Extreme diet, VLCD, proven safe with supervision

ON CALL

September 07, 1993|By Dr. Simeon Margolis | Dr. Simeon Margolis,Contributing Writer

Q: Because my weight is more than 300 pounds, my wife has urged me to go to one of the programs that advertises weight loss with the use of a special liquid diet over a period of 12 weeks. I would like to know whether such weight loss programs are safe and effective.

A: The National Task Force on the Prevention and Treatment of Obesity, organized by the National Institutes of Health, has published a report on the very low-calorie diets (VLCD) used in the type of weight-loss programs you describe. A VLCD is defined as one containing 800 calories a day or less. The report concluded that the currently used VLCD are safe when carried out with proper medical supervision.

The safety of the diets is in part due to the fact that they are enriched with protein and contain a full complement of vitamins, minerals, electrolytes (such as sodium and potassium) and essential fatty acids. The report recommends that VLCD only be used by individuals with modest or severe obesity who have been unable to lose weight by other means. During the modified fast period of the program, when the special VLCD replaces all other food intake, many people have relatively minor and transient side effects.

Two serious adverse effects -- gout and gallstones -- can occur, most often during the period when dieters are being reintroduced to solid foods. A marked rise in blood levels of uric acid (the substance that deposits in joints to trigger an attack of gout) is common during VLCD, but symptoms of gout tend to occur only in those with a prior history of gout. Gall bladder disease is the most serious complication associated with VLCD.

VLCD are effective. In one study, total weight loss over 12 to 16 weeks of a VLCD averaged 45 pounds. About 75 percent of the lost weight was fat; the remainder was lean body mass, mostly muscle.

As with all treatment for obesity, loss of weight is far easier than maintenance of weight loss. Sustained weight loss was more common when the program incorporated behavioral modification and especially if the dieters increased their physical activity.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

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