Clinical Use of a Protein-Sparing Modified Fast

OBESITY is notoriously resistant to treatment. Short-term weight reduction of greater than 18 kg occurs in fewer than 5% of outpatients.1Possible explanations for noncompliance and ineffectiveness of conventional diet therapy include hunger and the disappointingly slow rate of weight loss. Total fasting reduces hunger and induces rapid weight loss,2but half the weight loss in the first month and one fourth to one third thereafter is from muscle tissue,3and hepatic, renal, and endocrine function is affected. For these reasons fasting regimens are generally recommended only for inpatients. Long-term follow-up of persons who previously fasted has demonstrated a high rate of recidivism5due to obligate regain of lean tissue or the lack of a weight-maintenance program or both. When a fast is supplemented by small amounts of protein in the form of egg albumin,6casein,7casein with glucose,8or amino acids with