Frequently Asked Questions million

people who have participated in the program since 1974.

Why not design a low-calorie whole foods diet?

With self-prepared foods, it is not possible to achieve a balanced 800-calorie diet that meets nutritional requirements.  Studies utilizing doubly labeled water to quantify the energy balance in obese subjects on self-prepared foods indicate that people tend to underestimate calorie intake and over estimate energy expenditure.  Research comparing the use of meal replacements (MR) versus self-prepared meals consistently show greater weight loss with MR’s than with self -prepared foods.

Why is it so hard to maintain weight loss?

People usually go back to the old ways of eating that caused them to gain weight initially. Research has shown that it takes two years to change eating habits; these changes must be kept up for a lifetime. When a person gains weight, new fat cells are made by the body.  The cells do not go away with weight loss, they just decrease their size, and they easily refill when we overeat. Maintenance of weight loss requires a  continual practice of new eating and exercise habits.

Why is it so hard to lose weight?

Most overweight people are insulin resistant.  Insulin resistance may make a person feel hungry much of the time, and therefore, makes it difficult to stay on a low fat, high carbohydrate weight reduction diet. It also promotes fat storage and prevents the breakdown of fat in the body.   Insulin resistance requires a dietary intervention to allow the body to burn fat effectively.

What do you do with a patient who is lapsing into his/her old eating habits?

The OPTIFAST program resources include a detailed relapse protocol plan.  It is important that patients who are lapsing into their old eating habits be evaluated by a behaviorist, as well as by other members of the health care team so that underlying issues can be identified and addressed.

Is a full-formula diet safe?

All OPTIFAST formulas are nutritionally complete, containing high quality biological protein and meeting 100% of the U.S. RDI’s.   Individuals are medically monitored to reduce the potential for side effects and to maximize improvements in weight-related health risks.

Is losing and gaining significant amounts of weight bad for a person?

Although many people think repeated gaining and losing weight is bad, research has shown it is not.  Obesity is a chronic disease and people will naturally gain weight if they do not continually manage their eating.

What about phytochemicals?

Phytochemical and nutraceuticals derived from plant-based foods provide a variety of health benefits.  Most experts believe, however, that the benefits attributed to these substances only occur if people consume a diet rich in plant-based food for a prolonged period of time.  USDA surveys of the American diet have found few people eat an adequate amount of plant-based foods. The latest data examining 1998 food consumption patterns indicated that the majority of Americans eat less than half the recommended amount of produce and whole grains each week.  Much of the produce they consume is in less nutritious forms, like fried potatoes, lettuce drenched in dressing, and corn smothered with butter.  Given the fact that people have maintained good nutritional status after consuming a full formula diet for a decade or more, and that most people are not eating sufficient produce and whole grains, the twelve-week full formula diet is probably not long enough to impair phytochemical status.  Furthermore, during the transition phase people will be taught to build a diet rich in fruits, vegetables, and whole grains. Ultimately, they will end up with a diet better in phytochemicals and fiber than the one they were consuming when they entered the program.

Remember, most people do not become obese because they ate too much of a well balanced diet.  In fact, the nutritional status of many individuals is improved during the full formula diet phase of the OPTIFAST program.

Isn’t using the full formula diet a bit extreme?

When evaluating weight management approaches, it is important to remember that OPTIFAST was designed for individuals who are significantly overweight and are at health risk because of this excess weight.  Individuals who use the OPTIFAST have been unsuccessful using the traditional balanced deficit diets and less intensive approaches to weight management.  OPTIFAST is not a diet per se.  It is a comprehensive health risk management system designed to address obesity and weight-driven diseases.  As such, the efficacy of using OPTIFAST therapy for a particular patient needs to be evaluated in the context of the health management risk benefit ratio. Many life saving medical treatments have potential side effects.  We chose to pursue these therapies because the benefits outweigh the associated risks.  As proven by the OPTIFAST Five-Year Follow-Up study, the health benefits of using an OPTIFAST program far outweigh any potential side effects such as a short-term reduction in phytochemical intake and a maintenance diet composed of a limited variety of foods.  In fact, when used in accordance with the medical monitoring procedures outlined in the Reference Manual, no significant side effects have been reported.

Who benefits from extended stimuli narrowing?

Some programs use an intensified stimuli-narrowing process during the transition period with all patients. According to Rich Roell, LSW, an addiction therapy specialist associated with the Jewish Hospital Weight Management Program, about 40% of the people entering the OPTIFAST programs have some degree of food addiction. Many of these individuals need strict guidelines, precise instructions, and clear boundaries.  Instead of saying, “eat a small serving of lean meat,” people specify a 3.5 oz of roasted chicken breast, no sauce.  Intensifying the stimuli narrowing aspects of the transition diet helps people set boundaries and avoid trigger foods.

Isn’t using meal replacement (MR) products long-term a crutch?

A key goal of the OPTIFAST program is to help patients develop the skills they will need to plan and select healthy meals. Today’s super-sized servings of food, pervasive eating cues, and packed schedules can make it difficult for even the most dedicated weight manager to avoid overeating. Since 1995, at least 24 separate studies supporting the use of MR’s have appeared in the literature. Using a packaged diet dinner or OPTIFAST MR formula to meet part of an individual’s daily nutrition needs can help manage weight long term and reduce the risk of weight related diseases. Dietitians have the skills and knowledge to help patients plan a satisfying and balanced eating style that incorporates selected amounts of portion-controlled foods.

Why use a full formula diet for weight loss?

Full formula diets provide a unique set of advantages when used by individuals in weight management programs.  Many significantly overweight people have developed deeply entrenched eating behaviors that contribute to their excess body weight.  Cutting back on food portions, as is done in traditional weight loss programs, has not worked for these people long-term.  Replacing the usual food items in their diet, with a pre-measured, ready to serve, nutritionally balanced formula provides many advantages including:

•        Portion and calorie control

•        Optimal nutritional intake

•        Decreased encounters with food cues during the day as a result of a significant reduction of time and effort required for planning and obtaining meals.

•        Prolonged opportunity to break the cycle of old eating patterns. This is important considering it takes 6 weeks to learn a new behavior.

•        Gradual reintroduction of self-prepared foods during the Transition phase of the treatment to allow new eating behaviors to be established.

(Many individuals report that it is a relief to “take a vacation from food” and the often angst-provoking food choices.)

Can patients use the full formula diet for more than 12 weeks?

Very heavy patients may require longer than 12 weeks of full formula diet to achieve the level of weight loss necessary to facilitate movement and improve various health risks.  If the patient’s health is stable and the patient is compliant with the treatment, the full formula phase of treatment may be allowed to extend to 16 weeks.  The decision to maintain a patient on full formula diet must be made by the medical director after examination of the patient and through review of all aspects of the patient chart including entries by other members of the weight management health care team.

Why extend stimuli narrowing into transition and maintenance?

One of the goals of a dietitian is to teach people that there is no such thing as a “bad food” and thus all foods can fit into a healthy diet.  This advice may work well with people who have a healthy psychological relationship with food, but it can be problematic for individuals who use food as a coping mechanism.  Data collected by researchers associated with the National Weight Control Registry and the University of Pennsylvania demonstrate that limiting the variety of readily available foods, and serving pre-portioned foods decreases the amount of food eaten at any one time.  These observations were so well accepted that they were incorporated into the 2001 Dietary Guidelines for Americans, which now advise eating a wide variety of fruits, vegetables, and whole grains each day, but limiting the variety of other foods consumed.  Extending stimuli narrowing into the transition and maintenance phases of the OPTIFAST weight loss program can give patients an added measure of control they have over their eating habits.

The transition phase of the OPTIFAST program makes use of the stimuli narrowing approach by slowly adding different categories of self-prepared foods back into the patient’s diet.  The stimuli narrowing characteristics of the transition diet can be strengthened by allowing patients to select a single food from each food group for a period of several days to a week at a time.

Several programs use an intensified Transition protocol. It allows patients to add a single 3 oz serving of one type of low-fat meat (either chicken breast, turkey breast, or pork loin) and a ½ cup serving of one type of vegetable (either carrots or green beans) to their daily diet during the entire first week of transition.  The same meat and vegetable combination must be eaten all week long.  During week two, patients are allowed to alternate between two of the three types of meat and may choose either carrots or beans to meet their vegetable servings.  They are also allowed to add one serving of a single type of fruit to their daily diet.  Other food choices are added at a gradual pace, until a well balanced diet has been achieved.

Patients are encouraged to develop a maintenance diet of simply prepared foods they eat on a routine basis. The goal is to choose from foods that are pleasant, but not overly appealing in terms of taste or appearance. Moderately appealing foods do not over stimulate appetite (psychological desire for food driven eating) to the same extent that highly palatable foods do.  Limiting availability of highly palatable foods can foster weight management.  Favorite foods can still be eaten on special occasions provided they are worked into the meal plan.