Modified Fast: Overweight Problem : Part 2

by Food and Drug Administration (FDA)

(Page 2 of 3)

Other known adverse side effects of rapid weight loss include cold intolerance, dry skin, constipation, potassium deficiency, excess uric acid in the blood, gallbladder inflammation, and psychological changes ranging from elation to depression.

On the positive side, Kirschner and colleagues found that complications of obesity among the group including high blood pressure, Type II diabetes mellitus, and elevated blood lipids improved markedly. Unexplained sudden deaths, such as occurred with use of protein products in the 1970s, have not been reported with use of the improved formulas.

The American Dietetic Association is cautious about fasting diets, nevertheless. In a statement released in May 1989, the association noted the serious health hazards posed by very low calorie diets and warned that they should be undertaken only with the supervision of a multidisciplinary health team that includes monitoring by a physician and nutrition counseling by a registered dietitian.

According to the association, very low calorie diets have poor long-term results: Evidence shows that a high percentage of dieters regain over half the weight lost in the program. To improve these statistics, the association encourages follow-up with continued nutrition counseling, increased aerobic exercise, relaxation techniques, and behavior modification.

Behavior Therapy Key to Success

In a study of 59 subjects, Thomas A. Wadden, M.D., and Albert J. Stunkard, M.D., of the University of Pennsylvania School of Medicine compared the effectiveness of three different weight-loss regimens: very low calorie (400 to 500 calories) diet alone, behavior therapy with a 1,000- to 1,200-calorie diet, and very low calorie diet plus behavior therapy. After following the dieters for one year, they concluded that:

Weight is regained rapidly after treatment by very low calorie diet alone.

Behavior therapy produces favorable long-term results when used with either a conventional 1,200-calorie diet or a very low calorie diet.

Weight lost in behavioral treatment is associated with improved psychological functioning.

Karen knows well the problem of regaining weight. According to her, getting the weight off is not the issue. ?Most very heavy people have gained and lost weight millions of times, she says. They know how to lose weight. They don't know how to maintain weight.

She describes the refeeding phase of the Optifast program as a type of re-entry process. Okay, now you're allowed a little bit of food, she says, and then you're opening the refrigerator again and you've got to start making choices you've got to deal with all that again. She, too, believes that the emphasis in any low-calorie program must be on maintaining the loss. The program she took provided 14 weeks of relapse-prevention classes at the end of the 20-week diet.

So how has she fared up till now three years after the program? Of the 18 people who started in my group, only five finished, she recalls. Only three of the five went to relapse prevention, and I was the only one who stuck it out to the end.

Karen regained 6 pounds almost immediately after beginning maintenance; that is, when she began eating three meals a day and calculating on her own. I maintained the remaining 61-pound loss for a good while I'd say a year and a half and then I got sloppy, she says. Up until then, she had been religious about writing down every morsel of food that went in my mouth, drinking two quarts of water a day, exercising daily.

Karen has gained back a total of about 18 pounds most of them after she quit smoking a few months ago and is back to rigorous dieting, but not fasting. She says she exercises daily, eats the amount of calories she was instructed to eat, drinks two quarts of water a day, and is gaining weight anyway. She says, I'm concerned about my ability to lose weight on food again.

The Yo-Yo Syndrome

No one debates that maintaining weight loss is a bigger problem than taking the pounds off. One theory holds that the body's survival mechanism for protecting against starvation contributes to the difficulty in keeping slim. Strenuous dieting causes the body's metabolism to slow down in order to maintain vital functions. When caloric intake increases, metabolism speeds up again.

Some research indicates that repeatedly losing and regaining weight can lead to permanent damage to metabolism, resulting in the so-called yo-yo effect a vicious cycle whereby the more you diet, the slower your metabolism becomes and you must eat even less in order to maintain weight loss.

Another theory is that each person has a control system that sets how much weight, or fat, he or she should have. This set point theory holds that our bodies are programmed to level off at a certain weight, and no matter how much we lose, the set point will bring us back up to our original weight once we stop dieting.

Whether or not these theories are eventually proven to be scientifically valid, most experts agree that crash diets for a few days or weeks accomplish little of permanent value and that for a diet to be successful in the long term, it must be tailored to the individual patient.

As for Karen, she says, I know the statistics are abysmal. But I think what's important is to not say you're finished. It's important when you lose weight on a diet never to say, Phew! I've got that beat, because you don't.

WARNING: Very low calorie protein diets (below 400 Calories per day) may cause serious illness or death. Do Not Use for Weight Reduction in Such Diets Without Medical Supervision. Not for use by infants, children, or pregnant or nursing women.

In the spring of 1984 the Food and Drug Administration published a final rule in the Federal Register requiring that the above warning appear on protein products promoted for weight reduction.

The new regulation grew out of numerous reports of deaths associated with the use of very low calorie weight reduction regimens beginning in the late 1970s. An investigation by FDA and the federal Centers for Disease Control revealed a pattern of sudden death or death from irreversible abnormal heart rhythms in people who had been dieting for prolonged periods and had lost large amounts of weight.

About the Author

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