Safe year‐long use of a very‐low‐calorie diet for the treatment of severe obesity

Abstract

Clinical recordA 59-year-old severely obese man was admitted to hospital with a 3-day history of gradually progressive paraesthesia and mild weakness affecting all four limbs, with a background of polydipsia, polyuria and fatigue over the previous 4 months.On examination, his weight was 169.5 kg and his height was 1.90 m (body mass index [BMI], 47.0 kg/m 2 ). He was hypertensive (167/80 mmHg) and afebrile. He had mild weakness in a pyramidal pattern in the legs. Upper and lower limb reflexes were brisk, ankle jerks were absent, plantar responses were upgoing bilaterally, and sensation was reduced in a stocking distribution. The cranial nerves and speech were unaffected and visual fields were normal. Cardiovascular, respiratory and abdominal examinations were unremarkable. The presence of acanthosis nigricans and a fungal toenail infection were noted.Initial laboratory investigations revealed a random blood glucose level of 22.2 mmol/L (reference range, 3.3-5.5 mmol/L) and a glycated haemoglobin (HbA 1c ) level of 12.2% (reference range, 4.3%-6.0%). Urinary ketones were not detected. Levels of electrolytes, inflammatory markers and vitamin B 12 were normal. Liver function tests showed a mild generalised elevation, and lipid levels were raised (Box 1). An electrocardiogram (ECG), non-contrast computed tomography brain scan, lumbar puncture and carotid Doppler ultrasound were normal. Nerve conduction studies showed an axonal sensorimotor neuropathy, with the lower limbs more severely affected than the upper limbs.Neurological findings remained stable during the hospital stay, and a provisional diagnosis of a cervical myelopathy with peripheral neuropathy was made. Magnetic resonance imaging of the spine could not be performed because of the patient' s large size.The patient was treated with aspirin 100 mg daily, simvastatin 20 mg daily and metformin 500 mg twice daily. On the day of discharge (Day 6), he commenced a very-low-calorie diet (VLCD) (Optifast VLCD, Novartis Consumer Health Australasia, Melbourne, Vic) three times daily. Blood glucose readings at discharge were 6-8 mmol/L. After discharge, he commenced a daily exercise program.Over the following 12 months, the patient attended the weight control clinic at our hospital. He continued on an intensive regimen of Optifast VLCD three times a day for 5 months, and then began a transition phase (two Optifast VLCD meals plus one low-fat meal per day).Over the 12 months, the patient' s weight fell steadily (Box 2, Box 3). At 1-year follow-up, he had lost 43% of his initial weight and was down to 96.5 kg (BMI, 26.7 kg/m 2 ). He was normotensive (125/80 mmHg), and his fasting blood glucose and HbA 1c levels were in the non-diabetic range. Full blood examination, electrocardiographic readings, and levels of electrolytes, calcium, magnesium, folate, vitamin B 12 , vitamin D and uric acid were normal. Liver function tests had normalised, and the lipid profile had improved significantly (Box 1). Bone mineral density (measured by We report the case of a 59-year-old sev...

Preconception management of women with obesity: A systematic review

“…However, it is important to note that these studies focus on either a restriction of all macronutrients, or a restriction of protein. The impact of weight loss achieved using a VLED on offspring health remains to be determined, but may not be similarly detrimental given that protein and micronutrient intake is maintained …”

Experiences of using very low energy diets for weight loss by people with overweight or obesity: a review of qualitative research

“…The energy content of total meal replacement diets is typically less than 3,350 kJ d −1 (800 kcal d −1 ), and because of this, total meal replacement diets are often referred to as VLEDs, which – by definition – deliver less than 3,350 kJ d −1 . Total meal replacement diets are safe in the short term and have been reported to be used for up to 5 months with no ill effect . Furthermore, weight regain after total meal replacement diets is no faster or higher than after any other diet , and the greater initial weight loss after VLEDs compared with other diets has been shown to be predictive of successful long‐term maintenance of a lower body weight .…”

Obesity and Type 2 Diabetes Mellitus

“…The role of modern very low calorie diets (VLCD), a diet of < 800 Kcal/day, has been noted to result in short-term benefits with regards to glycaemic control, insulin sensitivity and inflammatory markers. VLCDs are especially useful for selected patients with diabesity under close medical supervision, particularly those who await a bariatric surgical procedure (in whom benefits include hepatic shrinkage) [47][48][49][50]. The long-term effects of VLCDs are however yet to be demonstrated [49,50].…”