Count carbs not calories. If you are restricting your 600lb patients to 1800 calories like you say, how do you know if they are getting enough carbs if the diet isn't carefully calculated to ensure they do?
If they aren't getting enough carbs, they won't loose weight even if you cut "calories" to 1000. Calories can be anything. pure fat if you like.
If they don't get enough carbs, their livers will just make sugar from protein.
http://www.diabetes.ca/
http://www.neha-diabeteseducation.ca/
http://www.diabetes.org/home.jsp
http://www.idf.org/home/
http://www.nada.ca/
http://www.ndep.nih.gov/
Thank you, Nathan.
Perhaps adjusting my diet somewhat will help with this daily, constant, painful hunger.
By the way, I eat 6 meals a day. It seems to help more than eating only 3 times a day. I once tried dividing the 1,200 calories into hourly portions but that was worse than eating 6 times a day.