Nonphysician supervision of a very-low-calorie diet. Results in over 200 cases

Nonphysician nutritional therapists treated 234 obese patients with a 12-week behavioral modification, nutrition education program followed by up to 12 weeks on a very-low-calorie diet (VLCD). Mean weight decreased from 104.5 kg to 85.8 kg after 12 weeks on VLCD. Mean maximal weight loss for all patients was 17.2 kg. Blood pressure decreased from 133/86 to a low of 111/70 during VLCD. In 91 hypertensive patients, blood pressure fell from 145/95 to 128/81 after 12 weeks of VLCD. No serious side effects of VLCD were noted, although two patients developed mild cases of gout and one patient was taken off the fast when premature ventricular contractions were noted on ECG. Cost analysis reveals that physician care is almost three times as expensive as care by non-physician nutritional therapists. We conclude that the treatment of obesity should be performed by nutritional therapists under physician supervision using a comprehensive program of behavioral modification and VLCD.