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Very-low-calorie diets: downsizing the hospitalised obese patient.

Article Excerpt
Abstract

The rising prevalence of obesity and its associated morbidity and mortality are placing significant strain on Australia's health-care system. The present case study examines the weight loss attempts of a 60-year-old male patient weighing 218 kg (body mass index 69 kg/[m.sup.2]) in the setting of an acute hospital ward. The patient was confined to bed, secondary to a previous above knee amputation, and was unable to be transferred or fit safely into a wheelchair because of his weight. He was also unable to return home alone because of his current size. Because of the need for rapid weight reduction, a novel inpatient approach to weight loss was adopted, using a very-low-calorie diet (VLCD) and multidisciplinary team management. The VLCD intervention was prescribed in conjunction with medical management, regular physical therapy, behaviour therapy and dietary counselling. Serial anthropometric and biochemical measurements were obtained throughout the treatment period. The patient achieved an 80-kg weight loss (37% initial body weight) over a six-month hospitalisation. Improvements in obesity-related comorbidities and the patient's functional and independence level were also observed, enabling discharge from hospital to residential care. Total weight loss at 24 months post hospital discharge was 103 kg (47% initial body weight). The use of a VLCD in a motivated individual in a controlled hospital environment, along with input from the multidisciplinary team, resulted in substantial and sustained weight loss with improved health outcomes.

Key words: comorbidity, hospitalised, multidisciplinary, obesity, very-low-calorie diet, weight reduction.

INTRODUCTION

The health risks associated with morbid obesity (body mass index (BMI) > 40 kg/[m.sup.2]) and the difficulties in achieving long-term weight loss in these individuals are well documented. (1-3) The fact that 67% of Australian men and 52% of Australian women are now considered overweight or obese (4) necessitates a broadening of traditional approaches to obesity management. Dietary intervention is still the most common therapeutic tool to combat obesity. However, the success of long-term weight loss through dietary treatment alone, especially in the morbidly obese, is limited and poorly researched. (3)

Currently, bariatric surgery is the only documented approach to achieve significant and lasting weight loss in obese individuals. (1) A recent review reports a mean excess weight loss of 16-43% over three to eight years post bariatric surgery. (4) However, considering the large proportion of obesity in our population, this option is limited in its availability in Australia. Successful non-surgical strategies are required to tackle this growing health problem.

Rapid weight loss for morbidly obese individuals has been demonstrated with the use of very-low-calorie diets (VLCDs). (1,2,5,6) VLCDs generally provide 3350 kJ (800 kcal) or less of energy per day and aim to induce substantial weight loss by means of a 'modified fast' while avoiding the reduction in metabolic rate, severe negative nitrogen balance and electrolyte disturbances associated with starvation. (7) The National Task Force on the Prevention and Treatment of Obesity reported that 90% of patients treated with VLCDs in randomised trials lose 10 kg or more within six months. (7)

With an ever-increasing demand on hospital resources and the need to ensure timely patient care and reduced length of stay, the economic burden of obesity in the healthcare system is significant. Despite this, there are...

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