VLCDs (very low calorie diets) are medically supervised, modified fasting programs that can be helpful for many dieters. Years ago, they used to be totally liquid diets, with no chewable food at all. However, that has changed, as many people find it too difficult to stay with such a regimen for more than a few months. Most VLCD programs have made their programs more flexible, adding "intermediate" level (more moderate) programs, food entrees, nutrition bars, and higher calorie levels.

Dieters simply can’t cope with liquid nourishment alone and need some solid food, in the form of bars, snacks or low-calorie entrees. Vendors report pressure on them by clients to offer these products. People are asking to be TOLD what to eat—which seems to be an attitude change. Another change from past years is that most physicians using modified fasting programs are now using higher calorie level plans. Years ago, VLCDs often had maximum daily caloric intake levels of under 1,000. That has been raised.

With a VLCD program, one can expect to lose up to 20% of body weight. However, liquid protein fasting regimens are difficult for many people. Many that begin a program do not complete it. Excluding the patients that drop out within the first week or so, the most widely-quoted figure for VLCD programs is a 60% completion rate (or 40% drop-out rate). If a company says that it has a 90% completion rate, you can be pretty sure it's not accurate.

Typically, about 70-80% of those on medically monitored fasting programs are women. Their average age is 34 years. Medicare and insurance firms will reimburse patients for the cost of the physical exam and any tests related to obesity conditions, but they generally do NOT reimburse for the supplement formula itself.

MD-based and hospital-based VLCD programs today use more nutritionally complete supplement than those used in the late 1970s, and are therefore safer. Also, weekly or biweekly in-person medical monitoring and monthly lab tests, as well as initial screening out of unsuitable fasting candidates, lessens the chances of unsafe fasting and harmful side effects, enhancing these program’s credibility and justification of relatively high cost to the public.

VLCD plans are highly structured programs for people that have a significant (not cosmetic) amount of weight to lose. Many patients have serious medical conditions related to their obesity. The good thing about these programs is that you are closely monitored by a staff of experienced clinicians and will rarely get into trouble on them. You are monitored via weekly doctor visits and monthly lab tests, and there is a long-term maintenance plan to help you keep the weight off. Virtually all the providers in the field have long-term clinical data, outcome data, and have a long track record in the medical weight loss arena.

BestDietForMe.com/Marketdata estimates that approximately 550 hospitals and clinics in the United States are now offering a modified fasting VLCD program. About 163,000 Americans were enrolled in these programs in 2002. We also estimate that approximately 5,400 independent physicians now use one of the five VLCD vendors’ programs. These MDs are NOT included among those affiliated with the 550 hospitals and clinics noted above.

Like so many other segments of the "Diet Industry", the popularity of very low calorie diets is cyclical as well, subject to competition, the herd mentality, and other competing diet programs. As an example, in the second half of 1996, the popularity of the phen-fen medications began to soar, cutting into these programs’ enrollments. Therefore, 1996 was a year in which VLCD enrollments probably dipped about 12-15%. In 1997, dieters clamored for Redux and after FDA approval was granted in April, prescriptions soared. Thus, the first half of 1997 was very weak for VLCD programs. However, in the Fall of 1997 when Redux was taken off the market, VLCD enrollments began to rebound. Enrollments in these types of weight loss programs have continued to grow since then.

Optifast (Novartis Nutrition)

P.O. Box 379

Minneapolis, MN 55440

Phone: 800-999-9978 or 800-662-2540

Website: optifast.com 

Health Management Resources

59 Temple Place, Suite 704

Boston, MA 02111-1346

Phone: 617-357-9876

Website: hmrprogram.com

Medifast (subsidiary: Jason Pharmaceuticals, Inc.)

11445 Cronhill Drive

Owings Mills, MD 21117

Phone: 410-581-8042 or 1-866-463-3432

Website: medifast.com

Robard Corp.

821 East Gate Drive

Mt. Laurel, NJ 08054

Phone: 609-778-9200 or 800-222-9201

Medibase (Dean Distributors)

2801 Salinas Highway, Building F

Monterey, CA 93940

Phone: 800-553-1754

It is important to distinguish medically monitored VLCD programs from over-the-counter meal replacement products such as Slim-Fast. Slim-Fast and other liquid shakes are not true liquid protein diets, since one "real food" meal per day is recommended for the plan. Also, the consumption of retail products is not medically supervised, and dieters using them are not likely to be the severely obese with complicated medical conditions.

Although liquid protein diets have been available to American consumers since the mid-late 1970s, many of today's competitors did not exist until the early-mid 1980s. For example, OPTIFAST (Novartis Nutrition) has been around the longest, since 1976 in the United States. Medifast was introduced in 1980 and the HMR program in 1983. Most other companies, however, did not appear until much later... Ross Labs' New Direction (now part of Robard) in 1988.

Consequently, in 1984 there were really only three main players in the market, all offered on a national scale. By 1986, this number grew to five companies (three national and two regional operations). By 1988, the field had grown to 10 main competitors (8 national, 2 regional). Today, it’s down to five vendors.

The most dramatic growth took place during the 1988-89 period, when BestDietForMe.com/Marketdata estimates that the medically monitored VLCD segment grew 45% in 1989, and the over-the-counter formula segment took off even faster--a 60% gain. Enrollments in medically monitored programs were growing strongly during 1989, due to the publicity generated when Oprah Winfrey announced on national TV that she had lost over 70 pounds on the Optifast plan.

The increase in the number of bariatric surgeries in recent years has spurred demand for VLCD programs and for fasting supplements. Many patients are put on the supplement to lose weight PRIOR to the surgery, to make the operation go smoother, and many patients also use the supplement AFTER the surgery, to assist in the long-term weight maintenance phase.

Most VLCD plans span 6-18 months, including the maintenance phase. The total cost usually ranges from $1,600 to $3,500. The high cost of medically-monitored VLCDs is an inherent inhibitor to the number of dieters that can afford to pay for them, especially during recessions when more people are out of work and not covered for at least part of the cost of the program from their health insurance. To counter this, nearly all VLCD program vendors have kept their prices stable for the past seven years.

Insurance Reimbursement - A Continuing Obstacle… A specific diagnosis is always required for a VLCD patient's insurer to reimburse them for part of the total program. The cost of the supplement is not covered (which may represent as much as 50% of the total bill). On average, the VLCD supplement alone accounts for 47% of the total cost of the program, and is not reimbursed by health insurance.

Personnel at various VLCD providers say that the most common diagnoses pertaining to patients include... obesity, type 2 diabetes, hyperlipidemia, hypercholesterol, hypertension, hypertriglycerdemia, degenerative joint disease, hyperglycemia, arthritis, and sleep apnea.

                       Estimated Costs For Major VLCD Plans

               VLCD Program Cost*     Patient out-of-pocket Cost

                                                      (total x 47%)

HMR                       $1,725                     $811

OPTIFAST                 1,620                       761

Robard (Nutrimed)    1,400                       658

Medifast                  1,374                       646

* weight loss, fasting phase only, avg. 12-16 weeks, medically supervised plan-not modified supplement and real food option, excludes refeeding and maintenance phases.