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Aim: The present article aimed to evaluate the feasibility of implementing a very low calorie diet (VLCD) weight loss program into the pre‐operative model of care for elective general surgery patients with obesity. Methods: A prospective, randomised control trial of adults with obesity awaiting elective general surgery was conducted at an outpatient clinic at a tertiary hospital. Patients were randomised to the intervention group, an 8‐week VLCD program incorporating Optifast (Nestle Health, Germany) shakes, or to standard care (generic healthy eating information). Data were collected at baseline, week 8 and at 30 days post‐surgery. The primary outcome of the study was feasibility, which was evaluated through demand, practicality, integration and acceptability measures. Results: Forty‐six participants (M 17: F 23, mean age 51.6 (13.1) years) with a mean body mass index ≥ 30 kg/m2 (40.5 kg/m2 (5.9)) were recruited. There was a higher mean weight loss in the intervention group (n = 23) compared to the control group (n = 14) (−6.5 vs +0.15 kg; P = <.001), with no excessive loss of muscle mass (MM), measured by bioelectrical impedance analysis. The reduction in waist circumference was greater for the intervention (n = 21) compared to control group (n = 5) (−6.11 vs +1.36 cm; P =.003). Quality of life increased significantly in the intervention group (P <.001). Conclusions: The pre‐operative VLCD program produced clinically meaningful rapid weight loss pre‐surgery and improved quality of life without an excessive loss of MM. [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To evaluate the efficacy of very low calorie diet (VLCD) in black and white obese women. Changes in weight, metabolic profile, and body composition are assessed. METHOD:: Patients are enrolled in a self-paid, university-based, outpatient weight loss program. All are prescribed VLCD (500-800?Cal/day), an exercise regimen, and group behavioral counseling. Black and white patients are matched for age, weight, body mass index, and by metabolic syndrome (MS) status. RESULTS:: A total of 304 black and white women (152 in each group) were included the analysis. Approximately 40%of patients had MS (white women: 39.5%; black women: 41.2%). Mean baseline weights were similar. After 12 weeks, weight reduction of 9.97%was seen in white women and 9.02%drop was seen in black women (both P<0.0001). However, the degree of weight change was not different between the groups (P=0.244). Marked improvements in fasting glucose, total cholesterol, LDL, triglyceride, and blood pressures (BP) were observed (all P<0.01); however, no difference between cohorts were seen. Patients with MS had higher baseline weight, BP, glucose and triglyceride levels when compared to patients without MS (all P<0.01). Significant reductions in%body fat were seen in white and black patients, independent of MS status. CONCLUSION:: Obese patients, independent of race, were able to achieve significant weight loss when enrolled in a structured outpatient program. Weight loss significantly correlated with all aspects of MS. Our results suggest that differences seen in past studies may be influenced by socioeconomic and behavioral factors rather than differences in physiological response to dieting.International Journal of Obesity (2005) 29, 436-442. doi:10.1038/sj.ijo.0802864 Published online 15 February 2005 [ABSTRACT FROM AUTHOR]

OBJECTIVE:: To compare two group treatment programmes for obese outpatients. Both programmes included behaviour modification, nutrition counselling, very-low-calorie diet (VLCD) and a continuous measuring of metabolic and anthropometrical status, but they differed regarding the treatment intensiveness. The main aim was to study whether intensive treatment gives a larger weight reduction compared with less intensive treatment and what level of input from health care personnel is needed to reach adequate treatment results. DESIGN:: A 2-y randomised clinical trial. SUBJECTS:: A total of 43 obese subjects aged 24-60?y, BMI 35?kg/m2 (29-48). INTERVENTION:: Two programmes were used. Both were based on group therapy and were supervised by a dietitian and a psychologist. Group 1 received a continuous intensive treatment with planned group meetings every fortnight during the first year and six group meetings the second year. Group 2 had planned group meetings every third month. Anthropometrical and metabolic data were measured every third month in both groups. The VLCD periods were the same. RESULTS:: There was no evidence that a more intensive treatment promotes a larger weight reduction. Weight reduction after 1?y: group 1, -7.6 (±0.97) kg, BMI -2.6 (±0.3) kg/m2; group 2, -6.4 (±1.16) kg, BMI -2.2 (±0.4) kg/m2. Weight reduction after 2 y: group 1, -6.8 (±1.4) kg, BMI -2.4 (±0.3) kg/m2; group 2, -8.6 (±1.6) kg, BMI -3.0 (±0.3) kg/m2. The dropout rate was 26%. CONCLUSION:: There were no significant differences in weight reduction, compliance or dropout rate between the groups and there was no evidence that a more intensive treatment promotes a larger weight reduction. This observation is of value when setting up treatment programmes. To measure the metabolic and anthropometrical status during the treatment and to give continuous feedback to the subjects seem to be important factors for compliance. Both treatment programmes gave highly significant weight reductions in the range of 5-10%, which has been referred to as a realistic goal for the treatment of obese patients.International Journal of Obesity (2003) 27, 1127-1135. doi:10.1038/sj.ijo.0802372 [ABSTRACT FROM AUTHOR]

Abstract Aims To evaluate the short-term and 1-year outcomes of an intensive very-low-calorie diet (VLCD) on metabolic and cardiovascular variables in obese patients with Type 2 diabetes (T2DM) and symptomatic hyperglycaemia despite combination oral anti-diabetic therapy ± insulin, and to assess patient acceptability and the feasibility of administering VLCD treatment to this subgroup of patients in a routine practice setting. Methods Forty obese patients with T2DM (22 M, mean age 52 years, body mass index (BMI) 40 kg/m2 , duration of T2DM 6.1 years) and symptomatic hyperglycaemia despite combination oral therapy (n = 26) or insulin + metformin (n = 14) received 8 weeks of VLCD therapy (750 kcal/day) followed by standard diet and exercise advice at 2–3-month intervals up to 1 year. Insulin was discontinued at the start of the VLCD, and anti-diabetic therapy was adjusted individually throughout the study, including (re)commencement of insulin as required. Results Immediate improvements in symptoms and early weight loss reinforced good compliance and patient satisfaction. After 8 weeks of VLCD, body weight and BMI had fallen significantly: 119 ± 19–107 ± 18 kg and 40.6–36.6 kg/m2 , respectively, with favourable reductions in serum total cholesterol (5.9–4.9 mm), blood pressure (10/6 mmHg) and fructosamine (386 ± 73–346 ± 49 µm) (equates to an HbA1c reduction of approximately 1%). Sustained improvements were evident after 1 year, with minimal weight regain, e.g. mean body weight 109 ± 18 kg and BMI 37 ± 4 kg/m2 . Glycaemic control tended to deteriorate after 1 year. Conclusions The absence of a control group is a major limitation, but the results indicate that 8 weeks of VLCD treatment may be effective and well tolerated in symptomatic obese patients with T2DM in secondary failure, producing sustained cardiovascular and metabolic improvements after... [ABSTRACT FROM AUTHOR]

This study investigated the effects of very-low-calorie-diet (VLCD) therapy on body weight, plasma glucose, and lipid metabolism in severely obese patients. Ninety-one patients were subjected to VLCD therapy for 4-24 wk. Reduction of body weight was remarkable during the first 4 wk, then leveled off despite continuous treatment. Fasting plasma glucose, triglyceride, and 75-g oral glucose-tolerance test showed a significant improvement. Total cholesterol fell in the early stages but then increased more than the pretreatment level during VLCD. VLCD therapy is useful for the treatment of severe obesity. [ABSTRACT FROM AUTHOR]

Neither diet nor exercise are effective as single modes of intervention in the treatment of obesity. Although it is logical that they be combined in the context of multidisciplinary treatment, restrictions in calorie or protein intakes while dieting may impair short-term or long-term function. The limited evidence available indicates that properly constituted very-low-calorie diets can effectively preserve physical function across major weight loss, but long-term preservation of this weight loss is strongly influenced by post diet exercise habits. In summary, counseling on and initiation of safe and effective exercise practices during dietary treatment of obesity are appropriate, but the ultimate goal should be to direct the patient towards lifelong exercise behaviors that will contribute to sustained weight maintenance. [ABSTRACT FROM AUTHOR]

The assumption that total energy expended is related to resting metabolic rate (RMR) has not been validated. Intuitively, weight lost should be determined by the difference between the total energy consumed and the total energy expended. The ratio of actual daily energy usage to RMR by subjects dieting for 11 wk on a 1695-kJ (405-kcal) very-low-calorie diet (VLCD) was variable 1.9 ± 0.3 (range 1.47-2.36). Weight loss correlated with total energy expenditure measured by ²H218O and not RMR, body mass index or body composition. Although RMR may be a reliable indicator of fat-free mass, there is little evidence that subjects with similar RMR will lose comparable weight or have comparable difficulty in weight maintenance. [ABSTRACT FROM AUTHOR]

We postulated that the return to nitrogen equilibrium after 3 wk of a negative balance during a very-low-calorie diet (VLCD) providing low-quality protein in obese subjects was due to availability of endogenously originating amino acids from a "pool" that, when depleted, would result in worsening balance. This should be reflected in altered kinetics of protein metabolism with the requirement for increased breakdown to maintain synthesis constant. Seven female obese subjects [body mass index (BMI) = 34.4 ± 1.8 kg/m²] were given a 1.7-MJ/d all-protein diet (16.8 g N) derived from hydrolyzed gelatin (supplemented with tryptophan and methionine) that provides 18% of its amino acids as essential, a multivitamin-mineral supplement, and 16 mmol KCl for 42 d. At baseline (7-d isocaloric diet), and weeks 4 and 6 of VLCD, amino nitrogen flux rate was calculated from the 15N abundance in urinary urea using the oral 15N-glycine method and rates of synthesis (5) and breakdown (B) inferred from N flux. Whole-body N flux did not change from baseline to weeks 4 and 6 (39.5 ± 2.0 vs 37.4 ± 2.0 vs 39.2 ± 1.9 g N/d). By contrast, S and B decreased at weeks 4 and 6 with S decreasing more so that net protein synthesis (S-B) was less positive at week 4 than at baseline (2.2 ± 0.2 and 0.9 ± 0.3 g N/d; P < 0.05) and became negative at week 6 (-0.9 ± 0.2 g N/d: P < 0.05). Concurrently, N equilibrium was achieved by week 4 but returned to negative balance by week 6. A decrease in net protein synthesis may reflect insufficient exogenous amino acid when such diets are used alone for a prolonged period of time and explain the return to negative N balance with net depletion of available endogenous sources. [ABSTRACT FROM AUTHOR]

A major concern with the use of starvation or semistarvation diets for weight reduction in severely obese people has been the reports of sudden death due to ventricular arrhythmias. Obesity per se is associated with cardiovascular changes, including left ventricular hypertrophy and prolongation of the QT interval. With weight loss, the mass of the heart and left ventricle decrease, but some signs of left ventricular dysfunction remain. The effect of weight loss on the electrocardiogram abnormalities of obesity appears to depend upon diet duration and upon whether protein and mineral nutritional status is maintained. Copper, potassium, and magnesium deficiencies may play important roles in promoting an electrically unstable heart. Stress, by eliciting autonomic imbalance, may act upon an electrically unstable heart to provoke acute arrhythmias in a subset of the obese population with QT interval prolongation. [ABSTRACT FROM AUTHOR]

When weight reduction was found to decrease blood pressure in the overweight hypertensive patient, it was hailed as the causative factor. A growing number of recent studies indicate that this association may be secondary to a correlation between diet-associated metabolic change and the sympathetic nervous system. A select group such as overweight hypertensive patients may have a genetic predisposition for such a correlation. In overweight hypertensive patients, low-calorie diet and especially very-low-calorie diet, correlate with improved glucose metabolism, a decrease in plasma insulin concentration, and altered norepinephrine concentrations and thus sympathetic nervous system activity. Several of these studies also show a lack of effect of salt intake on blood pressure. Thus, it seems that metabolic changes caused by the decrease in caloric intake are responsible for the decrease in blood pressure. These must be investigated to understand the effect of the different diets on blood pressure. Very-low-calorie diets were found very useful in breaking the vicious circle of severe nonresponsive hypertension to medication. [ABSTRACT FROM AUTHOR]

Hepatobiliary characteristics of untreated obese patients and those of patients reducing weight through very-low-calorie diets (VLCDs) are reviewed. In untreated obesity, hepatobiliary abnormalities are prevalent. Fatty change is common and may be related to insulin resistance. Moreover, portal inflammation and fibrosis are prevalent findings, also in the absence of alcohol abuse. The liver plays a key role in the hyperinsulinism and hyperlipidemia, and hepatic drug metabolism is influenced by enhanced glucuronidation and sulphatation. Predisposition to gallstone formation can be ascribed to increased biliary cholesterol secretion in concert with changed nucleating factors and altered gallbladder motility. Weight loss by VLCD reduces fatty change but may induce slight portal inflammation and fibrosis. Insulin resistance and pharmacokinetic abnormalities regress. During VLCD the risk of gallstone formation is markedly increased. The deleterious effects described of a rapid weight loss should draw some attention to the liver and biliary tract during VLCD treatment. [ABSTRACT FROM AUTHOR]

A 12-wk weight-management program was conducted to test the effectiveness of a combined very-low-calorie diet (VLCD) [2.0 MJ/d (470 kcal/d)] (week 1-5) and exercise (E) program supervised by each patient's general practitioner and dietitian. Throughout the program, patients [body mass index measured in kg/m² (BMI) 27-35] were encouraged to take part in an individually graded E program of walking (W), cycling (C), running (R), or swimming (5) (Van Baak and Binkhorst 1981). Ninety-four patients (65 female and 29 male, weight: 87.7 kg, BMI: 30.7, age: 39.8 y) completed the program (Δ: -10.6 kg). At the start, 46% were not involved in any type of physical exercise. After 12 wk only 8% were inactive (Drop out group (n = 14): 47%). Weight loss over 12 wk was significantly (P < 0.0 1) related to participation rate in the E program. Also, 24-wk follow-up showed a significantly better (P < 0.05) weight maintenance for patients who continued the E program (+0.4 vs + 1.8 kg). These data demonstrate the effectiveness of a weight-management program including exercise in primary health care. [ABSTRACT FROM AUTHOR]

To evaluate a long-term efficacy of very-low-calorie-diet (VLCD) treatment, 42 obese patients were reexamined 1 y after the initiation of the weight reduction by VLCD treatment for 1 mo. All the subjects participating in the long-term outpatient weight-reduction regime were divided into weight losers and regainers according to the weight change achieved at the end of 1-y follow-up. A final body weight decrease in weight losers was followed by a significant decline of total cholesterol-high-density-lipoprotein (HDL) cholesterol ratio together with significant rise of serum HDL cholesterol whereas almost all skinfold thicknesses declined. In weight regainers the sum of 10 skinfold thicknesses was the same at the end of follow-up as at the beginning of VLCD treatment, but body fat distribution was shifted towards the gynoid type when individual skinfold thicknesses were assessed. However, among the generally employed indexes of body fat distribution only waist-thigh ratio significantly decreased in weight losers. Nonsignificant differences in serum concentrations of total cholesterol, HDL cholesterol, and triglycerides between weight regainers and weight losers at the end of long-term follow-up suggest that some kind of adherence to weight reduction regime including physical exercise may favorably affect the lipid profile as well as body fat distribution independently on the body weight regained. [ABSTRACT FROM AUTHOR]

Forty-eight obese patients (¯x body mass index = 36.4) were retreated with a very-low-calorie diet (VLCD) at a mean of 104-wk after first VLCD. Mean weight regain was 23 kg or 86% regain of initial loss. Retreatment with VLCD required weekly physician monitoring and indepth psychotherapy group attendance. Five patients (10%) lost an average of 4.55 kg and withdrew within the first 4 wk (group A). Thirteen patients (27%) lost 13.8 kg over 11.5 wk, an average weight loss of 1.2 kg/wk and enrolled in maintenance (group B). Thirty patients (63%) lost 10.2 kg over 20 wk, an average weight loss of 0.5 kg/wk and did not enroll in the maintenance program (group C). Although weight loss occurs in patients retreated with the VLCD, adherence to the VLCD and commitment to the maintenance program are not optimal. [ABSTRACT FROM AUTHOR]

We report body composition in 11 moderately obese patients (¯x BMI < 30) treated for 8 wk with a 2530-kJ/d (605-Kcal) diet. Mean weight loss was 9.4 kg. Fat-free mass (FFM) loss of 2.3 kg was 23% of total weight loss and essentially equal to loss of total body water (2.5 L). Body composition was measured by the Futrex-5000 near-infrared technique. We conclude there is no excess loss of FFM in moderately obese patients treated with MNP 70/70, a 70-g protein, 70-g carbohydrate dietary supplement for 8 wk. [ABSTRACT FROM AUTHOR]

One-month treatment of obese patients (body mass index, 39.44 ± 0.94, measured in kg/m²) with a very-low-calorie diet (VLCD) resulted in a significant weight loss, which was higher in men than in women. In contrast, the decrease of percent fat content was higher in gynoid obese women than in men or women with android fat distribution. In females fat mobilization was depressed at the thigh region where a substantially lower percent decrement of thigh skinfold thickness was demonstrated in comparison with males. VLCD treatment positively affected blood pressure and concentrations of total cholesterol, triglyceride, insulin, and cortisol. Total cholesterol-high-density-lipoprotein (HDL) cholesterol ratio remained unchanged and HDL cholesterol in serum significantly declined. Indexes of body fat distribution were not significantly influenced by the short-term treatment by VLCD except waist-hip ratio, which declined in android obese females. VLCD does not decrease a tolerance of physical exercise, as the metabolic response to submaximal workload on a cycle ergometer as well as the responses of cortisol, growth hormone, and prolactin remained unchanged after the treatment. [ABSTRACT FROM AUTHOR]

Weight reduction improves glucose utilization, but it is not known whether this occurs primarily through the oxidative or nonoxidative pathways of glucose metabolism. We studied this question in 12 obese subjects [whose body mass index (BMI) was 33.4 ± 1.1 kg/m²)] before and after 6 wk on a very-low-calorie diet of 1680 kJ/d with the euglycemic insulin clamp technique in combination with indirect calorimetry. The mean body weight decreased from 105.3 ± 4.6 to 94. 1 ± 4.0 kg (P < 0.001). This was mainly due to a reduction in fat mass from 47.2 ± 3.6 to 37.7 ± 3.0 kg (P < 0.001), whereas lean body mass decreased only slightly (from 58.0 ± 2.0 to 56.4 ± 1.8 kg). The basal energy expenditure decreased with weight loss by 10.7%. This was associated with a reduced rate of lipid oxidation (P < 0.05). Weight loss increased glucose utilization by 26%, primarily by enhancing insulin-stimulated glucose oxidation (P < 0.05), whereas the effect on nonoxidative glucose metabolism was less pronounced (P > 0.05). Substantial weight loss increases glucose utilization by enhancing glucose oxidation. [ABSTRACT FROM AUTHOR]

Forty-five overweight patients (12 male, 33 female) were prescribed a very-low-calorie diet (VLCD) or a supplemental low-calorie diet (LCD), randomly, at an outpatient clinic. Twenty obese patients [31.6 ± 13.1 y; body mass index (BMI) 32.9 ± 6.1] were treated with a VLCD of 1757 kJ/d for 1-2 mo (five packages of Optifast 70/d; Sandoz Nutrition, Minneapolis). Another 25 patients (35.3 ± 1 1.7 y; BMI 31.9 ± 4.4) were treated by a supplemental LCD of 35 1 5-5021 kJ/d for 1-2 months, which consisted of two to three packages of Optifast 70 and 2678-3682 kJ of conventional balanced meals. By the fourth week, the weight reduction obtained by the VLCD was significantly greater than that achieved by the supplemental LCD (P < 0.01). At the eighth week, however, effect of the VLCD and the supplemental LCD in terms of weight reduction did not differ significantly. No serious side effects were observed in either treatment group. However, remarkable elevation of serum uric acid concentration was detected in seven patients on the VLCD. The treatment period of the VLCD is limited to 3 mo. On the other hand, obese patients can be treated with the supplemental LCD for > 3 mo. Therefore, the supplemental LCD is considered to be useful in the treatment of moderately obese Japanese patients on an outpatient basis. [ABSTRACT FROM AUTHOR]