you to lose weight.

Avoid foods that are high in fat and simple sugars -- specifically, fatty cuts of meat, full-fat dairy, white bread and white pasta, soda, sweets and processed snacks. Make approximately 50 to 55 percent of your calories come from complex carbohydrates -- particularly, vegetables, brown rice, oatmeal and sweet potatoes. Increasing your fiber intake also helps food digest more slowly so you don't experience as many physical cravings and bouts of hunger. High-fiber foods include fresh vegetables and fruits, as well as whole grains.

Lean proteins, such as grilled chicken, lean broiled steak and fish, improve satiety and can help you retain lean mass as you drop pounds. Go for about 0.55 grams per pound of your body weight per day, as long as this keeps you within your required calorie intake for weight loss. Small amounts of unsaturated fats are important for optimal bodily function, so have a teaspoon or two of olive oil, 1/8 of an avocado or 1/2 ounce of nuts at some meals.

Unless you have a deficiency of B-12, taking vitamin B-12 will not help.

Exercise

When you're obese, exercise feels harder - every step puts excessive pressure on your joints. Once you've lost about 10 percent of your weight with dietary intervention, add light- to moderate-intensity exercise.

When you first start exercising, even just 20 to 30 minutes every day of low-intensity movement will help. Break this up into 10-minute intervals, if needed, for stamina and adherence. Over time, work up to a more moderate intensity that makes you feel breathy and will raise your heart rate slightly. Eventually, do up to 90 minutes daily to lose weight, but this amount daily may take several months or even years to achieve.

Brisk walking, water exercise and cycling are appropriate forms of exercise, as they don't put too much additional impact on your back, ankles, hips and knees. Working with weights when you're morbidly obese - which means your body is easily physically stressed and your range of motion is limited - may be contraindicated. Talk to your doctor about when you can safely add regular strength training, which helps build muscle to assist in weight loss.

Psychological Interventions for Weight Loss

Incorporate lifestyle measures to help improve your adherence to a low-calorie diet and more physical activity. Enlist friends and family to encourage your efforts or seek support from the medical community and support groups, if you don't have the resources at home. Keep a food journal to track your intake and physical activity; seeing what you eat daily written on paper can help keep you accountable. A journal can also help you identify which types of triggers cause you to overeat - whether it's that time of the month, stress, anxiety, boredom or loneliness. When you know these triggers, you can take steps to avoid them.

You might hope to lose weight quickly like people on reality weight-loss shows, but keep your expectations realistic. Losing more than 3 pounds a week two weeks after you changed your routine, increases your risk of medical complications related to weight loss, such as gall stones. Reality shows are about people who are on a 24/7 regimen and who have constant access to dietitians, fitness professionals and support from medical professionals. Real life is different - you'll encounter day-to-day obstacles, personal defeats and temptations that you'll need to navigate on your own. Weight loss is a process, and when you have a lot to lose, it can take years to achieve a healthy weight.

Sometimes, depression accompanies severe obesity. If you feel this might be the case for you, talk to your doctor to get the appropriate help you need.
Medical Interventions to Help the Morbidly Obese

A very-low calorie diet that's medically prescribed and supervised may be warranted if you have immediate health issues that only quick weight loss will mitigate. These diets usually consist of 800 to 1,000 calories per day and yield about an average 3-pound per week-loss rate. Because they're so radical, you'll likely only be kept on this extreme calorie restriction for 12 weeks or less. A very low-calorie diet usually consists of specifically measured meal replacements, sometimes in the form of shakes, and require regular monitoring by your doctor.

Weight-loss surgery is also indicated in some cases of morbid obesity. This is not a treatment to enter into lightly; the risks of complications are great. Your doctor will determine if you're a good candidate, based on criteria such as your psychological stability, motivation level and social support. Bariatric surgery should be a last resort when efforts to exercise and following a lower calorie diet plan have proven insufficient.

Try the mentioned steps and let me know if I could help further.

Regards

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