Responsible and Irresponsible Use of Very-Low-Calorie Diets in the Treatment of Obesity

AMERICA'S most celebrated weight loss was announced on November 15,1988, when Oprah Winfrey disclosed to her 18 million television viewers that she had lost 30.5 kg (67 lb) in 4 months by consuming a medically supervised very-low-calorie diet (New York Times. November 24,1988:B17). Ms Winfrey's announcement sparked a frenzy of interest among the nation's dieters, reminiscent of that which greeted the appearance of the liquid protein diets in 1976 and 1977¹and the Cambridge Diet in the early 1980s.²Sadly, consumption of these diets was inadequately supervised; at least 58 deaths were reported among users of liquid protein products¹,³and 6 deaths in persons who consumed the Cambridge Diet.² Current very-low-calorie diets that provide essential nutrients and high-quality proteins are unquestionably safer than their liquid protein predecessors, as noted in a timely report prepared by the American Medical Association's Council on Scientific Affairs.⁴But the