Weight Reduction in Obesity by Outpatient Semistarvation

In a regimen of weight reduction for massively obese patients, all food was withdrawn during one week of hospitalization. The patients were maintained on 45 gm of casein calcium (Casec) and 30 gm of glucose for months on an outpatient basis, with close clinical and biochemical monitoring. Forty-five (60%) of 75 patients lost 18 kg (40 lb) or more. The average loss was 38 kg (85 lb). Men lost 2.1 kg (4.8 lb)/week and women lost 1.4 kg (3.2 lb)/week. No severe chemical derangements occurred. A modest state of catabolism existed, evidenced by an estimated minimum 2-gm negative nitrogen balance and small potassium and phosphate losses. The expected clinical benefits were obtained, and no serious disabilities were encountered as the patients engaged in normal activities. This regimen can be recommended when weight reduction per se is a medical imperative because of diabetes, hypertension, cardiopulmonary disease, or necessary elective surgery. (JAMA230:987-991, 1974)