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January 5, 1990, Vol 263, No. 1 >
ARTICLE | January 5, 1990

Responsible and Irresponsible Use of Very-Low-Calorie Diets in the Treatment of Obesity FREE

Thomas A. Wadden, PhD; Theodore B. Van Itallie, MD; George L. Blackburn, MD, PhD
[+] Author Affiliations

Reprint requests to Department of Psychiatry, University of Pennsylvania School of Medicine, 133 S 36th St, Philadelphia, PA 19104 (Dr Wadden).


JAMA. 1990;263(1):83-85. doi:10.1001/jama.1990.03440010081036
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Article
References

AMERICA'S most celebrated weight loss was announced on November 15,1988, when Oprah Winfrey disclosed to her 18 million television viewers that she had lost 30.5 kg (67 lb) in 4 months by consuming a medically supervised very-low-calorie diet (New York Times. November 24,1988:B17). Ms Winfrey's announcement sparked a frenzy of interest among the nation's dieters, reminiscent of that which greeted the appearance of the liquid protein diets in 1976 and 19771 and the Cambridge Diet in the early 1980s.2 Sadly, consumption of these diets was inadequately supervised; at least 58 deaths were reported among users of liquid protein products1,3 and 6 deaths in persons who consumed the Cambridge Diet.2

Current very-low-calorie diets that provide essential nutrients and high-quality proteins are unquestionably safer than their liquid protein predecessors, as noted in a timely report prepared by the American Medical Association's Council on Scientific Affairs.4 But the

REFERENCES

1 +
Van Itallie TB.  Liquid protein mayhem . JAMA. 1978;;240:140-141.
2 +
Wadden TA, Stunkard AJ, Brownell KD, Van Itallie TB.  The Cambridge Diet: more mayhem? JAMA. 1983;;250:2833-2834.
3 +
Sours HE, Frattali VP, Brand CD, et al.  Sudden death associated with verylow-calorie weight reduction regimens . Am J Clin Nutr. 1981;;34:453-461.
4 +
 Council on Scientific Affairs. Treatment of obesity in adults . JAMA. 1988;;260:2547-2551.
5 +
Wadden TA, Stunkard AJ, Brownell KD.  Very-low-calorie diets: their efficacy, safety, and future . Ann Intern Med. 1983;;99:675-684.
6 +
Bistrian BR.  Clinical use of a protein-sparing modified fast . JAMA. 1978;;240:2299-2302.
7 +
Blackburn GL, Bistrian BR, FlattJP.  Role of a protein-sparing modified fast in a comprehensive weight reduction program . In: Howard AN, ed. Recent Advances in Obesity Research . London, England: Newman Publishing; 1975;;1:279-281.
8 +
Barrows K, Snook JT.  Effect of a high-protein, very-low-calorie diet on body composition and anthropometric parameters of obese middle-aged women . Am J Clin Nutr. 1987;;45:381-388.
9 +
Hoffer LJ, Bistrian BR, Young VR, Blackburn GL, Mathews DE.  Metabolic effects of very low calorie weight reduction diets . J Clin Invest. 1984;;73:750-758.
10 +
Phinney SD, Bistrian BR, Kosinski E, et al.  Normal cardiac rhythm observed during hypocaloric diets of varying carbohydrate content . Arch Intern Med. 1983;;143:2258-2261.
11 +
Amatruda JM, Richeson JF, Welle SL, Brodows RG, Lockwood DH.  The safety and efficacy of a controlled low-energy (very-low-calorie) diet in the treatment of non—insulin-dependent diabetes and obesity . Arch Intern Med. 1988;;148:873-878.
12 +
Palgi A, Read JL, Greenberg I, Hoffer MA, Bistrian BR, Blackburn GL.  Multidisciplinary treatment of obesity with a protein-sparing modified fast: results in 668 outpatients . Am J Public Health. 1985;;75:1190-1194.
13 +
Kirschner MA, Schneider G, Ertel NH, Gorman J.  An eight-year experience with a very-low-calorie formula diet for control of major obesity . Int J Obes. 1988;;12:69-80.
14 +
Sikand G, Kondo A, Foreyt JP, Jones PH, Gotto AM.  Two-year follow-up of patients treated with very-low-calorie diet and exercise training . J Am Diet Assoc. 1988;;88:487-488.
15 +
Atkinson RL, Kaiser DL.  Nonphysician supervision of a very-low-calorie diet: results in over 200 cases . Int J Obes. 1981;;5:237-241.
16 +
Forbes GB.  Lean body mass—body fat interrelationships in humans . Nutr Rev. 1987;;45:225-231.
17 +
Forbes GB, Drenick EJ.  Loss of body nitrogen on fasting . Am J Clin Nutr. 1979;;32:1570-1574.
18 +
Van Itallie TB, Yang M-U.  Current concepts in nutrition: diet and weight loss . N Engl J Med. 1977;;297:1158-1161.
19 +
Van Itallie TB, Yang M-U.  Cardiac dysfunction in obese dieters: a potentially lethal complication of rapid, massive weight loss . Am J Clin Nutr. 1984;; 39:695-702.
20 +
 Life Sciences Research Office . Research Needs in Management of Obesity by Severe Caloric Restriction . Washington, DC: Federation of American Societies for Experimental Biology; 1979;. Contract FDA 223-75-2090.
21 +
Van Itallie TB.  Obesity . In: Jeejeebhoy KM, ed. Current Therapy and Nutrition . Toronto, Canada: BC Decker; 1988;:314-324.
22 +
Keys A, Brozek J, Henschel A, Mickelsen O, Taylor HL. The Biology of Human Starvation . Minneapolis: University of Minnesota Press; 1950;;1.
23 +
Van Itallie TB, Abraham S.  Some hazards of obesity and its treatment . In: Hirsch J, Van Itallie TB, eds. Recent Advances in Obesity Research, IV . London, England: John Libbey; 1985;:1-19.
24 +
Pope T, Watkins T.  Opting to take it off fast is one thing . ... Med Tribune . (February 9) , 1989;:1, 9-10.
25 +
Yang M-U.  Body composition and resting metabolic rate in obesity . In: Frankle RT, Yang M-U, ed. Obesity and Weight Control . Rockville, Md: Aspen Systems Corp; 1988;:71-96.
26 +
Ravussin E, Lillioja S, Knowler WC, et al.  Reduced rate of energy expenditure as a risk factor for body-weight gain . N Engl J Med. 1988;;318:462-472.
27 +
Brownell KD.  Understanding and treating a serious, prevalent, and refractory disorder . J Consult Clin Psychol. 1982;;50:820-840.
28 +
Bistrian BR, Sherman M.  Results of treatment of obesity with a proteinsparing fast . Int J Obes. 1978;;2:143-148.
29 +
Vertes V, Genuth SM, Hazelton IM.  Supplemented fasting as a large-scale outpatient program . JAMA. 1977;;238:1251-1253.
30 +
Blackburn GL, Greenberg I.  Multidisciplinary approach to adult obesity therapy . Int J Obes. 1978;;2:133-142.
31 +
Wadden TA, Stunkard AJ.  Controlled trial of very-low-calorie diet, behavior therapy, and their combination in the treatment of obesity . J Consult Clin Psychol. 1986;;54:482-488.
32 +
Perri MG, McAllister DA, Gange JJ, Jordan RC, McAdoo WG, Nezu AM.  Effects of four maintenance programs on the long-term management of obesity . J Consult Clin Psychol. 1988;;56:529-534.
33 +
Harris SS, Caspersen CJ, DeFriese GH, Estes H.  Physical activity counseling for healthy adults as a primary preventive intervention in the clinical setting . JAMA. 1989;;261:3590-3598.
34 +
 Formula diets for obesity . Med Letter. (March 10) , 1989;;31:22-23.
35 +
Andersen T, Backer OG, Stokholm KH, Quaade F.  Randomized trial of diet and gastroplasty compared with diet alone in morbid obesity . N Engl J Med. 1984;;310:352-356.
36 +
Lindner PG, Blackburn GL.  Multidisciplinary approach to obesity utilizing fasting modified by protein-sparing therapy . Obes Bariatric Med. 1976;;5:198-216.

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1 +
Van Itallie TB.  Liquid protein mayhem . JAMA. 1978;;240:140-141.
2 +
Wadden TA, Stunkard AJ, Brownell KD, Van Itallie TB.  The Cambridge Diet: more mayhem? JAMA. 1983;;250:2833-2834.
3 +
Sours HE, Frattali VP, Brand CD, et al.  Sudden death associated with verylow-calorie weight reduction regimens . Am J Clin Nutr. 1981;;34:453-461.
4 +
 Council on Scientific Affairs. Treatment of obesity in adults . JAMA. 1988;;260:2547-2551.
5 +
Wadden TA, Stunkard AJ, Brownell KD.  Very-low-calorie diets: their efficacy, safety, and future . Ann Intern Med. 1983;;99:675-684.
6 +
Bistrian BR.  Clinical use of a protein-sparing modified fast . JAMA. 1978;;240:2299-2302.
7 +
Blackburn GL, Bistrian BR, FlattJP.  Role of a protein-sparing modified fast in a comprehensive weight reduction program . In: Howard AN, ed. Recent Advances in Obesity Research . London, England: Newman Publishing; 1975;;1:279-281.
8 +
Barrows K, Snook JT.  Effect of a high-protein, very-low-calorie diet on body composition and anthropometric parameters of obese middle-aged women . Am J Clin Nutr. 1987;;45:381-388.
9 +
Hoffer LJ, Bistrian BR, Young VR, Blackburn GL, Mathews DE.  Metabolic effects of very low calorie weight reduction diets . J Clin Invest. 1984;;73:750-758.
10 +
Phinney SD, Bistrian BR, Kosinski E, et al.  Normal cardiac rhythm observed during hypocaloric diets of varying carbohydrate content . Arch Intern Med. 1983;;143:2258-2261.
11 +
Amatruda JM, Richeson JF, Welle SL, Brodows RG, Lockwood DH.  The safety and efficacy of a controlled low-energy (very-low-calorie) diet in the treatment of non—insulin-dependent diabetes and obesity . Arch Intern Med. 1988;;148:873-878.
12 +
Palgi A, Read JL, Greenberg I, Hoffer MA, Bistrian BR, Blackburn GL.  Multidisciplinary treatment of obesity with a protein-sparing modified fast: results in 668 outpatients . Am J Public Health. 1985;;75:1190-1194.
13 +
Kirschner MA, Schneider G, Ertel NH, Gorman J.  An eight-year experience with a very-low-calorie formula diet for control of major obesity . Int J Obes. 1988;;12:69-80.
14 +
Sikand G, Kondo A, Foreyt JP, Jones PH, Gotto AM.  Two-year follow-up of patients treated with very-low-calorie diet and exercise training . J Am Diet Assoc. 1988;;88:487-488.
15 +
Atkinson RL, Kaiser DL.  Nonphysician supervision of a very-low-calorie diet: results in over 200 cases . Int J Obes. 1981;;5:237-241.
16 +
Forbes GB.  Lean body mass—body fat interrelationships in humans . Nutr Rev. 1987;;45:225-231.
17 +
Forbes GB, Drenick EJ.  Loss of body nitrogen on fasting . Am J Clin Nutr. 1979;;32:1570-1574.
18 +
Van Itallie TB, Yang M-U.  Current concepts in nutrition: diet and weight loss . N Engl J Med. 1977;;297:1158-1161.
19 +
Van Itallie TB, Yang M-U.  Cardiac dysfunction in obese dieters: a potentially lethal complication of rapid, massive weight loss . Am J Clin Nutr. 1984;; 39:695-702.
20 +
 Life Sciences Research Office . Research Needs in Management of Obesity by Severe Caloric Restriction . Washington, DC: Federation of American Societies for Experimental Biology; 1979;. Contract FDA 223-75-2090.
21 +
Van Itallie TB.  Obesity . In: Jeejeebhoy KM, ed. Current Therapy and Nutrition . Toronto, Canada: BC Decker; 1988;:314-324.
22 +
Keys A, Brozek J, Henschel A, Mickelsen O, Taylor HL. The Biology of Human Starvation . Minneapolis: University of Minnesota Press; 1950;;1.
23 +
Van Itallie TB, Abraham S.  Some hazards of obesity and its treatment . In: Hirsch J, Van Itallie TB, eds. Recent Advances in Obesity Research, IV . London, England: John Libbey; 1985;:1-19.
24 +
Pope T, Watkins T.  Opting to take it off fast is one thing . ... Med Tribune . (February 9) , 1989;:1, 9-10.
25 +
Yang M-U.  Body composition and resting metabolic rate in obesity . In: Frankle RT, Yang M-U, ed. Obesity and Weight Control . Rockville, Md: Aspen Systems Corp; 1988;:71-96.
26 +
Ravussin E, Lillioja S, Knowler WC, et al.  Reduced rate of energy expenditure as a risk factor for body-weight gain . N Engl J Med. 1988;;318:462-472.
27 +
Brownell KD.  Understanding and treating a serious, prevalent, and refractory disorder . J Consult Clin Psychol. 1982;;50:820-840.
28 +
Bistrian BR, Sherman M.  Results of treatment of obesity with a proteinsparing fast . Int J Obes. 1978;;2:143-148.
29 +
Vertes V, Genuth SM, Hazelton IM.  Supplemented fasting as a large-scale outpatient program . JAMA. 1977;;238:1251-1253.
30 +
Blackburn GL, Greenberg I.  Multidisciplinary approach to adult obesity therapy . Int J Obes. 1978;;2:133-142.
31 +
Wadden TA, Stunkard AJ.  Controlled trial of very-low-calorie diet, behavior therapy, and their combination in the treatment of obesity . J Consult Clin Psychol. 1986;;54:482-488.
32 +
Perri MG, McAllister DA, Gange JJ, Jordan RC, McAdoo WG, Nezu AM.  Effects of four maintenance programs on the long-term management of obesity . J Consult Clin Psychol. 1988;;56:529-534.
33 +
Harris SS, Caspersen CJ, DeFriese GH, Estes H.  Physical activity counseling for healthy adults as a primary preventive intervention in the clinical setting . JAMA. 1989;;261:3590-3598.
34 +
 Formula diets for obesity . Med Letter. (March 10) , 1989;;31:22-23.
35 +
Andersen T, Backer OG, Stokholm KH, Quaade F.  Randomized trial of diet and gastroplasty compared with diet alone in morbid obesity . N Engl J Med. 1984;;310:352-356.
36 +
Lindner PG, Blackburn GL.  Multidisciplinary approach to obesity utilizing fasting modified by protein-sparing therapy . Obes Bariatric Med. 1976;;5:198-216.

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