S Rössner, H Flaten, Obesity Unit, Karolinska Hospital, Sweden and Nycomed Pharma, Oslo, Norway
International Journal of Obesity (1997) 21, 22-26
93 obese patients (BMI > 30 kg/m2) aged 20 - 65 years, of whom 30 were men. Initial average BMI was 38.7 kg/m2.
Very Low Calorie Diet (VLCD) products have been assessed in a large number of studies in which they were shown to provide effective and safe weight-loss, with moderate side effects. In recent years, the optimum calorie content and nutritional composition of safe, effective diet replacement products have been widely discussed, since studies show that different calorie levels produce similar weight loss results.
Patients were randomly divided into three groups, where one was treated with a VLCD formula containing 420 kcal per day supplemented with a multivitamin and a fish oil capsule, a second with a VLCD formula containing 530 kcal per day, and a third with an LCD formula containing 850 kcal per day.
Treatment was initiated with 6 weeks of a pure VLCD/LCD diet, after which patients were gradually transitioned to a hypocaloric diet with food that provided 1600 kcal per day.
After 26 weeks, patients once again received the same VLCD/LCD diet as previously for an additional two weeks. This practice has earlier been shown to have a beneficial effect on compliance and motivation at a stage when weight loss usually levels off.
After the second VLCD/LCD regimen, patients returned to the hypocaloric diet of about 1600 kcal per day. In addition to the diet, patients received counseling about food and exercise during the treatment period.
Results and discussion:
No significant differences in absolute weight loss or percentage of weight loss could be ascertained between the groups in any phase of the study, which lasted 52 weeks.
Urine ketones were measured in all treated patients, regardless of group.
The side effects were mild and usually transient, showing a tendency for lower incidence in the LCD group.
The results confirm that sustained long-term weight loss can be achieved by initially treating with VLCD or LCD and that an 8-15 percent weight loss may be expected after one year among those who complete such treatment.
It is reasonable to assume that the higher daily intake of an LCD formula would be safer, which may mean that additional patients groups could be candidates for LCD treatment, even in cases where safety concerns may preclude VLCD treatment.
Patients felt that two additional weeks of VLCD/LCD treatment after six months was highly beneficial, since they often experience a decline in motivation at that time because weight-loss had leveled off.
VLCD and LCD products are equally effective in achieving weight loss in the initial phase of a long-term treatment regimen. However, LCD formulations deserve greater attention because of their tendency to cause fewer side effects.