Very‐low‐calorie diets: Downsizing the hospitalised obese patient

The rising prevalence of obesity and its associated morbidity and mortality are placing significant strain on Australia's health‐care system. The present case study examines the weight loss attempts of a 60‐year‐old male patient weighing 218 kg (body mass index 69 kg/m 2 ) in the setting of an acute hospital ward. The patient was confined to bed, secondary to a previous above knee amputation, and was unable to be transferred or fit safely into a wheelchair because of his weight. He was also unable to return home alone because of his current size. Because of the need for rapid weight reduction, a novel inpatient approach to weight loss was adopted, using a very‐low‐calorie diet (VLCD) and multidisciplinary team management. The VLCD intervention was prescribed in conjunction with medical management, regular physical therapy, behaviour therapy and dietary counselling. Serial anthropometric and biochemical measurements were obtained throughout the treatment period. The patient achieved an 80‐kg weight loss (37% initial body weight) over a six‐month hospitalisation. Improvements in obesity‐related comorbidities and the patient's functional and independence level were also observed, enabling discharge from hospital to residential care. Total weight loss at 24 months post hospital discharge was 103 kg (47% initial body weight). The use of a VLCD in a motivated individual in a controlled hospital environment, along with input from the multidisciplinary team, resulted in substantial and sustained weight loss with improved health outcomes.