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Very Low Calorie Diets
Obesity affects nearly one-third of adults in the United States,
increasing their risk for diabetes, high blood pressure, and heart
disease. Traditional weight loss methods include low-calorie diets
from 800 to 1,500 calories a day and regular physical activity.
Health care providers sometimes consider an alternative method for
bringing about significant short-term weight loss in patients who
are moderately to extremely obese: the very-low-calorie diet.
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What is a very-low-calorie diet (VLCD)?
VLCDs are commercially prepared formulas of about 800 calories
that replace all usual food intake for several weeks or months.
VLCDs are not the same as over-the-counter meal replacements,
which are meant to substitute for one or two meals a day. VLCDs,
when used under proper medical supervision, effectively produce
significant short-term weight loss in patients who are
moderately to extremely obese.
Studies have shown that meal replacements at higher calorie
levels (800 – 1000 calories) produce weight loss similar to that
seen with much lower calorie levels, probably due to better
compliance with the diet. In addition, VLCDs are usually part of
weight-loss treatment programs that include other techniques
such as behavioral therapy, nutrition counseling, physical
activity, and/or drug treatment.
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Who should use a VLCD?
VLCDs are intended to produce rapid weight loss at the start
of a weight-loss program in patients with a body mass index
(BMI) greater than 30. BMI correlates significantly with total
body fat content. It is calculated by dividing weight in
kilograms by height in meters squared, or by dividing weight
in pounds by height in inches squared and multiplying by 703.
Use of VLCDs in patients with a BMI of 27 to 30 should be
reserved for those who have medical complications resulting
from their overweight. VLCDs are not recommended for pregnant
or breastfeeding women. VLCDs are not appropriate for children
or adolescents, except in specialized treatment programs.
Very little information exists regarding the use of VLCDs in
older people. Because people over age 50 already experience
normal depletion of lean body mass, use of a VLCD may not be
warranted. Also, people over 50 may not tolerate the side
effects associated with VLCDs because of preexisting medical
conditions or need for other medications. Physicians must
evaluate on a case-by-case basis the potential risks and
benefits of rapid weight loss in older individuals, as well as
in people with significant medical problems or who are on
medications.
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Health benefits of a VLCD
A VLCD may allow a patient who is moderately to extremely
obese to lose about 3 to 5 pounds per week, for an average
total weight loss of 44 pounds over 12 weeks. Such a weight
loss can rapidly improve obesity-related medical conditions,
including diabetes, high blood pressure, and high cholesterol.
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Adverse effects of a VLCD
Many patients on a VLCD for 4 to 16 weeks report minor side
effects such as fatigue, constipation, nausea, and diarrhea,
but these conditions usually improve within a few weeks and
rarely prevent patients from completing the program. The most
common serious side effect is gallstone formation. Gallstones,
which often develop anyway in people who are obese, especially
women, are even more common during rapid weight loss. Research
indicates that rapid weight loss may increase cholesterol
levels in the gallbladder and decrease its ability to contract
and expel bile. The drug ursodiol can prevent gallstone
formation during rapid weight loss, but is not often used for
this purpose.
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Maintaining Weight Loss
Studies show that the long-term results of VLCDs vary widely,
but weight regain is common. Combining a VLCD with behavior
therapy and physical activity may help increase weight loss and
slow weight regain. In the long term, however, VLCDs are no more
effective than more modest dietary restrictions.
For most people who are obese, obesity is a long-term condition
that requires a lifetime of attention even after formal weight
loss treatment ends. Therefore, health care providers should
encourage patients who are obese to commit to permanent changes
of healthier eating, regular physical activity, and an improved
outlook about food.
Endnote: This fact sheet is an updated, modified version
of a previously published review article appearing in the August
25, 1993 issue of the Journal of the American Medical
Association. Both the review article and this fact sheet
were developed with the advice of the National Task Force on
Prevention and Treatment of Obesity.
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Additional Reading
Dieting and Gallstones
NIH Publication No. 02-3677. February 2002. Available from WIN.
Active at Any Size
NIH Publication No. 00-4352. March 2001. Available from WIN.
Healthy Eating and Physical
Activity Across Your Lifespan: Better Health and You
NIH Publication No. 02-4992. June 2002. Available from WIN.
To request a free brochure, call WIN at 1-877-946-4627 or log on
to
www.niddk.nih.gov/health/nutrit/nutrit.htm.
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Weight-Control Information Network
1 WIN WAY
BETHESDA, MD 20892-3665
Phone: (202) 828-1025
FAX: (202) 828-1028
Toll-free number: 1-877-946-4627
Internet:
www.niddk.nih.gov/health/nutrit/nutrit.htm
E-mail:
win@info.niddk.nih.gov
The Weight-control Information Network (WIN) is a service of the
National Institute of Diabetes and Digestive and Kidney Diseases
of the National Institutes of Health, which is the Department of
Health and Human Services' lead agency responsible for
biomedical research on nutrition and obesity. Authorized by
Congress (Public Law 103-43), WIN provides the general public,
health professionals, the media, and Congress with up-to-date,
science-based health information on weight control, obesity,
physical activity, and related nutritional issues.
WIN answers inquiries, develops and distributes publications,
and works closely with professional and patient organizations
and Government agencies to coordinate resources about weight
control and related issues.
Publications produced by WIN are reviewed by both NIDDK
scientists and outside experts. This fact sheet was also
reviewed by Rena Wing, Ph.D., Professor, Brown University and
University of Pittsburgh School of Medicine.
This e-text is not copyrighted. WIN encourages users of this
e-pub to duplicate and distribute as many copies as desired.
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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
NIH Publication No. 03-3894
January 2003
e-text posted: March 2003 |
Source:
http://www.niddk.nih.gov/health/nutrit/pubs/vlcd.htm
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