An eight-year experience with a very-low-calorie formula diet for control of major obesity

We have utilized a very-low-calorie formula diet (VLCD) along with multidisciplinary group counselling in an attempt to achieve and maintain major weight loss in 4026 morbidity obese patients. Using a 420-cal protein supplement (Optifast), men lost weight, at an average of 4.6 +/- 0.9 lb/week and women, 3.1 +/- 1.1 lb/week. Men remained on the VLCD an average of 13.2 weeks, resulting in a mean weight loss of 66.0 +/- 8.1 lb; women remained on the fast an average of 14.1 weeks, with an average loss of 47.3 +/- 4.2 lb. Outcome analysis revealed that 25 percent of patients were unable to adapt to this approach, dropping out within the first 3 weeks. Of the patients remaining in the program, 68 percent lost considerable weight, but did not reach their goal; of this group, recidivism was extremely high, with only 5-10 percent maintaining weight loss after 18 months. Thirty-two percent of the patients successfully attained goal weight; the holding rate of this group has been considerably greater, with 30 percent of women and 58 percent of men maintaining weight loss (within 10 lbs) for a minimum of 18 months. Complications of obesity i.e. hypertension, type II diabetes mellitus, and hyperlipidemias were remarkably improved after weight loss. Complications of the VLCD including cardiac abnormalities, were minimal. Our 8-year experience strongly suggests that the VLCD approach using high quality protein supplement and multi-disciplinary counselling provides a reasonable success rate for achieving and maintaining weight loss in the morbidity obese population.