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Case Report
| THE | DIABETES ISSUE
Success with VLED
A very low – energy diet with meal replacements shows promising results in a patient motivated to lose weight through intense lifestyle changes .
Emma Armstrong Senior diabetes and endocrinology dietitian , Royal Melbourne Hospital , Victoria ; founder of Endocrine Nutrition , where she provides one-on-one dietitian telehealth ( phone or video ) consults .
SUSIE is a 61-year-old office worker who is referred to a dietitian for weight-loss advice . Susie ’ s weight is 124kg and BMI is 49kg / m2 . She has a history of asthma , osteoarthritis , psoriasis , hypertension , anxiety and depression . A recent sleep study showed obstructive sleep apnoea , and she has trialled CPAP with limited success . Her exercise tolerance is limited to mobilising 400m as a result of knee pain . She is not keen on either weight-loss surgery or pharmacotherapy because of the cost . However , Susie is extremely motivated to try intense lifestyle changes again after many previous unsuccessful attempts . She is currently prescribed atenolol 25mg daily , budesonide – formoterol ( Symbicort Rapihaler ) 200 / 6 two puffs twice daily and duloxetine 60mg daily .
Box 1 . Susie ’ s initial anthropometry and body composition analysis
Weight ( kg ) 124 Height ( m ) 1.59 BMI ( kg / m2 ) 49.05 Fat mass ( kg ): 69.7 Muscle mass ( kg ) 51.6 Body fat (%) 56 Waist ( cm ) 120
Assessment
Basic anthropometry and body composition analysis completed during the initial dietitian assessment are shown in box 1 .
Table 1 outlines Susie ’ s usual meals . Susie reports she is constantly hungry and finds herself grazing consistently throughout the day .
Management
After a discussion with the dietitian , Susie is keen to try a very low – energy diet ( VLED ) meal replacement program . She plans to replace two of her main meals each day with a
VLED meal replacement product and prepare a low-carbohydrate meal for her third main meal of the day . She is advised to aim to consume at least one serve of lean protein with her low-carbohydrate meal , as well as two cups of low-starch vegetables , 2L of energy ( kJ ) -free fluid and 1 tbsp of olive oil a day . The dietitian explains that , when Susie transitions to the VLED plan , it is likely she will initially feel hungry but that this should subside after about three days .
Discussion
A VLED , or very low – calorie diet , typically involves a partial or complete meal replacement program that restricts total energy intake to ≈800-900kcal or ≈3300kJ a day while consuming sufficient protein and
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