Eat less, move more. This may seem like the straightforward solution to the increasing obesity epidemic. But it is not as simple as that. Weight loss and maintenance are challenging.1 Seimon et al2 aim to provide some much-needed answers to questions regarding the health effects of very low-energy diets (VLEDs) compared with conventional caloric restriction diets. Postmenopausal women with obesity in the Type of Energy Manipulation for Promoting Optimum Metabolic Health and Body Composition in Obesity (TEMPO) Diet Trial2 were randomized to a 25% to 35% caloric restriction diet for 1 year (moderate intervention) or a VLED (aiming at 65%-75% caloric restriction) for 16 weeks followed by a 25% to 35% caloric restriction diet (severe intervention). Compared with the moderate intervention, the severe intervention resulted in a greater loss of total body weight, whole-body fat mass, and abdominal subcutaneous and visceral adipose tissue as well as a greater reduction in waist to hip ratio at 1 year. There was also a greater loss of whole-body lean mass and thigh muscle area in the severe intervention group, which was proportional to the greater total body weight reduction. There was no significant difference between interventions in whole-body bone mineral density (BMD) or lumbar spine BMD loss. On the downside, the severe intervention resulted in an approximately 3.3% reduction in total hip BMD compared with an approximately 1.3% reduction in the moderate intervention group, which was not explained by the greater total weight loss in the severe group.2
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Steur M. Very Low-Energy Diets—Opportunity for Greater Weight Loss, but Risk of Bone Loss. JAMA Netw Open. 2019;2(10):e1913752. doi:10.1001/jamanetworkopen.2019.13752
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