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Article
November 14, 1977

Precautions With Supplemented Fasting

JAMA. 1977;238(20):2142. doi:10.1001/jama.1977.03280210034005
Abstract

To the Editor. —  "Supplemented Fasting as a Large-Scale Outpatient Program" (p 2151), reviews our results with 519 massively obese patients treated up to March 1976. Since that time, our total patient experience has enlarged to approximately 1,300.Four instances of sudden death have now been seen in this enlarged series, three since acceptance of our manuscript. One was judged to be accidental, but three occurred in patients, aged 39 to 51 years and 115.3 to 144.6 kg in weight, who were found dead at home. Prior to institution of supplemented fasting, these three patients all evidenced cardiac disease (likely of coronary etiology) as well as one or more of the following risk factors: hypertension, hypertriglyceridemia, or diabetes.Sudden death is a well-known hazard of coronary disease, and its frequency is reported to increase directly with body weight.1 Its occasional occurrence in a large aggregation of obese persons, many

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