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In the UK the National Audit Office report in 2001 showed that over half of women and about two thirds of men are overweight or obese. The House of Commons Select Committee on Obesity in May 2004 reported that obesity was rising at an even quicker rate than expected and the costs of the disease in UK are £3.3-3.7 billion per year with obesity plus overweight at £6.6-7.4 billion.
The UK Government's White Paper on Public Health published in 2004 marked a significant shift towards the concept of Primary Care Trusts working in partnership with reputable commercial sector companies in tackling obesity.
This White Paper called for the creation of a strategy to develop innovative clinical models that will help support evaluation of different approaches to delivery of obesity services at local level including using quality assured, commercial diet providers.
VLCD: a useful alternative in the treatment of the obese NIDDM patient.
F Capstick et al. Diabetes Res Clin Pract 1997; 36; 105-111
Conclusion: 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.
An intensive weight loss programme in established type 2 diabetes and controls: effects on weight
and atherosclerosis risk factors at 1 year.
P B Paisley et al. South Devon Healthcare, Torbay Hospital. Diabetic Medicine 1998
Conclusion: 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.
Very low energy diets in the treatment of obesity.
P Mustajoki & T Pekkarinen. Peijas Hospital, Dept Medicine, Vantaa, Finland. Obesity Reviews 2001
Conclusion: VLEDs accomplish maximum initial loss and can be conducted safely in patients with obesity
associated diseases - diabetes, hypertension, or other chronic diseases.
Long-term efficacy of dietary treatment of obesity: a systematic review of studies published
between 1931 and 1999.
C Ayyad & T Andersen. Roskile County Hospital, Denmark
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
rate of 15% and a possible adjuvant effect of group therapy, behaviour modification and active follow-up.
Efficacy of very low-energy diets and meal replacements in the treatment of obesity.
S A Jebb & G R Goldberg. MRC Dunn Clinical Nutrition Centre, Cambridge. J Human Nutrition and Dietetics
1998
Conclusion: 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.
Lessons from obesity management programmes: greater initial weight loss improves long-term maintenance.
A Astrup & S Rossner. Obesity Reviews 2000
Conclusion: Greater initial weight loss as the first step of weight management may result in improved
weight maintenance.
Use of very low-calorie diet in preoperative weight loss: efficacy and safety.
T Pekkarinen & P Mustajoki. Dept of Med. Helsinki University Hospital. Obesity Research, 1997
Conclusion: A VLCD program is suitable for preoperative weight reduction in morbid obesity and seems
not to compromise the immune system.
Weight loss with very-low-calorie diet and cardiovascular risk factors in moderately obese women:
one-year follow-up study including ambulatory blood pressure monitoring.
T Pekkarinen et al. Dept of Med. Helsinki University Hospital. Int .J Obesity 1998
Conclusion: This weight loss programme with a VLCD enabled obese subjects to lose weight and decrease
cardiovascular risks. Despite some regain in weight during follow-up, the beneficial effects were overall
maintained over the year.
No evidence of excessive losses of protein during acute weight loss.
S A Jebb et al. MRC Dunn Clinical Nutrition Centre, Cambridge. Poster presented at 8th International
Congress on Obesity, Paris, September 1998
Conclusion: This four-compartment analysis of changes in body composition provides no evidence of any
significant loss of protein in this treatment programme. However if two-compartment models are used
to assess changes in body composition during acute weight loss the very significant loss of water will
appear as losses of lean tissue.
Very low calorie diets and sustained weight loss.
W H M Saris. Maastricht University. Obesity Research 9, Supp 4 Nov 2001
Conclusion: VLCD with active follow-up treatment seems to be one of the better treatment modalities
related to long term weight maintenance success.
An eight-year experience with a very low calorie formula diet for control of major obesity.
M A Kirschner et al. Newark Beth Israel Medical Centre, New Jersey. IJO 1988 12(1) pp 69-80
Conclusion: 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 morbidly obese population.
Long term weight loss maintenance: a meta-analysis of US studies.
Anderson, Konz, Frederich and Wood. American Society for Clinical Nutrition, 2001
Conclusion: Five years after completing structured weight-loss programme, the average individual maintained
a weight loss of more than 3kg and a reduced weight of more than 3% of initial body weight. After VLEDs,
or weight loss of more than 20kg, individuals maintained significantly more weight loss than after HBDs
or weight losses of less than 10kg.
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