Program I (VLCD): 700-800 kcal weight loss diet plan utilizing medically formulated high protein supplements. When used under a physician’s supervision this nutritional program is both safe and effective in producing very rapid weight loss. Patients are seen in the office every week throughout the VLCD to monitor the safety and effectiveness of the program, looking for potential side effects from the fast. Following the JAMA August 25, 1993 article which will help you better appreciate the science behind VLCDs, you’ll find a section on the common side effects and potential complications of a VLCD titled ‘medical supervision of a VLCD’ which is required reading. This section will help you find potential pitfalls, complications and side effects of a VLCDs. The role of the VLCD is to obtain rapid and significant weight loss which is followed up with a gradual and supervised return to table foods over time. Once you start a patient on a VLCD you must see them within 7 days of the start of the fast then every other week for as long as the patient is on the fast or VLCD and monitor the appropriate lab and physical findings. You’ll also be asked to participate in group and educational programs as well. Your clinical staff will see patients on the weeks you do not to monitor vital signs, weight loss and side effects, so the patient is in the office weekly throughout the VLCD program.
Following the section on ‘medical supervision of a VLCD’ you’ll find a section on the ‘rationale for meal replacement nutritional supplements which explains the clinical rationale for taking complete control over the patient’s quality and quantity of calorie intake through portion control which becomes vital for long-term success. In this section you’ll find peer review references supporting the use of meal replacement supplements. Next you’ll find patient handouts summarizing the VLCD that each patient should receive. In this chapter you’ll also find a diet schedule (the prescribed time of supplement intake) and an outline of total calories and protein intake, followed by a price guide, and finally a cost comparison sheet that compares the cost of the nutritional supplements to grocery foods showing the financial savings of using nutritional supplements over grocery foods.
Patients may choose to enter Program I (VLCD) for 12-24 weeks. Studies show that patients lose the greatest amount of weight regardless of the techniques employed within the first 24 weeks, so we strongly encourage our patient to complete at least 12 weeks in Program I before moving onto Program II. Some patients may enter Program I and drop out after a few weeks, which is o.k., at that point put them directly into Program II. Try to encourage all patients who qualify for a VLCD to start with Program I since this brings about the most significant initial weight loss. Rapid weight loss will helps keep patients engaged in the weight loss process. Those who cannot or will not start in Program I can be started in Program II, only those who complete a full 24 weeks in Program I, Program II or some combination of these two programs may progress to Program III. In most cases there is no need for anorectic medications in Program I since these patients are mildly ketotic and thus have no appetite. Patients should lose their appetite in 4-5 days of the VLCD. If they complain of hunger they may be eating carbohydrates, which takes them out of the mild ketosis. Carbohydrates levels above 50 grams a day will stimulate hunger. Anorectic medications may be used when absolutely needed during Program I the VLCD (see chapter 3 for more on the use of anorectic medications) but keep in mind these medications seem to lose their effectiveness in 3-6 months so delay the use of them for as long as possible. Medications are best used when the patients return to eating ‘real’ foods (higher carbohydrates) which stimulate appetite.