European Stars And Stripes (Newspaper) - August 9, 1988, Darmstadt, Hesse                                By Marian Burros new York times thousands of people lose tens of thousands of pounds quickly and easily on very Low calorie liquid diets. Within three years most of them put the weight Back on and so far no one has figured out How to improve that Success rate. To make matters worse some experts say the vast majority of these very Low calorie diets take off the wrong kind of weight too much lean body mass and not enough fat. Today s diet formulas in the United states Are quite different from those that resulted in 60 deaths a decade ago. While the exact cause of the deaths remains in question the Federal centers for disease control says they were probably caused by starvation. American authorities on the subject say today s diet formulas Are safer. The Quality of the protein is higher and unlike the diet formulas in the 70s these cannot be bought Over the counter. They can be obtained Only through a weight loss program run by a physician or a Hospital. There Are 1,500 to 2,000 such diet programs across the United states using such Brand name formulas As med fast opt fast and her according to or. Theodore b. Van Itallie until july the co director of the obesity research Center at St. Luke s Roosevelt Hospital Center in new York City. Generally the programs provide 400 to 800 calories a Day usually in the form of a protein powder that the patient mixes with a liquid some however provide a combination of solid food and the protein formula. The fast generally lasts 12 weeks and is followed by a reseeding program where Normal meals Are introduced. Programs Are expensive about $500 a month and provide a Quick and relatively easy source of Revenue for hospitals and private clinics that provide them. The Best of these programs offer medical monitoring by a qualified physician nutrition education an exercise program and training in behaviour modification. The monitoring includes a Complete evaluation before the diet is started weekly evaluations by a physician and regular blood and urine tests and electrocardiograms. These diets often represent the Only successful method for Many severely overweight people 40 pounds or More to lose weight and thus reduce the risks of such obesity related problems As diabetes High blood pressure High serum cholesterol and arthritis. Dramatic reductions in Levels of cholesterol and blood pressure Are usually seen in patients once they have taken off 15 to 20 pounds. My cholesterol level went from 200 to 142 and my blood pressure from 148 Over 90 to 120 Over 70," said Robert Goldberg who has lost 60 pounds on a Hospital program in new York. The question is whether Goldberg and the thousands of others like him will keep the weight off. Tamara Shaff of Palo Alto calif., who has been on zillions of diets said people who have a weight problem know How to lose weight and How to gain weight. They Don t know How to maintain  Shaff has lost 65 pounds on the Stanford medical Center program. This time she said is different because of the exercise and behaviour modification training she is receiving. I never had that before she said. They teach you strategies for maintaining weight How to under eat As Well As overeat. Research has shown that combining diet with behaviour modification enhances the like Hood that weight loss will be maintained but there is substantial room for improvement. The real Issue said or. Thomas a. Wadden associate professor of psychology at the University of Pennsylvania school of Medicine is what happens once the diet is Over. All of our research shows that without exercise and behavioural modification weight is regained rapidly. The diets Are Good for getting weight off but they Are just the first step. People need the second step How to keep it  in a study of 45 patients some of whom had been treated with a very Low calorie diet of regular food and some of whom had been on a similar diet plus behaviour modification Wadden and or. Albert j. Stunkard found that three years later 47 percent of the subjects who had been on diets alone weighed As much As or More than their pretreatment weight while 38 percent of those who had been on diets and behaviour modification weighed As much As or More than before. Nineteen percent of those on the diet with behaviour modification were still within five pounds of the lowest weight they had achieved while Only 13 percent of those who dieted without behaviour modification were still within five pounds of their end of treatment weight. Behaviour modification appears to improve some patients ability to maintain diet formulas losing the weight is the easy part weight loss but for the majority nothing seems to work. Experts have been unable to discover a sure fire method of making weight loss permanent. The diets themselves Are not without risks. They Are used indiscriminately said Van Itallie giving everyone the same number of calories no matter their weight size activity or sex. Under Ideal circumstances the number of calories should be matched to the severity of the obesity. So Many of these programs give very Low calorie diets without considering what composition of the weight loss is. All too often people lose 60 percent lean body mass and 40 percent fat. What you Are striving for is 25 percent lean body mass loss and 75 percent fat  Van Itallie s concern is that the loss of too much lean body mass or muscle tissue May adversely affect the heart muscle. He describes this theory in an article in the publication current therapy in nutrition the ability of an overweight individual to tolerate calorie restriction that is conserve body protein during weight loss depends in considerable part on the degree of severity of his obesity. Thus morbidly obese individuals generally can tolerate very Low calorie diets providing 300 to 500 calories per Day far better than moderately obese persons  the program at St. Luke s Roosevelt where Van Itallie was co director operates on the principle. It offends me As a physician and a specialist in nutrition to see people advertising rapid weight loss and not pay attention to the science that underlies it " he said. I m bucking a trend i know he said. My views Are not necessarily shared my most people in the Field but they have not looked at this carefully. What the people who run those diets Don t talk about is the people who go into emergency rooms with All kinds of  these symptoms include dehydration which can cause dizziness and fainting inability to tolerate cold diarrhoea constipation dry skin hair loss which is reversible and a buildup of uric acid that can cause gout. Van Itallie said there were no figures on the number of people who have Adverse Side effects but he said no one denies that they exist. Page 16 the stars and stripes tuesday August 9,1988