Dear DOCTOR Owen:

I wanted to participate in a very low calorie diet (VLCD) program to lose weight and control my diabetes, as well as improve my back pain. But, my doctor would not refer me. He said that it would be “nonsense” and that I would re-gain the weight in a few years. I know that diets have poor results over the long term. Do you have any statistics on my chances?

Stuck in Reverse

Dear “Reverse”:

You might be surprised at how wrong and outdated your doctor’s thinking is. Say, you have lung cancer, and that the media, numerous testimonials, and many recent studies show that a certain new treatment has proven very effective in curing that disease. Would your doctor refuse to refer you to that therapy also? Lung cancer is, sadly, very debilitating. Historically, the five-year cure rate is approximately 5%. And, treatment with radiation, chemotherapy, surgery, and testing for a year would probably exceed $100,000. It seems to me that a doctor would urge you to undergo a therapy that shows positive results. Even the most poorly designed and run Diet Therapy program has better results than those just mentioned for lung cancer.

Your physician is uninformed and probably unconsciously prejudiced. The mantra taught to doctors in medical schools is that diets fail 95% of the time; the doctors’ experience probably backs up that view. Researchers at the University of Kentucky performed a meta-analysis* of diet program outcomes from 1989 to 1999. They evaluated two types of diet programs. The first were very low calorie diets (VLCDs) that use a liquid food supplement for the weight-loss phase, supported by behavioral education and maintenance. The second was a typical exchange-type diet that uses foods averaging 1200 calories, and was also supported by behavioral education and maintenance.

The subjects in both groups were similar in age and initial weight, and had similar medical problems. The VLCD dieters lost more than twice as much weight, averaging 50 pounds. At five years, the VLCD group was maintaining 30% of the weight lost. The low-calorie food dieters, on the other hand, were able to keep off 15% of their original weight. (Keep in mind that most of the subjects in both groups would have gained weight, based on historical data, during the same time period.) Even the 15% weight loss maintained is associated with substantial health benefits. The “gold standard” stated by the National Institutes of Health and Centers for Disease Control is that even a 10% weight loss results in substantial health benefits.

The researchers also looked at groups participating in long-term maintenance programs. Here, the data were even more impressive. At more than five years, the subjects were keeping off 50% of their original weight lost! Even more striking: 77% of the patients were still attending behavioral education classes on a regular basis. Their message was the same as the one at my clinic: The process is forever. The day you think you have a serious weight-related problem totally under control is the day you start to relapse.

The researchers summarized why the program reported on above succeeded:

1. Long-term follow-up enhances training.
2. Exercise is important for maintenance.
3. Vegetables/Fruits promote satiety and health in volumes of five servings/day or more.
4. Meal replacements decrease calorie intake.

The unfortunate reality is that your physician probably does not have, and is unaware of, any programs like the ones discussed here. Intensive programs are expensive (not 1/10th as much as the treatment for lung cancer!) because they require a team of professionals to evaluate, educate, motivate, and problem-solve as certain issues unfold. That team becomes a part of the life of anyone who is intent on achieving successful weight loss and weight maintenance. The notion that someone seriously participating in such groups will simply “see the light” is a dangerous delusion. Unfortunately, our medical and lay culture has not experienced reality—yet.

*A meta-analysis reviews all prior similar studies on a subject and gives an outcome to the whole. Many of the studies used here were of different diet programs and, certainly, with different patients and investigators.