Program III (Transition): In this phase, patients are transitioned to ‘real’ foods, beginning with the dinner meal which has been up to this time a package entrée. Patients are now asked to introduce 250-350 calories of real food into their diet utilizing the enclosed food exchange and meal plan outlines. The educational lessons delivered throughout Program I and Program II where patients were taught how to weigh, measure and count calories will be utilized in Program III to help them select real foods. Patients will be asked to count calories, measure and weigh food. You and your staff will review these diaries and monitor their weight to ensure that weight loss continues. First replace dinner with 250-300 kcal of real food see http://hp2010.nhlbihin.net/menuplanner/menu.cgi for a NIH meal planner to help patients count calories for this return to grocery foods. After 4 weeks if the patient continues to lose weight or their weight stays stable, begin to replace lunch with a 250-300 calorie meal from the meal planner. If the patient continues to lose weight or maintains weight loss after 4 more weeks replace breakfast. If the patient begins to regain weight take away a ‘real food’ meal and replace it with a meal replacement or protein supplement until the weight stabilizes again. Once the weight stays stable or moves down for a period of two weeks, replace the meal replacement or protein supplement with real food again and continue to monitor weight loss. What you will find is that many patients will not be able to replace all three meals and maintain weight loss, so one or two meals a day may remain as meal replacements or protein supplement. We strongly encourage all patients to continue to utilize at least two protein supplements a day in the transition diet. Women are asked to stay in the 1,200 kcal/day range and men in the 1,500 kcal/day range dependent upon their starting weight, goal weight, level of activity and your healthcare team’s recommendations. You may need to vary this daily calorie content to best fit the patient’s weight loss needs. Anorectic medications may be very useful during this stage of the weight management program. Please, review Chapter 3 on the use of weight loss medications.