Very-Low-Calorie Diets

To the Editor.— The treatment of obesity is a matter of opinion, not of fact. The recent commentary by Wadden et al 1 recommends a responsible program of very-low-calorie diets plus behavioral therapy for those who are 30% overweight or more. Yet studies conducted by Dr Wadden and others working with the Sandoz Nutritional Company do not support this recommendation. Wadden et al 2 compared three groups of patients: those treated by very-low-calorie diets alone, by behavioral therapy alone, and by a combination therapy such as that recommended in the commentary. At the three-year follow-up, however, subjects in all three conditions had regained between 74% and 85% of their end-of-treatment weight loss and differences in weight loss among conditions were no longer significantly different. 2 Dr Stunkard, 3 writing separately, recommended conservative treatments with behavioral therapy over such radical ones as jawwiring and very low calorie diets. Another study