Very Low Calorie Diet (VLCD) Meal Replacement Plans: An Informative Guide

Very Low Calorie Diet (VLCD) meal replacement plans have gained recognition since 2008. These plans involve replacing some or all regular meals and snacks with specially formulated, nutritionally complete food packs. These food packs include diet shakes, soups, meals, porridges, and bars. It is difficult to follow a VLCD without using Meal Replacement Products (MRP), both nutritionally and to avoid constant hunger.

Understanding VLCDs

A VLCD plan should not be considered a long-term replacement for a conventional balanced diet. Instead, consider a VLCD plan as a short-term weight loss option for those considered medically obese or overweight. It helps to drop weight fast and step away from conventional eating and bad eating habits. This can also decrease cravings for high-calorie, carbohydrate, and sugary foods.

To maintain a healthy weight, the recommended daily calorie intake is 2,000 for women and 2,500 for men. However, to lose weight, you need to decrease your calorie intake from these figures. Following a VLCD meal replacement plan, you will consume significantly fewer calories than stated above and, therefore, lose weight quicker than following a conventional calorie-controlled diet.

Is a VLCD Right for You?

Following a VLCD with your doctor's support is a safe and effective way to reduce body fat and lose weight fast. VLCDs are generally targeted at those with a BMI of 30+, however, your doctor may approve a VLCD for those struggling to lower their weight with a BMI of 27+ and may agree to support and approve its use. Those with a BMI of 40+ your doctor may recommend that following a higher calorie weight loss plan in the initial stages of weight loss is prudent.

Rapid Weight Loss Diets Explained

A rapid weight loss diet is a type of diet in which you lose more than 2 pounds (1 kilogram, kg) a week over several weeks. These diets are most often chosen by people with obesity who want to lose weight quickly. People on these diets should be followed closely by a provider, as rapid weight loss may not be safe for some people to do on their own.

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These diets are only to be used for a short time and are usually not recommended for more than several weeks. People who lose weight very quickly are much more likely to regain the weight over time than people who lose weight slowly through less drastic diet changes and physical activity. The weight loss is a bigger stress for the body, and the hormonal response to the weight loss is much stronger.

Most VLCDs use meal replacements, such as formulas, soups, shakes, and bars instead of regular meals. This helps ensure that you get all of the nutrients you need each day. A VLCD is only recommended for adults who have obesity and need to lose weight for health reasons. These diets are often used before weight-loss surgery. You should only use a VLCD with the help of your provider. Most experts do not recommend using a VLCD for more than 12 weeks.

VLCDs vs. LCDs and Other Dietary Approaches

Low-Calorie Diet (LCD): These diets usually allow about 1,000 to 1,200 calories a day for women and 1,200 to 1,600 calories a day for men. An LCD is a better choice than a VLCD for most people who want to lose weight quickly. You will not lose weight as fast with an LCD, but you can lose just as much weight as with a VLCD. An LCD may use a mix of meal replacements and regular food, making it easier to follow than a VLCD.

Time-Restricted Eating: This diet strategy limits the number of hours per day you can eat. A popular strategy is the 16:8, where you eat all your meals during an 8-hour period, for example, 10 am to 6 pm, and fast for the rest of the time.

Intermittent Fasting: This involves periods of fasting or very low-calorie intake. One of the most popular is the 5:2 system, which involves 2 days a week of fasting or VLCD and 5 days a week of eating your normal diet.

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Fad Diets: Some fad diets also severely limit calories to achieve rapid weight loss. In some cases, these diets are not safe, and in most cases, they are not sustainable for long enough to cause long-term weight loss. Once you stop the diet, you are at risk of regaining the weight if you return to your old eating habits.

The Role of Exercise

Rapid weight loss is more about cutting calories than exercising. Talk with your provider about what type of exercise you should do while you are on this type of diet.

Potential Health Concerns and Benefits

A rapid weight loss diet is usually for people who have health problems because of obesity.You should only follow one of these diets with the help of your provider. Losing more than 1 or 2 pounds (0.5 to 1 kg) a week is not safe for most people. It can cause you to lose muscle, water, and bone density. Rapid weight loss can also cause some side effects including:

• Gallstones
• Gout
• Fatigue
• Constipation
• Diarrhea
• Nausea

People who lose weight quickly are also more likely to gain back the weight quickly, which can lead to other health problems. In general, a rapid weight loss diet is not safe for children. It may also not be safe for teens, pregnant women, or older adults unless a provider recommends it.

The OPTIFAST VLCD Program

The OPTIFAST VLCD Program is a very low-calorie diet program consisting of 4 levels but is designed to be flexible and fit individual needs. If the Intensive Level is unsuitable, you can consider starting the program on either the Active 2 or Active 1 Level after consulting with your healthcare professional. On the Active 2 or Active 1 Levels of the program, your rate of weight loss will be slower than the Intensive Level.

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There are 3 Levels for active weight loss in the OPTIFAST VLCD Program: the Intensive Level, Active 2, and Active 1 Levels. The Intensive Level of the OPTIFAST VLCD Program is the Very Low Calorie Diet part of the program. This level is designed to achieve a large initial weight loss while helping to preserve lean body mass. You can stay on this level for anywhere up to 12 weeks; however, this period is variable and depends on your weight loss goals. If there is still a significant amount of weight to be lost at the end of the initial 12 weeks, it is recommended you follow the Active 2 Level for a minimum of two weeks before repeating the Intensive Level again. In some instances, if you are doing well on the Intensive Level and still have more weight to lose at the end of the initial 12-week period, your healthcare professional may advise for you to stay on the Intensive Level for longer.

The OPTIFAST VLCD Program Levels are intended to assist you to lose weight quickly. The goal of the remaining levels following completion of the Intensive Level is to assist you to continue to lose weight but also to develop healthy eating habits for the long term. The OPTIFAST VLCD Program should always be used under the supervision of a healthcare professional.

Key Components of VLCD Meal Replacements

The meal replacement product is a medically formulated, low-calorie, low-carbohydrate meal replacement product with high biologic-value (HBV) protein. The meal replacement product also functions to minimize side effects typically experienced with food-based VLCDs. No extra vitamins/minerals are needed; each meal replacement provides 33% of the Daily Value for vitamins and minerals.

Most people would be concerned about physical hunger while on a VLCD. However, the low-carbohydrate content of the meal replacement promotes a mild level of ketosis (typically by Day 3 or 4 after starting), which is associated with decreased hunger and cravings. Ketosis is a metabolic state where fat stores are being used as the primary fuel source as carbohydrate intake is restricted. To maintain ketosis while on the VLCD, it is important to avoid extra sources of carbohydrate during that time period. Ketosis is associated with potential side effects, however, medical monitoring and management helps minimize side effects. No travel outside of the country while on this program.

If considering bariatric surgery, one should be aware this program provides a NON-SURGICAL option for rapid weight loss and medical improvements WITHOUT the potential short and long-term risks associated with surgery.

VLCD Program Elements and Structure

Basic Qualification Criteria:

• 21 years of age
• BMI of 30 or a BMI of 27 with medical risks

Program Elements:

• Average weight loss rate of 3-5 pounds weekly; women typically in the lower range and men in the upper range.
• Exclusive use of meal replacement product to create a safer (compared to food-based) VLCD, mild ketosis, consistent weight loss results, and avoidance of nutritional deficiencies.
• Weekly medical monitoring is required and provided by nursing staff who monitor blood pressure, weight changes, and potential side effects, which may include dizziness, fatigue, constipation, diarrhea, gallstones, and hair loss.
• A monthly physician exam and labs are conducted by supervising physicians. An EKG is repeated with every fifty pounds of weight loss.
• Physician review of blood glucose logs and adjustment of medications throughout the weight loss phase is included as medical monitoring. Patients have access to physicians by pager, if necessary, after hours and on weekends.
• Group clinic/class conducted by staff:
  • Registered and Licensed Dietitian with advanced training in medical weight management and eating disorders
  • Behaviorists—Individuals who have master’s degrees in counseling, in social work, or licensed counselors
• Referrals for adjunctive therapy with psychologists or counselors, if indicated
• Clinic/class options midday, evening, and early morning, as enrollment needs indicate

Program Structure:

• Screening Phase consists of a medical exam, in-depth behavioral interview, nutritional questionnaire, and exercise questionnaire. Labs and an EKG are done as part of the medical screening. 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.
• Weight Loss Phase consists of consumption of meal replacements in a variety of flavors and textures: chocolate, vanilla, strawberry, pineapple apricot, lemon, hot cocoa, mocha, chocolate pudding, vanilla pudding, lemon pudding, cream of chicken soup, cream of tomato soup, and cheddar-broccoli soup. Each flavor comes packaged as a powder which is mixed with water or any other non-calorie liquid. Recipes are also provided where the product could be cooked to consume as pancakes, muffins, crepes, etc.

The Importance of Education and Support

While “tools” such as meal replacements have been shown to be helpful in weight management, they are likely to be ineffective as a “single solution” without additional education and training. During the phase of meal replacement use, the staff’s focus is on helping an individual become more aware of the emotional, psychological, and environmental reasons for overeating. Participants also discover skills, behaviors, attitudes, and resources which will support new lifestyle changes for balanced, healthy eating, and living. A long-term weight management plan will include whole grains, fruits, vegetables, low-fat protein sources, and regular exercise, in addition to the use of meal replacement products IF helpful specific to an individual’s needs.

Transitioning and Maintaining Weight Loss

• Adapting or Transition Phase is a series of four weeks of guided, structured meal plans which accomplishes a gradual transition from meal replacements to a full-food plan.
• Indirect Calorimetry Test and an Individual Appointment are conducted before entering the maintenance phase to confirm calorie needs before entering the maintenance phase.

A participant’s weight is assessed by zones—Green Safety Zone, Yellow Caution Zone, or Red Correction Zone—which then direct how frequently one should attend after the initial 12-week course. Research indicates that a two-year focus on practicing new behaviors and skills is consistent with optimal success.

On-going Support is offered with a free monthly support group meeting and a free weekly weigh-in clinic every Monday. Some individuals find it helpful to meet with our staff one-on-one at least monthly for additional support and monitoring.

Goal Weight Determination is unique to each individual. Most often goal weights fall into a BMI range of 25-30 or, in some cases, a reduction of 20-30% from initial weight. It is not the intent of this program to create an ideal BMI but to help reduce medical risk through weight reduction.

Cost and Insurance

Program Costs will vary depending on individual calorie needs, the amount of weight to lose, and the number of weeks on New Direction. All interested applicants are encouraged to attend an information meeting so that they are fully informed about program options and fees. Once enrolled in the program, fees are collected weekly. There are no hidden charges or advance fees associated with our program. In most cases, people will spend less on the VLCD program compared to normal weekly grocery and restaurant purchases! Also important to consider is the “saved” cost of insulin and/or other medications which may be reduced or discontinued secondary to the rapid rate of weight loss associated with this particular approach.

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.

Please note: Insurance reimbursement is not typical for weight loss programs even if your physician has advised you to lose weight. Due to increasing awareness of obesity, though, some employers groups or insurers may begin to consider and include this type of benefit. Please check your Benefit Summary handbook for language referring to obesity treatment or weight loss programs; if such a benefit IS included, please provide notification at the time of application. In most cases, if bariatric surgery is a covered benefit, then the physician’s appointments and labs on the VLCD program may be covered, too.

For those who do not have insurance coverage, you could save tax dollars through reimbursement from a cafeteria plan or Health Savings Accounts (HSA) for unreimbursed medical expenses. The IRS requires a BMI equal to or greater than 30. In most cases, expenses related to appointments, diagnostic tests, and class fees qualify; the costs for meal replacement products DO NOT qualify.

Medical Nutrition Therapy and Meal Replacements

Obesity is a complex chronic disease with increasing prevalence across the globe. Medical nutrition therapy (MNT) is an important component of obesity treatment, and low-calorie diets (LCDs) and very-low-calorie diets (VLCDs) are part of the MNT toolbox. Meal replacements (MRs) can be used in conjunction with food as partial diet replacement (PDR) or can be used exclusively to serve as the sole source of dietary energy (total diet replacement [TDR]). Use of MR may be associated with better control of cravings and hunger typically observed during reduced calorie intake through effects of ketosis or stimuli narrowing, although the exact mechanisms for these effects remain unclear.

Several clinical guidelines have endorsed the use of MRs as a part of MNT for obesity, primarily based on evidence that shows an average weight reduction of ~10 kg or more with TDR over at least 12 months in large, randomized controlled trials. When compared to usual care controls, these effects are 6-8 kg greater, and when compared to food-based diets, the effects are nearly twice the effect of a food-based diet. MR-based diets have been found to be safe and associated with improvements in quality of life. These diets are also effective for improving key cardiometabolic health outcomes, including dysglycaemia, blood pressure, lipids, and metabolic associated fatty liver.

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