Modified Fast: A Sometime Solution to a Weighty Problem
Segal, Marian, FDA Consumer
Overweight is a hefty problem in the United States. It's estimated that 24 percent of men and 27 percent of women in this country-about 34 million adult Americans-are obese. And sometimes it seems that there are 34 million different diets or diet products promoted to combat the problem. The latest to win the nation's fervent attention is a revival of a sort-a return to very low calorie diets, generally 400 to 800 calories per day.
Very low calorie, or "modified fasting," diets, as they are sometimes called, are not a new concept. Protein formula products (either liquid or powdered) were popular more than a decade ago until serious health effects-including several deaths-dampened the public's enthusiasm and led to new federal requirements for labeling of these products (see accompanying article, "Protein Diet Warning").
New Product, New Program
The modified fast regimen is enjoying renewed popularity, but today's very low calorie diet products differ markedly in both content and use from those of the past. While many of the formulas of the '70s were directly available to consumers through supermarkets and other retail outlets, the newer products are sold only to doctors or hospitals for use in medically supervised programs that include frequent medical examinations and behavior modification training.
Some dieters using the old products subsisted on as few as 300 calories per day of a nutritionally deficient product consisting primarily of a poor-quality protein (usually a hydrolyzed gelatin). Unlike the old diet formulas, today's Optifast, Medifast, HNM, and similar products contain a high-quality protein (egg white- or milk-based), carbohydrates, and some fat and are supplemented to meet recommended dietary allowances for vitamins, minerals and electrolytes. They are not a panacea, however, and, as the American Dietetic Association recently warned, they are not for everyone.
The comeback of very low calorie diets had been fairly quiet until last winter, when they were catapulted into the limelight by talk show host Oprah Winfrey. With some flair, Winfrey demonstrated on national television how she won the battle of the bulge with Optifast. Carting 67 pounds of animal fat on the television set to dramatize how much extra weight she had been carting around in her body pre-Optifast, Winfrey made quite an impact on her viewers-and many more of the nation's dieters who learned about her transformation from newspapers, magazines, television, and radio.
That Lean and Healthy Look
Shedding that 67 pounds not only took inches from Winfrey's torso, it may add years to her life as well. For the problem of obesity is not simply a matter of whether a "slim, svelte" look is or is not more appealing than one that's "pleasingly plump." Observations from the famous Framingham Heart Study, in which several thousand members of the small Massachusetts town have been followed medically since 1948, have shown that a 20 percent excess over ideal weight constitutes a health risk.
Overweight has been linked to a long list of health problems-high blood pres sure, respiratory problems, nighttime sleeplessness and (resulting daytime sleepiness), heart disease, diabetes mellitus, elevated blood lipids, gallstones, arthritis, and some cancers-including that of the breast, endometrium and gallbladder in women, and colon, rectum and prostate in men.
Like Winfrey, "Karen," who asked that her real name not be used, has been battling the bulge for years. A 41-year-old registered nurse, Karen has been on one diet or another almost continuously since she was 15 years old, losing and regaining pounds for 26 years.
And, like Winfrey, Karen lost 67 pounds on Optifast. Hers was a 20-week program that consisted of 12 weeks of fasting," six weeks of "refeeding," and two weeks of maintenance. During the fasting phase, Karen subsisted on five packets a day of an 85-calorie powder formula reconstituted with water or a very low calorie diet beverage with no sodium or caffeine. …