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Low Calorie Liquid Diet (LCLD)
Pilot
Gillian Clarke
- Clyde Team Lead/Advanced Dietitian
October 2013
Rationale behind LCLD
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Eating less leads to weight loss.
Having the choice at mealtimes/snacks
can be very difficult for some to control
their intake.
Requires more effort for example
weighing out food/counting portions.
LCLD Pilot – Aims
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To improve adherence to a recommended
calorie prescription by removing food choices
and replacing food with liquids.
To achieve a 10kg minimum weight loss over
a 12 week period.
To measure the effect of liquid diet induced
weight loss on patients’ mood/quality of life
and eating behaviours.
To support patients with reintroducing food.
Why use liquid meal
replacements for weight loss?
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Evidence shows use of liquid MR as part
of a calorie-controlled diet is an
effective strategy for long-term
maintenance of weight loss as well as
the promotion of short-term weight loss
compared with a traditional reduced
calorie diet. (Ashley et al. 2001)
Why use liquid meal
replacements for weight loss?
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Provides a structured eating pattern.
Easy to follow.
Makes it easier to plan and prepare meals.
Removes food choices – improve accuracy of
energy intake.
Patients can often under estimate their
calorie intake (Samaras et al, 1999; Mertz et
al, 1991).
Can improve nutritional adequacy (vitamins
and minerals).
Use within GCWMS
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Additional intensive treatment option as part
of specialist service.
To support patients in following a low calorie
diet by removing food choices and being in a
liquid form.
To promote motivation to engage with the
programme due to good weight losses.
Change in surgery criteria - LCLD may be an
‘alternative’ to surgery for those not eligible.
Exclusions
Any patients who had completed
phase 1 and whose BMI <30kg/m2.
 Patients with diabetes on medications
other than Metformin.
 No evidence to exclude patients with
disordered eating/binge eating.
 Upper age limit consideration - <70yrs
old for pilot.
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Recruitment
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Patients were recruited from groups
having completed at least phase 1 of
the programme.
Patients attended an information
session on the LCLD pilot.
Written consent obtained from all
participants.
Pilot Design
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Patients energy requirements calculated and they were
provided with a 1200 calorie deficit diet.
LCLD plans were 1000/1200/1500 calories.
Plans devised from over the counter meal replacements
and a homemade version which patients had to selfpurchase.
All plans were nutritionally analysed considering protein,
vitamins, minerals and fibre content against recommended
amounts for adults.
LCLD Pilot results
Baseline
Group
(n=24)
Weight loss in
prog. prior to
LCLD
3.24 + 5.4
Completers at
6 weeks
(n=13)
Completers at
12 weeks
(n=12)
5.1 + 5.8
5.1 + 6.1
LCLD Weight
loss (kg)
8.0 + 4.1
12.0 + 6.4
LCLD weight
loss (%)
6.4 + 2.5
9.5 + 4.7
BMI (kg/m2)
44.5 + 13.0
43.4 + 13.5
Total wt loss in
prog. (kg)
17.1 + 9.9
Total wt loss in
prog. (%)
13.0 + 6.4
Some individual patient results
Weight at start of
LCLD (kg)
Weight after 12
weeks on LCLD (kg)
Female (66yrs)
1000 calorie liquid diet
109.8
91.4
Male (56yrs)
1500 calorie liquid diet
206.3
185.3
Male (52yrs)
1500 calorie liquid diet
128.8
113.3
Female (48yrs)
1200 calorie liquid diet
120.5
100.3
Patient
Patient feedback
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“I feel a lot better a lot healthier, lost weight
and surprised myself.”
“Big improvements, not tired, feeling good
and being very active.”
“Ability to control what I eat, listening to my
body to find out if I'm actually hungry.”
“I have more will power than I realised. A lot
of my eating is just for the sake of it.”
Food reintroduction phase
(16 weeks)
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Gradually reintroduced one meal at a time,
revisiting portion guide as covered in phase
1 of programme.
Continuing on at least a 600 calorie deficit
diet.
Aiming to return to a healthy balanced
calorie-controlled diet.
LCLD Pilot results – Food
reintroduction phase
FR completers at
28wks (n=10)
Wt loss in prog prior to
LCLD trial (kg)
6.0 + 6.3
LCLD weight loss (kg)
12.9 + 6.5
Food Reintroduction
Weight Loss (kg)
+1.3 + 3.8
Next stage - ongoing
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Patients currently in the weight
maintenance phase of the programme.
Preliminary results at 1 year post LCLD
mean weight loss of 7.7kgs maintained
(8/12 patients still in the programme).
Evaluation
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Range of outcomes being collected including:
- weight loss
- weight regain
- weight maintenance.
Psychologists have developed psychology
assessments using QEWP-R, HADS, QOL
questionnaires throughout LCLD phase for
quantitative results.
Qualitative data will also be gathered.
Research
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Poster of findings exhibited at European
Congress on Obesity, Liverpool (May
2013).
Also exhibited at AHP National
Conference, Edinburgh (October 2013).