LCD and VLCD

Norman Hardi Utama

Rendy Andika
Weight-Reducing Diets
calorie intakeenergy deficit, weight
loss
Reducing diets based on calorie content:
Balanced-deficit diets
Low-calorie diet
very-low-calorie diets
Low-Calorie Diets
Low-calorie diets (LCDs) contain 800 to 1500 kcal/day
indicated for people with:
BMI 30
OR {[BMI 25 to 29.9 OR waist circumference > 35inch in (F) > 40 inch
(M)] AND 2 risk factors}.
The risk factors:
cigarette smoking
hypertension
high-risk low-density lipoprotein (LDL) cholesterol
low high-density lipoprotein (HDL) cholesterol
impaired fasting glucose
family history of premature coronary heart disease
Age 45 years for men or age 55 years for women (or
postmenopausal).

Contraindications

>30 randomized trials have shown that LCDs
produce losses of approximately 8 to 10% of
initial weight in 16 to 26 weeks of treatment
Benefit:
helps prevent stroke, heart disease, hypertension,
and high blood pressure, lowers cholesterol levels,
decreases risk of Type 2 diabetes
Adverse effects:
fatigue, constipation, nausea, diarrhea and the
formation of gallstones (less food consumption
gall bladder contraction)

LCD in practice
Traditional LCD diet of self selected foods
Failed?
Portion controlled LCDfixed amount of food
Liquid meal replacement LCD2 meals and 2
snack replaced with liquid shake and bars
both produce more significant weight loss
(obese persons underestimate their calorie
intake up to 50%)
Very Low Calorie Diet
An option for those failed with LCD
Preparation for bariatric surgery
By definition <800calorie/day
Alternative definition: <50% of REE
Induces approx. 15-20% loss of initial weight
in 12 weeks


Risk vs Benefit vs Cost
The National Task Force on the Prevention and
Treatment of Obesity,
34
recommend that
VLCDs are restricted to those:
With a BMI of >30
Who are well motivated
Who have failed at more conservative approaches
Have a medical condition that would be
immediately improved with rapid weight loss e.g.
severe obstructive sleep apnoea.

Contraindications
Unstable cardiac or cerebrovascular disease
Acute and chronic renal failure
Severe or end stage liver disease
Psychiatric disorder that could interfere with
compliance

1988: Oprah winfrey lost 67 pounds(30KG)
1990: all weight loss regained, announced
would never diet again
2004: >200.000 Amerricans used VLCDs
Except France, VLCD is available over the
counter in EU nations.
Total food cost:
3000-3500USD
Baseline Predictors for Greater Weight
Loss Through VLCD
Women
Having more children
Lower education
Better perceived physical
health
R
2
=12.7%

Men
Better ambulation capacity
Living w/partner or children
Snacking on ice cream more
often
R
2
=39.4%


VLCD
100% RDA essential vitamins and minerals
70-100g protein/daypreserve lean body
mass
Source of protein:
milk, soy, or egg-based powder mixed with water
Lean meat, fish, fowl
+2L/d non-caloric fluid
Followed by 12-14 weeks of refeeding and
weight stabilization
Rapid Weight Loss Period
Monitored at least every 2 weeks
risk of gallstones, cold intolerance, hair loss,
headache, fatigue, dizziness, volume depletion
(with electrolyte abnormalities), muscle cramps,
and constipationussually mild
Gallstones25% patients during 8 weeks VLCD,
6% required cholecystectomy. +12% develop
asymptomatic gallstones within 6 months, half
eventually required cholecystectomy

The risk can be decreased by
ursodeoxycholic acid
Moderate amount of fat in the diet(>7g)
Limitting the rate of weight loss to 1.5kg/wk
Safety
60 recorded deaths in US, most developed
cardiac complications after an average of 4
months diet.
No death were reported in <8weeks
Efficacy for weight loss
Short term:
VLCD>LCD: 16.1 + 1.6% vs 9.7 + 2.4%
Mean difference: 6.4 + 2.7% (p=0.0001)
Long term(2 years):
Comparable, about 6%
VLCD and LCD patients regained 62% and 41% of
lost weight, respectively.
Ketotic and non ketotic VLCD have comparable
hunger level and weight loss


References
Gripeteg L, Karlsson J, Torgerson J, Lindroos AK. Predictors
of Very Low Energy Diet Outcome in Obese Women and
Men. Obes Facts 2010;3: 159-65
National Heart, Lung, and Blood Institute and North
American Association for the Study of Obesity (NAASO).
Practical Guide to the Identification, Evaluation, and
Treatment of Overweight and Obesity in Adults. Bethesda,
M D: National Institute of Health, 2000.
Shils, Maurice E, Shike, et al. Modern Nutrition in Health
and Disease. 10th edition. Lippincott Williams & Wilkins
2006. Ch64: Obesity:Management.
Tsai AG, Wadden TA. The Evolution of Very Low Calorie
Diets: An Update and Meta-analyses. Obes
2006;14(8):1283-93