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Listed here are
just a few of the many clinical papers which demonstrate the health benefits and safety of using
VLCDs in the treatment of obesity. Please contact Cambridge for a complete listing or further
details of the papers summarised here.
Great Initial Weight Loss Improves Long-term Maintenance: By A Astrup and S Rossner of Sweden. Obesity Reviews 2000. It is a common myth (belief) that weight loss achieved at a slow rate is better preserved than if the weight is lost more rapidly. However, this review of the literature shows that initial weight loss is positively, not negatively, related to long-term weight maintenance. There is evidence from randomised intervention trials to support the view that a greater initial weight loss induced without changes in lifestyle - eg liquid formula diets improves long-term weight maintenance, providing it is followed by a 1 - 2 years integrated weight maintenance programme consisting of lifestyle interventions involving dietary change nutritional education behaviour therapy and increased physical activity.
Conclusion: "Greater initial weight loss as the first step of weight management may result in improved weight maintenance".
A systematic Review of Studies published between 1931 and 1999 by C Ayyad and T Andersen of Denmark Published in Obesity Reviews 2000. A MEDLINE survey was carried out to identify publications on long-term outcome for dietary treatment of obesity. 898 papers were identified and of these 17 met the criteria for inclusion: Dietary treatment Adults Follow up period more than 3 years Follow up rate more than 50% of original study group Information in one of the success criteria was either:- Maintenance of all weight initially lost or Maintenance of at least 9 to 11 kg of initial weight loss. These 17 papers reviewed 3,030 patients, with over 2000 being followed up for 3 - 14 years. Mean initial weight loss ranged from 4 to 28 kg (with a median of 11kg). The report shows that diet combined with group therapy leads to better long-term success rates - median 27% (as opposed to 15% on diet alone). Active (rather than passive) follow-up was generally associated with better success rates - 19% versus 10%. This again stresses the importance of support during maintenance. Although conventional diet seemed to work best when used with group therapy, VLCD apparently was most efficacious when combined with behaviour modification and active follow-up.
Conclusion: "VLCD was most efficacious if combined with behaviour modification and active follow-up. The literature on long-term follow-up of dietary treatment of obesity points to an overall median success of 15% and a possible adjuvant effect of group therapy, behaviour modification and active follow-up."
by P Mustajoki and T Pekkarinen of Finland Published in Obesity Review 2001 - This research looks at the current status of VLCDs in the management of obesity. Some 80 papers were reviewed with different VLCD formulations and different modes of delivery - including inpatients and outpatients. A total of 59 patients (with BMI of 32 - 40) showed an average weight loss over 8 - 9 weeks of nearly 12 kg. In one study, 62 subjects were asked their feelings during the last week of an 8-week VLCD period: Re-feeding following VLCD was recommended at 3 to 8 weeks to prevent abrupt fluid retention and abdominal discomfort - which is in line with our own recommendations.
| Better % | Same % | Worse % | |
| General well being | 74 | 26 | 0 |
| Feeling tired | 63 | 22 | 15 |
| Physical condition | 59 | 33 | 8 |
There is a general agreement that VLCDs should not be used alone but in connection with cognitive and behaviour consulting for permanent lifestyle changes. Without it there is a real risk of weight regain. Those studies with 1 or 2 year follow-up show a mean weight loss of 7.2 to 12.9kg with VLCDs and 5.7 to 9.5 without.
The paper states that: "Maintenance is the greatest problem in all approaches to obesity management." It also says there is no evidence that VLCD-programmes lead to worse long-term results than programmes with low calorie or other dietary approaches." It emphasises that cognitive behavioural consulting should be included in a weight reduction programme using a VLCD.
Conclusion: "VLCDs accomplish maximum initial loss and can be conducted safely in patients with obesity associated diseases - diabetes, hypertension, or other chronic diseases".
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Anderson et al, 2001 Five years after completing structured weight-loss programme, the average individual maintained a weight loss of >3kg and a reduced weight of >3% of initial body weight. After VLEDs, or weight loss of >20kg, individuals maintained significantly more weight loss than after HBDs* or weight losses of <10kg Capstick F et al VLCD: a useful alternative in the treatment of the obese NIDDM patient. Diabetes Res Clin Pract 1997; 36; 105-111. The short-term use of a VLCD is very effective in rapidly improving glycaemic control and promoting substantial weight loss in obese patients with Type 2 diabetes. Moreover, a VLCD increases insulin secretion and reduces substrate for gluconeogenesis. Thus VLCD treatment may improve glycaemic control by factors more than caloric restriction alone. Paisley RB et al An Intensive Weight Loss Programme in Established Type 2 Diabetes and Controls: Effects on Weight and Atherosclerosis Risk Factors at 1 Year. South Devon Healthcare, Torbay Hospital. Diabetic Medicine 1998. Substantial weight loss and improvement in cardiovascular risk factors could be maintained for 1 year in Type 2 diabetic patients by the use of a very low calorie diet. Mustajoki P & Pekkarinen T Very Low Energy Diets in the Treatment of Obesity. Peijas Hospital, Dept Medicine, Vantaa, Finland. Obesity Reviews 2001. VLEDs accomplish maximum initial loss and can be conducted safely in patients with obesity associated diseases - diabetes, hypertension, or other chronic diseases. Jebb SA & Goldberg GR Efficacy of Very Low-Energy Diets and Meal Replacements in the Treatment of Obesity. MRC Dunn Clinical Nutrition Centre, Cambridge. J Human Nutrition and Dietetics 1998. VLEDs are a proven success in achieving significant short-term reduction in body weight. There is evidence to suggest that meal replacements may make a contribution to the maintenance of weight loss in some individuals. |
Pekkarinen T et al Weight Loss with VLCD and Cardiovascular Risk Factors in
Moderately Obese Women: One-year Follow-Up Study Including Ambulatory Blood Pressure Monitoring.
Dept of Med. Helsinki University Hospital. Int .J Obesity 1998. Jebb SA et al No Evidence of Excessive Losses of Protein During Acute Weight
Loss. MRC Dunn Clinical Nutrition Centre, Cambridge. Poster presented at 8th International Congress
on Obesity, Paris, September 1998. Saris WHM VLCDs and Sustained Weight Loss. Maastricht University. Obesity Research 9, Supp 4 Nov 2001. VLCD with active follow-up treatment seems to be one of the better treatment modalities related to long term weight maintenance success. Kirschner MA et al An eight-year experience with a very low calorie formula diet for control of major obesity. Newark Beth Israel Medical Centre, New Jersey. IJO 1988 12(1) pp 69-80 Our 8-year experience strongly suggests that the VLCD approach using high quality protein supplement and multi-disciplinary consulting provides a reasonable success rate for achieving and maintaining weight loss in the morbidity obese population. Pekkarinen T & Mustajoki P Use of VLCD in Preoperative Weight Loss: Efficacy and Safety. Dept of Med. Helsinki University Hospital. Obesity Research, 1997. A VLCD program is suitable for preoperative weight reduction in morbid obesity and seems not to compromise the immune system. |
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