Year-long weight loss treatment for obese patients with type II diabetes: Does including an intermittent very-low-calorie diet improve outcome?
Abstract
Purpose To evaluate a year-long behavioral weight control program, used with and without an intermittent very-low-calorie diet (VLCD) in the treatment of type II diabetes mellitus. Patients and methods Subjects (n = 93) were randomly assigned to 50-week treatment programs that used either a balanced low-calorie diet (LCD) of 1,000 to 1,000 kilocalories (kcal) per day throughout or included 2 12-week periods of a VLCD of 400 to 500 kcal per day alternating with the balanced LCD. Weight, glycemic control, blood pressure, and lipids were assessed at baseline, at the end of the year-long treatment, and at 2-year follow-up. Results Subjects in the VLCD program lost significantly more weight than did LCD subjects at the end of the 50-week program (14.2 kg versus 10.5 kg; P = 0.057) and remained off diabetes medication longer (P < 0.05). These benefits of the VLCD were due primarily to the first 12 weeks of the diet; the second diet maintained, but did not increase, these effects. Subjects in both groups experienced marked improvements in glycemic control and cardiovascular risk factors over the year-long program, but attendance declined in the latter weeks of treatment and weight was regained. There was also marked recidivism in both groups in the year following treatment. Conclusions The intermittent VLCD improved weight loss and glycemic control, but these effects were quite modest and do not appear to justify the clinical use of an intermittent VLCD. Moreover, lengthening treatment to a full year did not prevent relapse. Thus, further research is needed to develop a successful approach to long-term weight control.
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Simply alternating between different levels of energy intake (while still maintaining a degree of ER) during a dietary intervention appears to be no more effective than using a continuous fixed level of ER.
“On the other hand, simply alternating between different levels of energy intake (while still maintaining a degree of ER) during a dietary intervention appears to be no more effective than using a continuous fixed level of ER.50, 51”
From Intermittent energy restriction improves weight loss efficiency in obese men: the MATADOR study (2018) · cites this paper as [51]
The VLCD approach is necessarily temporary, with weight regain and impaired glucose control typically occurring within 3-6 months of reintroduction of substantial proportions of dietary carbohydrates.
“This approach is necessarily temporary, however, with weight regain and impaired glucose control typically occurring within 3–6 months of reintroduction of substantial proportions of dietary carbohydrates (9, 18–20).”
VLCDs providing <900 kcal/day allow rapid discontinuation of most medications, improved glycemic control, and weight loss.
“VLCDs providing <900 kcal/day allow rapid discontinuation of most medications, improved glycemic control, and weight loss.”
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- Authors
- Wing, R. R., Blair, E., Marcus, M., Epstein, L. H., & Harvey, J.
- Affiliations
- University of Pittsburgh (US)
- Corresponding author
- Wing, Rena R.
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 1994-10
- Volume
- 97
- Issue
- 4
- Pages
- 354-362
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W2026654554
- Cited by
- 228
- References
- 35
- Citations by year
- 2025: 2 · 2024: 6 · 2023: 4 · 2022: 9 · 2021: 6 · 2020: 11 · 2019: 8 · 2018: 6 · 2017: 11 · 2016: 7 · 2015: 10 · 2014: 6 · 2013: 3 · 2012: 11
- FWCI
- 3.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01dk029757-15)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK 29757)
- Topics
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Keywords
- type 2 diabetes, obesity, hypocaloric diet, weight loss, behavioral weight control, glycemic control, weight regain, relapse, cardiovascular risk factors
- MeSH terms
- Adult, Aged, Analysis of Variance, Energy Intake, Diabetes Mellitus, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Obesity, Obesity, Morbid, Time Factors, Weight Loss, Cognitive Behavioral Therapy, Treatment Outcome
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