The effects of three-week fasting diet on blood pressure, lipid profile and glucoregulation in extremely obese patients
Srp Arh Celok Lek. 2007 Jul-Aug;135(7-8):440-6[Article in Serbian]
Beleslin B, Cirić J, Zarković M, Vujović S, Trbojević B, Drezgić M.
INTRODUCTION: Obesity is often accompanied by a number of complications including diabetes mellitus and cardiovascular diseases. Elevated blood pressure and lipids, as well as deterioration of glucoregulation are attributed, as the most significant factors, to development of diabetes mellitus and cardiovascular complications in obese patients. OBJECTIVE: The aim of our study was to evaluate the effects of a fasting diet on blood pressure, lipid profile and glucoregulatory parameters. METHOD: We included 110 patients (33 male and 77 female; mean age 35 +/- 1 years, body weight 131.7 +/- 2.6 kg, body mass index 45.4 +/- 0.8 kg/m2) who were hospitalized for three weeks for the treatment of extreme obesity with the fasting diet. At the beginning, during, and at the end of this period, we evaluated changes in blood pressure, lipid profile, as well as parameters of glucoregulation including glycaemia, insulinaemia, and insulin sensitivity by HOMA. Oral glucose tolerance test (OGTT) was performed in all patients at the beginning and at the end of the fasting diet. RESULTS: During the fasting diet, the body weight decreased from 131.7 +/- 2.6 kg to 117.7 +/- 2.4 kg (p < 0.001), the body mass index decreased from 45.4 +/- 0.8 kg/m2 to 40.8 +/- 0.8 kg/m2 (p < 0.001), and both systolic and diastolic blood pressure significantly declined (143 +/- 2 vs. 132 +/- 2 mm Hg, p < 0.001; 92 +/- 2 vs. 85 +/- 2 mm Hg, p < 0.001). In addition, the fasting diet produced a significant decrease in total cholesterol, LDL cholesterol, triglycerides, as well as basal glycaemia and insulinaemia (p < 0.001) Before the fasting diet, OGTT was normal in 76% of patients, whereas 21% of patients showed glucose intolerance, and 4% of patients diabetes mellitus. After the fasting diet, OGTT was normal in 88% of patients, whereas 12% of patients still had signs of glucose intolerance (p < 0.05). In addition, insulin resistance significantly (p < 0.05) increased from 54 +/- 6% to 89 +/- 13% after the fasting diet. CONCLUSION: The three-week fasting diet in extremely obese patients produced a significant decrease and normalization of blood pressure, decrease in lipids, and improvement in glucoregulation including the increase in insulin sensitivity.

Changes in food cravings during low-calorie and very-low-calorie diets.
Obesity (Silver Spring). 2006 Jan;14(1):115-21
Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA.
OBJECTIVE: This study examined food cravings during a primarily food-based low-calorie diet (LCD) and a supplement-based very-LCD (VLCD). RESEARCH METHODS AND PROCEDURES: The Food Craving Inventory (FCI) was used to measure general cravings and cravings for specific types of foods (sweets, high fats, carbohydrates/starches, and fast food fats). The FCI was completed by participants in the LCD and VLCD programs at baseline and after 11 weeks of dieting. The VLCD group also completed the FCI at Week 6 and after 5 weeks of a refeeding phase, when their diet consisted primarily of solid food. RESULTS: From baseline to Week 12, craving decreases were greater for the VLCD group than for the LCD group on all measures. All craving measures decreased significantly for the VLCD group. The LCD group experienced a marginally significant decrease in sweet cravings. Within the VLCD group, all craving measures decreased significantly by Week 6 and did not change thereafter, including after resumption of solid food intake, and craving scores during all dieting points were lower than baseline. Changes in cravings were not related to weight loss. DISCUSSION: Cravings did not increase during either diet; all changes represented decreases. Compared with a primarily food-based diet (LCD), a more restrictive supplement-based diet (VLCD) resulted in significantly larger decreases in food cravings that occurred by the end of the 5th week of supplement use and did not rebound with resumption of solid food intake. The results of this study suggest that food cravings diminish with calorie restriction.

Effect of a very low calorie diet on the diagnostic category of individuals with binge eating disorder.? Indications for fasting
Obesity Int J Eat Disord 2002 Jan;31(1):49-56?
Raymond NC, de Zwaan M, Mitchell JE, Ackard D, Thuras P.
Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota.

This study examined the factors associated with the diagnostic outcome of obese individuals with and without binge eating disorder (BED) 1 year after completing a very low calorie diet (VLCD) program. METHOD: Participants included 63 individuals with BED, 36 individuals with subthreshold BED, and 29 individuals with no binge eating symptoms. Diagnoses before and after VLCD were obtained using the Structured Clinical Interview for DSM-IV (SCID) interviews. The severity of psychiatric symptoms were assessed using various rating scales. RESULTS: Fifty-six percent (n = 36) of the participants who met criteria for BED at baseline did not meet diagnostic criteria 1 year later. None of the baseline factors were statistically associated with outcome. DISCUSSION: Although the main hypothesis was not supported, absence of a BED diagnosis at 12-month follow-up after a VLCD diet appears to be associated with less weight gain at 1-year follow-up regardless of baseline diagnosis.

Very-low-calorie diets and sustained weight loss. (A review)
Obes Res 2001 Nov;9 Suppl 4:295S-301S
Saris WH.
Nutrition and Toxicology Research Institue Maastricht, Maastricht University, The Netherlands.
To review of the literature on the topic of very-low-calorie diets (VLCDs) and the long-term weight-maintenance success in the treatment of obesity. RESEARCH METHODS AND PROCEDURES: A literature search of the following keywords: VLCD, long-term weight maintenance, and dietary treatment of obesity. RESULTS: VLCDs and low-calorie diets with an average intake between 400 and 800 kcal do not differ in body weight loss. Nine randomized control trials, including VLCD treatment with long-term weight maintenance, show a large variation in the initial weight loss regain percentage, which ranged from -7% to 122% at the 1-year follow-up to 26% to 121% at the 5-year follow-up. There is evidence that a greater initial weight loss using VLCDs with an active follow-up weight-maintenance program, including behavior therapy, nutritional education and exercise, improves weight maintenance. CONCLUSIONS: VLCD with active follow-up treatment seems to be one of the better treatment modalities related to long-term weight-maintenance success.

Treatment of extreme obesity with a very low calorie diet.
Med Pregl 2001 Nov-Dec;54(11-12):534-8
Ivkovic-Lazar T.
Klinika za endokrinologiju, dijabetes i bolesti metabolizma, Institut za interne bolesti, Klinicki centar, Novi Sad.

This paper presents the results of treatment of very obese persons with a very-low-calorie diet (VLCD). MATERIAL AND METHODS: A group of 28 extremely obese subjects, average age 32 years, was treated in the course of one month by the following regime: 3-4 l of mineral water with "Enemon" pulv. 3 x 1 and vitamin substitution and allopurinol 300 mg/day. RESULTS: In addition to a statistically significant (p < 0.5) loss of body mass, significant changes were observed in regard to decrease of atherogenic lipid profile (cholesterol, triglycerides, LDL-cholesterol, apoprotein B), as well as lowered level of hyperinsulinism which, though, was not statistically significant. The degree of protein catabolism did not reach statistical significance, and the results were also more favourable with respect to potential changes in electrolytes, as well as with respect to the degree of hyperuricemia in regard to subjects being under the regime of total starvation. DISCUSSION AND CONCLUSIONS: VLCD represents an extremely efficient and safe therapeutic procedure which, apart from body mass loss, is characterized by favourable changes in metabolism of lipids and a decrease in hyperinsulinism, which eventually results in reduction of the risk from early and accelerated atherosclerosis.

Treatment of diabetes in patients with severe obesity.
Biomed Pharmacother 2000 Mar;54(2):74-9
Scheen AJ.
Department of Medicine, CHU Sart Tilman (B35), Liege 1, Belgium.

Besides genetic predisposition, obesity is the most important risk factor for the development of diabetes mellitus, and weight reduction has been shown to markedly improve blood glucose control in obese subjects with type 2 diabetes. Therapeutic strategies for the obese diabetic patient include: 1) promoting weight loss through lifestyle modifications (hypocaloric diet and exercise) and anti-obesity drugs (orlistat, sibutramine, etc.); 2) improving blood glucose control, essentially through the reduction of insulin resistance (metformin, eventually thiazolidinediones) or insulin need (alpha-glucosidase inhibitors) and, at a later stage, the correction of defective insulin secretion (sulphonylureas, repaglinide) or low circulating insulin levels (exogenous insulin); and 3) treating common associated risk factors, such as arterial hypertension and dyslipidaemias, to improve cardiovascular prognosis. When morbid obesity is present, both restoring a good glycemic control and correcting associated risk factors can only be obtained through marked and sustained weight loss. This primary objective justifies more aggressive weight reduction programmes, including very low-calorie diets and bariatric surgery, but only within a multidisciplinary approach and in well-selected patients .

VLCD a safe and simple treatment of obesity (A review).
Lakartidningen 2000 Sep 6;97(36):3876-9?
Rossner S, Torgerson JS.
Article in Swedish Huddinge Universitetssjukhus.

This review summarizes Swedish experience with VLCD (Very Low Calorie Diets). VLCD-treatment is a safe and relatively simple way to induce weight reduction in obese patients. The rapid and profound initial weight loss reduces cardiovascular risk factors and relieves obesity-associated symptoms. Weight loss on the order of 20-25 kg is common after 12-16 weeks of treatment. The long-term results, about 10% weight reduction after two years, are similar to what can be expected with pharmacological treatment. VLCD's should be incorporated into long-term treatment programs including diet, physical exercise and lifestyle modification. A team of nurses and/or dieticians can, to a large extent, manage a VLCD-program, restricting the need for involvement of the physician.

Racial differences in metabolic predictors of obesity among postmenopausal women.

Department of Medicine, University of Maryland School of Medicine, Baltimore V.A. Medical Center, 21201, USA.

This study determined whether there are racial differences in resting metabolic rate (RMR), fat oxidation, and maximal oxygen consumption (VO2max) in obese [body mass index (BMI = 34+/-2 kg/m2)], postmenopausal (58+/-2 years) women. RESEARCH METHODS AND PROCEDURES: Twenty black and 20 white women were matched for fat mass and lean mass (LM), as determined by dual energy X-ray absorptiometry. RMR and fat oxidation were measured by indirect calorimetry in the early morning after a 12-hour fast using the ventilated hood technique. VO2max was measured on a treadmill during a progressive exercise test to voluntary exhaustion. RESULTS: RMR, adjusted for differences in LM, was 5% higher in white than black women (1566+/-27 and 1490+/-26 kcal/day, respectively; p<0.05); and fat oxidation rate was 17% higher in white than black women (87+/-4 and 72+/-3 g/day, respectively; p<0.01). VO2max (L/minute) was 150 mL per minute (8%) higher (p<0.05) in white than black women. VO2max correlated with LM in black (r=0.44, p=0.05) and white (r=0.53, p<0.05) women, but the intercept of the regression line was higher in white than black women (p<0.05), with no significant difference in slopes. In a multiple regression model including race, body weight, LM, and age, LM was the only independent predictor of RMR (r2 = 0.46, p<0.0001), whereas race was the only independent predictor of fat oxidation (r2 = 0.18, p<0.05). The best predictors of VO2max were LM (r2 = 0.22, p<0.05) and race (cumulative r2 = 0.30, p<0.05). DISCUSSION: These results show there are racial differences in metabolic predictors of obesity. Determination of whether these ethnic differences lead to, or are an effect of, obesity status or other lifestyle factors requires further study.

Long-term weight maintenance after an intensive weight-loss program.
J Am Coll Nutr 1999 Dec;18(6):620-7
Anderson JW, Vichitbandra S, Qian W, Kryscio RJ. VA
Medical Center and University of Kentucky (HMR) Weight Management Program, Lexington, USA.
  This prospective study assessed long-term weight maintenance of patients completing an intensive very-low-calorie diet (VLCD) weight-loss program. SUBJECTS: Individuals who had completed the 12-week core education program and lost > or = 10 kg were recruited. RESULTS: Of 154 eligible subjects, follow-up weights were obtained at > or = 2 years in 112 subjects (72.7%, 72 women, 40 men). Subjects had an average initial body mass index of 37.3 kg/m2 and an average weight loss of 29.7 kg in five months. Six hundred and forty-five follow-up weights (median, five per subject) were obtained over two to seven years of follow-up from clinic visits (70%) and self-report by telephone or mail (30%). Subjects regained an average of 2.5% per month of their lost weight during the first two to three years of follow-up; however, their weight stabilized over the next four years. Subjects regained an average of 73.4% of their weight loss during the first three years. The average weight loss maintained for 112 subjects was 22.8% of initial weight loss after an average of 5.3 years of follow-up. When successful weight maintenance was defined as maintaining a weight loss of 5% or 10% of initial (pre-treatment) body weight, 40% were maintaining a 5% weight loss at five years and 25% were maintaining a weight loss of 10% at 7 years. Multiple regression analyses suggested that age had a significant (p=0.004) and positive effect on weight maintenance. CONCLUSIONS: This study suggests that weight maintenance after an intensive VLCD program is improving but still needs intensive efforts to enable most individuals to maintain a substantial percentage of their weight loss long-term.

Predictors of long-term weight reduction in obese patients after initial very-low-calorie diet.
Adv Ther 1999 Nov-Dec;16(6):285-9
Hoie LH, Bruusgaard D. Norsk Legesenter, Oslo, Norway.

This prospective interventional study assessed possible predictors of long-term weight loss and compared them with factors previously identified as predicting short-term variations in weight reduction after initial treatment with a very-low-calorie diet (VLCD). Eighty-two overweight patients with a body mass index of at least 27 kg/m2 were recruited from primary health-care settings into a structured weight-reduction and maintenance program. All patients used the VLCD for 8 weeks and were followed up 13.2 months later. Mean body weight decreased an average of 13.3 kg during the 8-week treatment and was still 8.6 kg below pretreatment levels after 13.2 months. Triglyceride levels were also significantly reduced. Sex, baseline weight, baseline body mass index, and age predicted 37% of the variation in short-term weight loss but had no long-term predictive value.?

Obesity wars: a pilot study of very low calorie diets in obese patients in general practice.
Br J Gen Pract 1998 May;48(430):1251-2
Molokhia M.

St George's Hospital Medical School Department of General Practice and Primary Care, London.
In this study we aimed to determine whether very low calorie diets (VLCDs) can be an effective means of weight reduction in obese patients in general practice. Twenty-six patients showed a mean reduction in weight of 15 kg and in body mass index (BMI) of 6.1% within a 12-month period. VLCDs with regular monitoring and feedback were shown to be effective in reducing and maintaining weight loss for up to a year with no reported serious side effects.

Very low-calorie diets
JAMA 1993 Aug 25;270(8):967-74
National Task Force on the Prevention and Treatment of Obesity,? National Institutes of Health.
  To provide an overview of the published scientific information on the safety and efficacy of very low-calorie diets (VLCDs) and to provide rational recommendations for their use. DATA SOURCES AND EXTRACTION--Original reports obtained through a MEDLINE search for 1966 through 1992 on VLCDs or reducing diets plus obesity, supplemented by a manual search of bibliographies and the opinions of experts in the field of nutrition and weight loss therapy for obesity. Only studies of humans were cited. DATA SYNTHESIS--Current VLCDs are usually provided in the context of comprehensive treatment programs, during which usual food intake is completely replaced by specific foods or liquid formulas containing 3350 kJ/d (800 kcal/d) or less. Weight loss on VLCDs averages 1.5 to 2.5 kg/wk; total loss after 12 to 16 weeks averages 20 kg. These results are superior to standard low-calorie diets of 5020 kJ/d (1200 kcal/d), which lead to weight losses of 0.4 to 0.5 kg/wk and an average total loss of only 6 to 8 kg. There is little evidence that intakes of less than 3350 kJ/d (800 kcal/d) result in better weight losses than 3350 kJ. Intake of at least 1 g/kg of ideal body weight per day of protein of high biologic value appears to be important in helping to preserve lean body mass. Serious complications of modern VLCDs are unusual, cholelithiasis being most common. CONCLUSIONS--Current VLCDs are generally safe when used under proper medical supervision in moderately and severely obese patients (body mass index [weight in kilograms divided by height in meters squared] > 30) and are usually effective in promoting significant short-term weight loss, with concomitant improvement in obesity-related conditions. Long-term maintenance of weight lost with VLCDs is not very satisfactory and is no better than with other forms of obesity treatment. Incorporation of behavioral therapy and physical activity in VLCD treatment programs seems to improve maintenance.

Long-term efficacy of dietary treatment of obesity: a systematic review of studies published between 1931 and 1999.
Obes Rev. 2000 Oct;1(2):113-9
Ayyad C, Andersen T.
Roskilde County Hospital, DK-4000, Roskilde, Denmark.

  MEDLINE surveys were carried out and reference lists were cross-checked to identify publications on long-term outcome for dietary treatment of obesity. 898 papers were identified, 17 fulfilled our planned criteria for inclusion (dietary treatment; adults; follow-up period > or = 3 years; follow-up rate > or = 50% of original study group; information on one of the success criteria: maintenance of all weight initially lost (or further weight reduction) or maintenance of at least nine to 11 kg of initial weight loss; obesity complications of the patient group not over-represented; English, German or Scandinavian languages). RESULTS: The 17 included publications (here of three publications on randomized clinical trials with control group relevant for this review) reported on 21 study groups, comprising 3030 patients. Of these 2131 (70%) were followed-up for 3-14 years (median 5 years). Mean initial weight loss ranged from four to 28 kg (median 11 kg). Overall, 15% (median, range 0-49%) of followed-up patients fulfilled one of the criteria for success. Overall, success rates seemed stable for up to 14 years of observation. Diet combined with group therapy lead to better long-term success rates (median 27%) than did diet alone (median 15%) or diet combined with behaviour modification (median 14%). Active follow-up was generally associated with better success rates than was passive follow-up (19% vs. 10%). Conventional diet seemed to be most efficacious in addition with group therapy, whereas VLCD apparently was most efficacious if combined with behaviour modification and active follow-up. CONCLUSION: The literature on long-term follow-up of dietary treatment of obesity, although limited and inhomogeneous, points to an overall median success rate of 15% and a possible adjuvant effect of group therapy, behaviour modification and active follow-up.?

Very-low-calorie diets and sustained weight loss.
Obes Res. 2001 Nov;9 Suppl 4:295S-301S
Saris WH.
Nutrition and Toxicology Research Institue Maastricht, Maastricht University, The Netherlands.
 To review of the literature on the topic of very-low-calorie diets (VLCDs) and the long-term weight-maintenance success in the treatment of obesity. RESEARCH METHODS AND PROCEDURES: A literature search of the following keywords: VLCD, long-term weight maintenance, and dietary treatment of obesity. RESULTS: VLCDs and low-calorie diets with an average intake between 400 and 800 kcal do not differ in body weight loss. Nine randomized control trials, including VLCD treatment with long-term weight maintenance, show a large variation in the initial weight loss regain percentage, which ranged from -7% to 122% at the 1-year follow-up to 26% to 121% at the 5-year follow-up. There is evidence that a greater initial weight loss using VLCDs with an active follow-up weight-maintenance program, including behavior therapy, nutritional education and exercise, improves weight maintenance. CONCLUSIONS: VLCD with active follow-up treatment seems to be one of the better treatment modalities related to long-term weight-maintenance success.?

VLCD versus LCD in long-term treatment of obesity.
Int J Obes Relat Metab Disord. 1997 Jan;21(1):22-6
Rossner S, Flaten H.
Obesity Unit, Karolinska Hospital, Stockholm, Sweden.

To compare the long-term effects of three different programs including initial 6 weeks (V)LCD diets 420 kcal/d, 530 kcal/d, 880 kcal/d) on sustained weight loss, attrition and obesity associated conventional cardiovascular risk factors. DESIGN: Prospective, randomized clinical 52 weeks trial. Two weeks of a booster (V)LCD period after week 26. SETTING: University outpatient obesity clinic. SUBJECTS: Ninety-three middle-aged obese patients (30 men), initial mean BMI 38.7 kg/m2, age 20-65 y, from the waiting list. MAIN OUTCOME MEASURES: Weight loss pattern, attrition, reported side effects, blood pressure, blood glucose and serum lipid levels. Repeated frequent measurements up to week 26, intermittently up to final measurements at week 52. RESULTS: One year attrition (30-45%), sustained weight loss (8-15% of initial body weight) and changes in obesity associated risk parameters were similar in all three group. Fewer adverse events were reported in the LCD group. CONCLUSION: The results compare favorably with most previous reports of similar design. VLCD (420 kcal or 530 kcal/ d and LCD 880 kcal/d) were equally effective in long term treatment of obesity. The tendency to less side effects with LCD suggests that such preparations deserve further attention.