Until 2025, obesity prevalence in Germany may rise up to 30% in adults, since 67.1% of men and 53% of women are overweight . According to the World Health Organization (WHO) data from 2016, a total of 26% of German adults and 10% of adolescents (10–19 years) have obesity . In addition, hip/waist circumferences, body fat and fat-free mass decreased significantly. There was no significant difference between the two diet intervention arms on outcome parameters. Improvements in insulin sensitivity, beta cell function, and quality of life were also demonstrated. With increasing prevalence of obesity and type 2 DM in Asian countries (Jayawardena et al., 2012; Nanditha et al., 2016; Yang et al., 2016), it is therefore critically important to investigate the effects of VLCD in this specific population. Furthermore, early beta cell dysfunction has been noted in Asian patients, resulting in development of DM at a younger age. At any given BMI, Asian patients tend to have more visceral adiposity than those European counterparts. A power calculation (Altman, Practical Statistics, 1998) was based on results from a clinical trial using a nylon cord to maintain weight loss . Compliance reported by the patients at the meetings was considered acceptable if the corset was used at least five hours per day and five days per week. All subjects received advice on healthy lifestyle throughout the whole study. After VLCD and an investigation by general practitioners (GPs) the participants achieving at least 8 kg weight reduction were randomized (sex-stratified, using sealed envelopes) to corset treatment (A) or no corset treatment (B). Www.eatright.org/health/wellness/diet-trends/staying-away-from-fad-diets. If you have a health condition, it is a good idea to talk with your provider before starting this or any diet plan to lose weight. You should only follow one of these diets with the help of your provider. For most people, it is safest to choose a diet in which you lose a 1/2 pound to 1 pound (225 grams to 500 grams) a week. Once you stop the diet, you are at risk for regaining the weight if you return to your old eating habits. Furthermore, all the women nominated LighterLife as their model weight-loss intervention.Read more. The experiences of women with polycystic ovary syndrome on a very low-calorie diet.Love JG, McKenzie JS, Nikokavoura EA, Broom J, Rolland C, Johnston KL (2016). A VLCD, very low calorie diet, isn’t about starving it’s a structured, science-backed approach for meaningful change. In that case, a low-calorie diet with exercise may be a better match. Choosing a very low-calorie diet is a big decision. The altered metabolites in obese subjects post-VLCD intervention include arachidonate, cis-11,14-eicosadienoate, cis-11,14,17-eicosatrienoate, 2-aminobutyrate, acetyl-carnitine, and threonate, all of which are involved in inflammation and oxidation processes. More studies are needed to evaluate long‐term efficacy beyond 18 months and determine the best time to start medications throughout the weight reduction program to avoid side effects. Additionally, larger sample sizes and longer‐term follow‐up are necessary to gain a more comprehensive understanding of the clinical outcomes observed in this study and to assess whether continued use of AOM maintains weight loss beyond 18 months or if further weight regain occurs. However, these findings are consistent with previous studies, further supporting the notion that AOM can be used in conjunction with other weight loss approaches. Furthermore, patients who withdrew from the OPTIFAST program early or lacked follow‐up data around the 18‐month mark were excluded from this analysis. To address this concern, future research could explore alternative methods for calculating weight regained that consider individual weight trends. The authors recognize that some participants may have started to regain weight before this time frame, while others might have continued to lose weight. One notable limitation pertains to the methodology used for calculating weight regained. The focus may lean more toward targeted comorbidity reduction rather than social pressure or the desire to appear thinner. Our study has several limitations, primarily the included study designs had a degree of heterogeneity, possibly explained by culture. This information is useful for clinicians and healthcare practitioners to share with patients. A study by Goff et al. comparing vegans and omnivores found a significantly lower concentration of IMCLs in the soleus muscle of the vegan cohort. Excess IMCL has cytotoxic effects on the mitochondria through overproduction of ROS and metabolic stress thereby promoting insulin resistance . Diets rich in fat increase intramyocellular lipid (IMCL) concentration through downregulation in skeletal muscle of mitochondrial oxidative phosphorylation genes . 8. Long‐term glycemic effects Can a VLCD be a realistic alternative to bariatric surgery for the super-morbidly obese? Weight loss commensurate with reversal of type 2 diabetes using a VLCD approach.Hallam CL, Broom J, Mullins G, Cox JSA, Hewlett B (2012). ‘Start weight and BMI are increasing year on year, which may be a reflection of our increasingly obesogenic environment. This large retrospective analysis suggests that the LighterLife Total VLCD could be an effective way for women with PCOS to lose weight. Despite the medication group having a greater frequency of diabetes, no significant baseline differences or predictors of weight recovery were found. Such a trial should ensure consistent initiation of AOM at the same phase of the lifestyle program, while control patients receive the same overall care without AOM. In this study, 6 months was selected as the reference point for assessing weight regain, which may not capture individual variations in weight trajectories. While some individuals may experience short-term weight loss, the lack of robust scientific evidence, potential health risks, and unsustainable nature raise serious concerns. Skipping this phase may increase the likelihood of experiencing severe hunger, fatigue, and other adverse effects during the subsequent weight-loss phase. This initial phase involves consuming a relatively normal diet, allowing your body to adjust to the upcoming restrictions. VLCDs caused significant decreases in weight (loss), parameters of the lipid profile, urea, insulin resistance, and reduced glutathione (GSH). This is the first study on the permanent genomic (in)stability in such VLCD patients. TABLE 1. In light of the extensive background of VLCD/TMR, this study adds valuable insights into the role of AOM in combination with meal replacements for weight loss. In this study, men were more likely to have diabetes, indicating potential differences in selection based on the motivation of referring physicians and male patients. This may be attributed to the use and effectiveness of type 2 diabetes medications that have weight loss and weight maintenance effects but are not approved as AOMs (such as other GLP‐1 agonists, SGLT2 inhibitors, and metformin). In this cohort, a difference in weight loss results between individuals with and without diabetes who were not taking AOM was not observed. During the study period, we solely considered semaglutide at doses of 1.0 mg or lower for treating type 2 diabetes mellitus (T2DM) or obesity, as higher doses were neither sanctioned nor accessible. For example, type 2 DM often develops in Asian patients at the lower BMI than that of European patients. Type 2 DM is a heterogeneous disorder, and certain differences have been observed among Asian and European patients (Ma & Chan, 2013). Interestingly, no significant differences in clinical characteristics were found between those who achieved and those did not achieve remission of diabetes at 12 months (Supporting Information Table S4). Using FPG and HbA1c cutoffs, diabetes remission was 35% at 6 months (30% by ITT analysis) and 24% at 12 months (20% by ITT analysis). There were no serious adverse events during the course of the study. A liver cirrhosis (what was unknown before) was diagnosed in 2 (2.9%) study participants. Comparison of liver fat content measured by MRI or histopathological Consequently, the number of patients with increased pathologic CrP dropped from 46 to 37. Table 1. This combination of meal replacement drinks and low-calorie diets has proven to be effective when researched. Typically, it involves eating 800 calories or less as a way to speed up the weight loss process. In a nutshell, a VLCD program is a clinically supervised weight loss plan that involves restricting the number of calories you consume for a specific period of time. The metabolites responsible for the differentiation of metabolic profiles of obese subjects; or obese subjects with 4 weeks intervention; or obese subjects with 8 weeks intervention, from controls and metabolic profiles of obese subjects with 4 weeks intervention; or obese subjects with 8 weeks intervention from obese subjects were obtained using a univariate statistical analysis, Mann Whitney U test. Here we applied a comprehensive metabonomics approach using an ultra-performance liquid chromatography-quadrupole time of flight mass spectrometry and gas chromatography-time of flight mass spectrometry to study the effects of an 8-week dietary intervention with VLCD on serum metabolic profiles in obese subjects. A prospective, well‐controlled study that excludes these medications in patients with diabetes would be necessary to determine whether VLCD/TMR programs yield similar weight loss results in both diabetic and non‐diabetic populations. Meal replacements, including those utilized in very low‐calorie diets (VLCDs) and total meal replacement (TMR) programs, have demonstrated their effectiveness as powerful tools for short‐term weight loss. The first step to a healthier you starts here. Talk to our experts now To our knowledge, only one preliminary report of a very short‐term VLCD in obese Chinese subjects with type 2 DM had been published (Liu et al., 2015). Data on caloric restriction in Asian patients with obesity and type 2 DM, however, are relatively scarce, and its long‐term durability is unknown. Even among Asian patients, in fact, differences in ethnic‐specific diabetes phenotypes also exist between East Asians and South Asians (Maskarinec et al., 2009, 2015). Rapid improvement in glycemic control leading to short‐term diabetes remission is observed. Figure 1. Analysis of client records showed that 86.2% of all obese individuals who sought to join the LighterLife Total VLCD weight-loss programme in 2014 presented with no obesity-related co-morbidities and did not require any medical supervision. When done correctly, a VLCD very low-calorie diet can offer a range of benefits, especially for those who’ve struggled with obesity for years. The body enters an excessive calorie deficit that forces it to use stored fat for its energy needs within the first stages of VLCD. If you’ve ever wondered whether drastically cutting calories can fast-track weight loss, especially when nothing else seems to work, you’re not alone. Although these data are promising, the majority of VLCD studies have focused on weight loss and not T2D remission as a primary endpoint. The program involved twice monthly visits with a registered dietitian (RD) for 6 months, covering diet and lifestyle topics. Exclusions included patients on the program for less than 6 months, pregnant patients during or within the next 12 months, and patients undergoing bariatric surgery within the program or the subsequent 12 months. Inclusion criteria comprised men and women over 21 years old with a BMI ≥30 kg/m2, enrolled in the OPTIFAST program, and who completed the initial 6‐month program with additional 12‐month follow‐up weight data. After applying the inclusion criteria, 109 patients were excluded, resulting in a study cohort of 206 patients. Only semaglutide at doses of 1.0 mg or lower were included as higher doses were neither approved nor available for the treatment of type 2 diabetes mellitus (T2DM) or obesity. Demographic information, diabetes history, psychiatric medication usage, and data on FDA‐approved anti‐obesity medications (i.e., phentermine; phentermine‐topiramate; liraglutide; bupropion‐naltrexone; lorcaserin) were extracted from the EMR through manual chart review. The OPTIFAST program at UPMC is a medically supervised program utilizing Nestle's very low‐calorie diet products. ‘Of 4881 female patients that started the LighterLife Programme in 2005, 70% (3417) remained on the programme until at least week 12. Weight loss results for 4881 females who started the LighterLife Programme in 2005 and who completed at least 12 weeks. Randomized clinical trial of standard dietary treatment versus protein-sparing modified past or the LighterLife Programme in the management of obesity. Baseline characteristics of the patients before the run‐in period are shown in Table 1 and Supporting Information Table S1. Analysis of variance (ANOVA) with repeated measures was used to detect changes in metabolic parameters over time during the study periods. Assuming a 2‐sided significance level of 0.05, 18 subjects were needed to provide 90% of power to detect differences in an expected proportion of 0.95. In order to lose weight and keep this weight off, this patient needed to swap at least 1 meal a day out for a VLCD program shake. Because VLCD programs are considered to be quite restrictive, it's important to speak with your GP first to ensure you're managing your diet in a safe way. These products will provide all the essential vitamins and nutrients you need, while still being incredibly low in calories and helping you lower your energy intake. These diets are less commonly recommended by health care providers. To lose weight this quickly you eat very few calories. VLCD is able to attenuate metabolic perturbation in obese subjects, characterized by the less significant metabolic alterations. Mean weight (95% confidence interval), kg, before and after 4 weeks dietary treatment with fructose containing VLCD. The subjects underwent four weeks dietary treatment with VLCD Slanka®, Table 3, (Slanka Sverige AB, Sweden) corresponding to approximately 680 kcal per day (four portions). Seven subjects presented with type 2 diabetes mellitus (T2DM), four were treated with metformin, one with insulin and two had only dietary treatment. The aim of this observational study is to investigate the effects of fructose containing VLCD in obese subjects, prior to bariatric intervention, on selected metabolic variables. Blood samples including fasting plasma glucose, HbA1c, cholesterol and triglycerides were performed at start and after four weeks of diet. This can make it easier and more convenient to stick to the low-calorie limits and see a greater initial weight loss in a short space of time. Rather than worrying about portion size or your level of carbohydrate intake, very low-calorie diets take the guesswork out of mealtime. That's because a very low-calorie diet totally transforms your diet and replaces some (if not all) meals with protein-rich shakes and diet products. For people who are navigating obesity and looking for a rapid weight loss solution, VLCDs can offer large initial weight loss in a short space of time. Studies have shown that these foods can lower weight gain long term and ameliorate systemic inflammatory pathways involved in the disease processes of type 2 diabetes 53,54. There are several possible mechanisms which may help in explaining the favorable outcomes observed with plant-based diets. As both diet and exercise are two key components for the effective management of T2DM, this would be an important factor to consider for T2DM patients. Results from the five studies investigating vegan diets found no significant reductions in bodyweight, improvement in anthropometric markers or improvement in glycaemic control, compared with the control diets (conventional diabetes diets) 28,40,41,46,47. Our study assessed the evidence available to support very low-calorie diets (VLCD) and vegan diets for management of body weight and/glycemic control in patients with T2DM. Several obesity-related changes described herein confirm prior studies, including the higher levels of blood glucose, insulin and HOMA-IR in obese subjects compared to healthy controls.12 The OPLS-DA analysis of healthy controls and obese subjects revealed that obese subjects had a clearly distinct metabolic profile from healthy controls. ‘After eight weeks on the LighterLife Programme in 2008, a mean BMI reduction of 4.65 and a mean 14.8kg weight loss in male patients were observed… which is in excess of 12% of their body weight.’ ‘After 12 weeks on the LighterLife Programme, a mean BMI reduction of 6.5 and a mean weight loss of 17.5kg in female patients were observed… which is in excess of 15% of their body weight.’ A body of evidence demonstrates that adherence to VLCD in adults with type 2 diabetes (T2D) can result in marked improvements to glycemic control and even full T2D remission, challenging the convention that T2D is a lifelong disease. Seventy-one per cent of the weight loss was fat. However, the results from several studies demonstrated that insulin sensitivity did not alter after a short-term VLCD intervention for 5–7 days 4, 23. It was suggested that water may account for some of the initial rapid weight loss, but fat loss subsequently accelerated and lean tissue was preserved over a longer period, which may be the main cause of weight loss . In our study, we only observed a significant reduction of NEFA at week 8. They also contain 2.5g of VERISOL Collagen to help boost the appearance of your skin, as losing weight can often result in sagging skin if lost quickly and in excess. Our best-tasting VLCD shakes at IsoWhey are formulated with 24 vitamins and minerals to help you meet your nutritional requirements while losing weight. Weight-loss results for 1000 males following a male-specific weight management programme in 2007. The combination did not yield any additive effects on weight and body composition above VLCD alone, but did provoke greater improvements in pancreatic beta-cell function. Adding VLCD to Semaglutide stimulated further weight loss than Semaglutide alone. HbA1c and fasting glucose reduced significantly in all groups, however fasting insulin and HOMA-IR improved in VLCD and COMB only. VLCD and COMB resulted in a 5.4 and 7 percentage-point greater weight loss than SEM, respectively. The regional ethical review board approved the study and informed consent was obtained from all participants. However, it is crucial to understand that major medical organizations, including the FDA, have not approved HCG for weight loss. Proponents claim HCG is the key that makes the 500-calorie diet bearable and effective. The duration of Phase 2 depends on your individual weight loss goals. Very low‐calorie diets (VLCDs) employing total meal replacement (TMR) offer substantial short‐term weight loss. For those consuming 1 meal replacement shake per day alongside a low-calorie diet, you can lose up to 4% of your body weight in 12 weeks. Four weeks treatment with fructose containing VLCD of obese subjects preparing for bariatric surgery gave a substantial weight reduction without any significant negative metabolic effects. ‘A mean weight loss of 19.5kg (3st 1lb) following 8 weeks on the LighterLife Total for Men VLCD and a mean BMI reduction of 6.1 were observed in male patients.’ To report on the weight loss achieved in 8 weeks by 950 male patients on the LighterLife Total for Men VLCD weight-loss programme in 2009; a retrospective study. This study comprehensively examined various FDA‐approved AOMs, including phentermine, phentermine‐topiramate, liraglutide, bupropion‐naltrexone, and lorcaserin.To address this concern, future research could explore alternative methods for calculating weight regained that consider individual weight trends.So, in the transition phase, gradually include a balanced diet and regular physical exercise to prevent weight regain.Forest plot comparing mean fasting glucose levels after the consumption of low-fat vegan and control diets 28,40,41,46.The corset was to be used 12–16 hours per day, seven days per week for nine months.This diet involves replacing 1 or 2 meals with shakes or bars and can be used after a VLED or VLCD to slowly transition back to meals with whole foods.Demographics and clinical characteristics of healthy control and obese human are shown in Table 1. Standard mean difference favored a reduction in body weight after the VLCD diets. The results from all VLCD studies found no significant reduction in bodyweight or anthropometric markers compared with control. Forest plot comparing mean fasting glucose levels after the consumption of low-fat vegan and control diets 28,40,41,46. Standard mean difference favored no reduction in weight between vegan and control diets. Dietary restriction therapies for management and cessation of T2DM have mainly focused on weight loss through the implementation of either low-calorie diets (LCD) defined as 1200–1500 kcal/day 9,10,11 or very low-calorie diets (VLCD) ranging from 450–800 kcals/day . Therefore, a list of differential metabolites (Table 2) responsible for the separation between obese subjects before and after VLCD intervention was identified.Firstly, it provides a targeted insight on dietary approaches for patients with type 2 diabetes, which considers the most recent weight loss diets, acknowledging the shift toward plant-based eating.The corresponding fold change shows how these selected differential metabolites varied in the obese subjects before and after VLCD intervention from those of normal controls or in the obese subjects after VLCD intervention from those of obese subjects.The patients have been instructed to drink 2 l calorie-free beverages daily.Percentage body fat, total body water (TBW) and body cell mass (BCM) were measured by bioelectrical impedance analysis (BIA).At baseline and week 8, all participants underwent a 75-g OGTT in the morning after 10 h overnight fasting.Advantages of a VLCD are that they promote very rapid weight loss and thus can provide clinical efficacy in a short period of time, as well as often coming in liquid meal replacement form making it easier to ensure adequate vitamin, mineral, and macronutrient intake. Standard mean difference suggested no difference between VLCDs and non-dietary therapies in reducing weight. Standard mean difference suggested no difference in total cholesterol between either diet. Triglycerides were also unaffected by the diet approach; however, it is noted that the triglyceride levels were higher among patients in the vegan group. Of the nine RCTs, one study was deemed to be high risk of bias, five studies were moderate risk of bias, and three were low risk of bias. It also appears that VLCD induced significant metabolic alterations independent of the obesity induced metabolic changes.In that study, 5% weight loss reduces intrahepatic triglyceride by 13%; 11% weight loss reduced it by 52% and 16% by 65% .In most cases, an individual may choose New Direction initially and then transition into our second program–the Outlook program–when they are ready to begin utilizing food on a daily basis while losing weight.295 obese women with hypothyroidism achieve the same weight loss as those without hypothyroidism by following the formula-based very low calorie diet (VLCD) LighterLife Total for 12 weeks.Johnston KL, Haynes S, Dyson L, Capehorn M, Broom J, Cox J, Hewlett B (2014).Blood samples were analyzed for HbA1c, fasting plasma glucose (FPG), cholesterol and triglycerides.In obese patients preparing for bariatric surgery with VLCD there seems to be no negative metabolic effects regarding blood samples and laboratory analysis measured in this study. Changes in metabolic variables; weight, blood pressure, glucose and lipids After diet 10 of these were improved but 5 subjects still had elevated SBP. According to a review of health implications of fructose consumption , moderate fructose consumption of less than 50 g/day probably does not have any deleterious effect on lipid and glucose control. The development of a new VLCD formula (Slanka®) with fructose instead of aspartame raises questions as to effects on glucose and lipid control. ‘A mean weight loss of 18.9kg (3st) following 12 weeks on the LighterLife Total VLCD and a mean BMI reduction of 7.0 were observed in female patients.’ This is a mean BMI reduction of 8.5 and a mean weight loss in excess of 15% of their body weight in 12 weeks on the LighterLife Total VLCD.’ This corresponds to an average BMI reduction of 7.2…The LighterLife Programme can successfully assist obese women to lose in excess of 10% of their body weight in just 14 weeks. This corresponds to an average BMI reduction of 5.5… The LighterLife for Men Programme can successfully assist obese men to lose in excess of 10% of their body weight in just 8 weeks. ‘Average weight loss for 12 patients with BMI≥50 was 66.3kg (10st 6lb) in an average 34 weeks… The LighterLife Total VLCD enables super-morbidly obese patients (BMI≥50) to achieve a BMIECO 2010 p.8Can a VLCD be a realistic alternative to bariatric surgery for the super-morbidly obese? Methodological quality of studies was assessed using Cochrane RoB Tool for RCTs, Cochrane ROBINS-I RoB Tool for non-RCTs and NIH Quality Assessment tool for other studies. Always prioritize safety and consult with a healthcare professional before beginning such an extreme diet. It’s defined by its strict 500-calorie limit, a very specific list of approved foods, and the daily administration of HCG. Hip circumference was measured and reported in two studies 28,39. Standard mean difference suggested no difference in waist circumference between either diet. Standard mean difference suggested no difference in triglycerides between either diet. Standard mean difference suggested no difference in BMI between either diet. Risk of bias presented using Cochrane ROBINS-I tool for the non-randomized control trial . Subjects attaining ≥ 8 kg reduction were randomized to corset (A) or no corset (B) treatment for nine months. Participants, consecutively included in groups of 8–14 subjects, underwent three months of VLCD with lifestyle advice at group meetings. People who lose weight quickly are also more likely to gain back the weight quickly. Using the ratio of metabolite change over baseline (FC value), we also evaluated the correlation of this ratio versus the corresponding change of BMI, serum glucose level and insulin sensitivity at 4 weeks and 8 weeks within the sub groups of female and male participants, correspondingly.Thus, interventions to induce effective weight loss are anticipated to help reduce the prevalence and potential morbidity of both obesity and T2D.A total of 21 patients with type 2 diabetes were recruited during January 2014–June 2014, and 1 was later excluded due to meeting the exclusion criteria.The primary objective was to investigate the feasibility and cost-effectiveness of weight reduction using very low calorie diet (VLCD) in groups.This remains controversial and contradicts current recommendations for slower weight loss.Informed consent was obtained from all individual participants included in the study.With this clear differentiation, you can choose the right diet plan according to your situation and needs.Most mainstream medical professionals advise against it due to the severe calorie restriction and the unproven use of the HCG hormone. The corset used in this study was perceived as uncomfortable and suffered from poor compliance. The total cost per patient and year was calculated at SEK 4440 (treatment A) and SEK 1940 (treatment B). Costs for the Public Medical Service were for individual and follow-up meetings in groups (10 participants) for one year, for the GP 1 hour and 40 minutes, for the nurses 52 hours, and for the dietitian 13 hours. The resources spent during the first year were for the GP 112 hours, for the nurses 192 hours, and for the dietitian 90 hours. However, AOM + patients exhibited better weight maintenance and significantly less weight regain. Interestingly, there were no significant differences in weight loss percentages between AOM+ and AOM‐ groups. These findings were consistent with statistically significant mean differences from the baseline, indicating substantial weight loss at 3, 6, and 18 months. In the study, an analysis of 206 participants in the OPTIFAST program revealed that after 3 months, the cohort exhibited a significant TWL% of −14.22% (4.57), which further improved to −17.87% (7.02) at 6 months, which is highly consistent with prior studies. Conversely, the Liraglutide and Bupropion/Naltrexone group exhibited the highest weight loss (−15 kg) while Bupropion/Naltrexone alone users experienced modest regain (+7.27 kg). These findings were consistent with statistically significant mean differences from the baseline, indicating substantial weight loss at 3, 6, and 18 months.Our results support findings of Colles et al. and demonstrate a good tolerance of VLCDs.One important limitation of our study is the lack of a control group.The mean difference between the intervention and comparator group is stated alongside 95% confidence intervals (95% CI), p-values and I2 statistics to assess statistical heterogeneity .Plasma and serum samples were collected in the morning after overnight fasting at the beginning and at the end of the diet.Significant weight loss was accompanied by a significant reduction in IR and an increase in beta cell function, starting at 4 weeks of VLCD.Similarly, there were no significant changes in serum levels of AST and ALT at the end of the study (Table 1).All these beneficial effects might have been due to enhanced hepatic and whole-body lipolysis and oxidation. Plasma and serum samples were collected in the morning after overnight fasting at the beginning and at the end of the diet. Patients are in a supine position, the arms relaxed at the sides but not touching the body and thighs separated. The mean fat area of the 10 slices was computed and further used for analysis as described previously. The visceral adipose tissue and subcutaneous fat areas are determined by MRI scans. Liver fat content was assessed by 1H-NMR spectroscopy (blinded analyses). Viljanen et al. found that after 16 obese subjects underwent a 6-week VLCD, visceral adipose and abdominal subcutaneous fat decreased while whole body insulin sensitivity increased, but adipose tissue regional glucose uptake remained unchanged . As part of the personalized weight loss program developed at the Duga Resa Special Hospital for Extended Treatment, Croatia, we evaluated anthropometric, biochemical, and permanent DNA damage parameters (assessed with the cytochalasin B-blocked micronucleus cytome assay-CBMN) in severely obese patients (BMI ≥ 35 kg m-2) after 3-weeks on a 567 kcal, hospital-controlled VLCD. Although a very-low-calorie diet (VLCD) is considered safe and has demonstrated benefits among other types of diets, data are scarce concerning its effects on improving health and weight loss in severely obese patients. Weight loss was significant over the 12-week period, with a mean 19.7kg weight loss, representing a mean 62% excess weight lost across the three years examined.’In our study, we compare two commercially available liquid low-energy formula diets in a randomized, prospective setting.The number of patients with an increased pathologic bilirubin value dropped from 6 to 4.Taheri et al. reported mean changes of −5.60 mmHg and −2.24 mmHg in the intervention and control groups, respectively but this difference was not significant.There was no significant difference between the two diet intervention arms on outcome parameters.The greatest improvement was seen at the end of week 8, which was the end of the caloric restriction period.The body enters an excessive calorie deficit that forces it to use stored fat for its energy needs within the first stages of VLCD. New Direction: A Medically-Supervised Very Low Calorie Program (VLCD) Firstly, we did not measure the metabolic parameters at the first week which may contribute to interpret the acute effect of VLCD. One of the major hypothesis was that the reduction of triacylglycerol stores in pancreas and liver contributed to the normalization of β cell function . There were several mechanisms involved in the amelioration of β cell function and insulin sensitivity. Fat mass progressively and significantly decreased by 28% from week −2 to week 12. Effect of VLCD on anthropometric measurement, body composition, and quality of life This pattern mirrors the changes in glycemic control during the same periods. Each flavor come packaged as a powder which is mixed with water or any other non-calorie liquid. Contraindications for this program include liver or kidney disease, Type 1 diabetes, active ulcers or inflammatory bowel disease, bulimia, psychiatric disorders, pregnant or breastfeeding women and children or adolescents. Patients have access to our physicians by pager, if necessary, after hours and on weekends. Ketosis is a metabolic state where fat stores are being used as the primary fuel source as carbohydrate intake is restricted. Nutrilett (Cederroth International AB) with recommended calorie intake of 800 kcal per day was used and patients were advised to drink at least 2.5 litres of non-caloric liquids 12,18. Fasting blood glucose, serum uric acid, total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides were analysed at inclusion and after one year using standard methods (Capio Diagnostik AB, Skövde). The secondary aim was to examine whether treatment with a soft corset can maintain the weight loss achieved with VLCD. Anecdotally, weight reduction has been observed during treatment of scoliosis with the Boston corset, but no report has been found in the literature. Garrow showed in that weight reduction achieved by jaw fixation could be maintained by a nylon cord around the waist, prohibiting overeating. Because of the severe comorbidities of obesity, people attempt to lose weight through several alternative diets. Furthermore, the impact of low-energy diets prior to elective, non-bariatric surgery in patients with obesity is subject of ongoing research . In our study, liver fat after diet content dropped, determined by MRI, significantly of 18.35% over all patients; after diet with diet 2, the decline was higher with 21.51% vs. 14% after diet 1. In the study, it was demonstrated that this trend also holds true for newer FDA‐approved anti‐obesity medications. Previous studies have shown that adjunct pharmacotherapy with dexfenfluramine or sibutramine can minimize weight regain after VLCD treatment.21 Although these drugs have been withdrawn from the market due to adverse effects, the concept of combination therapy remains valuable. Studies have indicated that combining VLCD therapy with intensive lifestyle changes leads to longer‐term weight reduction, which is more successful than VLCD therapy alone. These findings suggest a potential role for anti‐obesity medications in long‐term weight management within the OPTIFAST program, warranting further investigation. Therefore, the magnitude of weight loss should not be compared to studies that employed an intention‐to‐treat analysis, and the results do not reflect the mean outcomes of all patients who initiate similar programs in a real‐world setting. These results underscored the complexity of obesity management and the potential benefits of combining various interventions to address both short‐term and long‐term weight control challenges. Individuals with diabetes tend to lose less weight compared to those without diabetes in lifestyle interventions, AOM trials, and metabolic surgery.13, 22 Insulin resistance plays a significant role in the trajectory of weight loss. There was a correlation between the reduction of body weight and liver volume (Fig. 1). Twelve patients in diet 1-arm and 9 in diet 2-arm dropped out from the study. Percentage body fat, total body water (TBW) and body cell mass (BCM) were measured by bioelectrical impedance analysis (BIA). The study was prospective, open-label, two-armed, randomized controlled mono-centre trial in an obesity treatment centre in a university hospital setting. In our study, we compare two commercially available liquid low-energy formula diets in a randomized, prospective setting. The International Diabetes Federation estimate that approximately 537 million adults (20–79 years) are living with diabetes. Type 2 Diabetes Mellitus (T2DM) is a global epidemic, driven by an increased prevalence of obesity in both children and adults . However, LDL cholesterol was significantly decreased by vegan diet.