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Very low-energy diet plus behavioral program optimal for long-term weight loss
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Adults who adhered to a very low-energy diet of less than 800 kcal per day combined with a behavioral intervention program lost more weight during 12 months and maintained greater weight loss up to 5 years than those assigned behavioral intervention alone, according to a meta-analysis in Obesity Reviews.
Helen M. Parretti, MD, a National Institute for Health Research (NIHR) clinical lecturer at University of Birmingham, United Kingdom, and colleagues analyzed data from 522 adults randomly assigned to a very-low energy diet (VLED) of 800 kcal per day or less and 452 adults assigned to a comparator program (behavioral intervention or no intervention) in 12 randomized controlled trials conducted through November 2014 (71% women; mean age, 46 years; mean BMI, 38.2 kg/m²). All studies reported a measure of weight change at 12 months or more from baseline; median length of initial VLED intervention was 10 weeks; median energy content was 463 kcal per day.
Participants assigned to VLED plus a behavioral intervention program lost an average of 3.9 kg more than adults assigned behavioral intervention alone at 12 months (10.3 kg vs. 6.4 kg; 95% CI, –6.7 to –1.1). Participants in the VLED plus intervention group saw continued sustained weight loss at 24 months (mean of 1.4 kg difference; 95% CI, –2.6 to –0.2) and at 38 to 60 months (mean of 1.3 kg difference; 95% CI, –2.9 to 0.2) vs. those assigned intervention alone, according to researchers.
The proportion of adults who discontinued the program was similar between groups (19% for VLED vs. 20% for behavioral intervention). One study reported one serious adverse event in the VLED group, cholecystitis; the majority of other adverse events were mild and transient (fatigue, dizziness, cold intolerance).
“Adding a VLED to a behavioral weight-loss program produces greater weight loss in the medium and longer term than a behavioral program alone,” the researchers wrote. “Such programs appear well tolerated. Current advice against their use for routine weight loss in medical clinics should be reconsidered.” – by Regina Schaffer
Disclosure: Parretti reports being sponsored by Ethicon to attend Royal College of General Practitioners (RCGP) conferences in 2014 and 2015 to promote the work of the RCGP nutrition group. Please see the full study for the other authors’ relevant financial disclosures.
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