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Optifast
®
The when, where and how
of the Optifast® VLCD™ Program
These guidelines have been
developed by Joanne Turner
MSc, APD, MAAESS, MSDA,
in conjunction with Nestlé
Healthcare Nutrition.
Joanne Turner is both an Accredited Practicing Dietitian
and Exercise Physiologist, with a Master of Science degree
in nutrition, dietetics and exercise rehabilitation, from the
University of Wollongong.
Joanne is the owner and director of NuActive Health,
a busy health consultancy business in Sydney, which
consults to thousands of individual clients, sporting teams,
corporate organisations, government and non-government
organisations, the food industry and the media.
www.joanneturner.com.au
With almost 4 million adult Australians currently obese,
the recent decision by the Australian Health Minister to make obesity
a National Health Priority Area (NHPA) will now hopefully ensure that
obesity receives the attention it deserves, as a matter of urgency.1
Research demonstrates that achieving just 5-10 per cent weight loss can result in significant health benefits
for obese people 2. However, the reality is, Australians are losing the war on weight, and the associated
health risks of obesity are immense. With the numbers of obese Australians increasing, how can health
professionals such as dietitians make a difference?
Most patients have unrealistic expectations of weight loss, however all health professionals may not be
considering all evidence based treatment options available to them.
The Dietitians Association of Australia’s (DAA) Best Practice Guidelines for the treatment of Overweight and
Obese Adults, 2008, state that the overriding aim of diet therapy is to establish a long term eating pattern
that supports optimal health guided by the Dietary guidelines for Australian Adults. However there are many
methods of short term dietary therapy that are being constantly overlooked, which can be used to initiate
weight loss, improve weight-related co-morbidities, and when combined with lifestyle changes, can help
patients to reach their long term goals.
The DAA guidelines, state that very low calorie diets (between 1450 and 3280 KJ/450-800kcal) per day) are
useful in initiating a weight loss plan, for the first 4-20 weeks, and support that very low calorie diets can be
considered in obese (BMI >30) or for those with a BMI >27 plus co-morbidities or where rapid weight loss
is required prior to surgery.
Furthermore, the National Health and Medical Research Council (NHMRC) Clinical Practice Guidelines
for the Management of Overweight and Obesity in Adults, state that all successful obesity treatments involve
some form of lifestyle change affecting energy intake; energy expenditure, or both. Among the aids for weight
loss treatment are behaviour modification, some medications, low-energy or very low energy diets, and surgery.
Clients should be individually assessed by health professionals, considering all treatment methods to
choose the most appropriate program.
The effects of weight-loss treatments in overweight or obese adults:
Mean %
Weight loss
(4–20 wks)
Weight Loss Method
Surgery
24-38%
Ability to prevent weight regain
• Optifast® VLCD™ program is conducive to ketosis
which can help suppress hunger and preservation
of lean muscle tissue.
Yes
• Adherence to a completely structured dietary regime
may be easier for some clients.
Optifast® VLCD™
14.7%
Yes, if followed by a lifestyle program
Orlistat (Xenical) + low fat diet
8.6%
Only while drug continues to be taken
Low fat Diet + Physical Activity
8.1%
Yes
Sibrutramine (alone) trade Name - Reductil
6.0%
Only while drug continues to be taken
Meal Replacements
6.0%
Yes, if followed by a lifestyle program
Diet Alone
4.4%
Yes to some degree
Exercise Alone
2.2%
Yes if more than 80 minutes or more a day is achieved
Adapted from The National Health and Medical Research Council (NHMRC)
Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults 2006.
The Optifast® VLCD™ program is a safe and effective way for obese patients
to achieve significant weight loss, particularly those at medical risk.
• Optifast® VLCD™ is a nutritionally complete very low
calorie diet, containing all the required daily nutrients,
minerals and trace elements the body needs.
• Established in 1974, and extensively researched
by international leading dietitians, doctors
and endocrinologists.
• Supported by over 80 clinical studies, the Optifast®
VLCD™ program is clinically proven as an effective
weight management tool.
Additional benefits of Optifast® VLCD™
• Research on more than 20,000 obese people
who completed the Optifast ® VLCD™ program
demonstrated significant reductions in weight as
well as weight related co-morbidities:3
- 12% average decrease in blood glucose
- 12% average decrease in total cholesterol
- 10% average decrease in blood pressure
- 22% average weight loss
Weight loss of 22%
Blood sugar
Total cholesterol
Blood pressure
12%
12%
10%
• Optifast® VLCD™ can be tailored to suit your clients’
needs, replacing one, two or all three main meals of
the day, adding in extra meals or snacks if nutritionally
required.
Support by a dietitian improves the results on Optifast® VLCD™
Optifast® VLCD™ is not a fad weight loss product. It is
an evidence-based practice, and with the assistance
of a dietitian, it can be part of a complete weight
management program, which encourages the transition
to long-term lifestyle changes, while providing the
support, guidance and resources that people require
on their weight loss journey.
A dietitian plays a vital role during and after the
Optifast® VLCD™ Program, by providing education,
ongoing monitoring and patient support. A dietitian
can tailor the program to suit individual needs, address
behavioral change and lifestyle issues and develop an
individualised lifestyle plan, in conjunction with exercise
physiologists to maintain or extend a patient’s weight
loss at the end of the Optifast® VLCD™ program.
Living in an obesogenic society, it is well documented
that obese people find it hard to lose weight and even
harder to maintain their lost weight, making weight
regain inevitable and frequent weight cycling a
common problem4. The best long term results come
from continued self monitoring, social support, clinician
monitoring of physical activity levels and food intake.5-8
Therefore it is important to organise intensive contact
with the client during the weight loss phase and educate
the client about the importance of regular monitoring
over the long term for life, just as their doctor and their
dentist does.
Currently, too many people are time-poor and lack
confidence in choosing nutritious foods and preparing
them quickly, and many obese clients find it difficult to
exercise, making lifestyle plans extremely difficult for
some. A benefit for dietitians in initiating an Optifast®
VLCD™ program is that it gives the dietitian time to
educate clients on ways to overcome barriers that
prevent individuals from changing their food selection
and preparing their own food, while still losing weight,
before transitioning onto a lifestyle plan.
Initial weight loss can boost clients’
self esteem and ability to participate
in more forms of physical activity.
How can a dietitian modify the Optifast® plan?
A dietitian can use their clinical judgment to modify the
Optifast® VLCD™ program to suit the needs of the client,
in such ways as:
• Extend or reduce the length of each phase.
• Change the order of the phases or skip a phase.
• Add extra low starch vegetables with the
3 Optifast® products per day.
• Spread the Optifast® products more evenly
throughout, like ½ bar at Morning Tea and
½ bar at Afternoon tea.
• Add ½ or 1 whole additional Optifast® product
per day, and have additional free vegetables,
such as in clients with a BMI over 40.
• Add additional energy free fluids.
• Add additional fibre supplements if required.
• Add extra vitamins or minerals if required.
• Add additional carbohydrates, protein or fat if required.
• Add 1 teaspoon of unsaturated oil to help the
gall bladder contract in the absence of additional
fat in the diet.
• Add more Omega 3 fatty acids if clinically beneficial.
• Modify electrolyte intake in clients that become
hyponatremic or hypokalaemic, for example,
in cases of clients receiving diuretic therapy.
• Refer to an exercise physiologist or other exercise
professional for specific exercise advice particularly
in clients that have many barriers to exercise.
• Refer client to a GP for medication review, blood
tests and other medical checks suggested in the
Optifast® treatment protocol, or if you feel the client
may require pharmocotherapy during the transition,
maintenance or lifestyle stage.
When should you consider recommending Optifast® VLCD™ to a client?
OPTIFAST® PRE-ASSESSMENT CHECKLIST
BMI > 27 with additional risk factors / co –morbidities associated with obesity.
Or
BMI > 30 with no additional risk factors
AND
• Wanting to achieve a greater than 8.1% weight loss,
as research shows this is more likely to be achieved
with a very low calorie diet or surgery in obese patients.
• A history of failure with diet and exercise or
pharmacotherapy or a dissatisfaction with the
weight loss they are achieving with other methods.
• Considering weight loss surgery. It is recommended
that all other weight loss methods are attempted
before undergoing invasive weight loss surgery.
• A need for rapid weight loss, prior to elective surgery.
Morbidly obese patients who need to undergo
surgery are at much higher risk from anaesthesia,
pulmonary infection, thromboembolism, and
pulmonary embolus. It is often advised to reduce
weight to reduce these risks.
• A need for rapid weight loss e.g. for an improvement
in an obesity related medical condition. Aggressive
intervention may be required when conditions such
as osteoarthritis, diabetes / IGT, CV risk factors
become evident or the person has a history of
those risk factors.
• Recent rapid weight gain, where it may be advisable
to try to break the pattern with a very low calorie diet.
• Motivation and a high readiness to undergo the
.
strict supervision and discipline of Optifast® VLCD™
Treatment with a very low calorie diet requires the
person to learn to modify their behaviour, undertake
caloric restriction, and increase phycial activity.
• Mild mental disability and difficulty following an
unstructured plan.
• A desire to boost moods and motivation of client
with a quick result.
• Prior to any type of surgery particularly abdominal
surgery to reduce visceral fat and liver size (see
checklist).
• Wanting to break bad food habits, by initially
removing the need to make food choices,
and reintroducing and educating clients one
meal at a time to make healthy food choices.
• Prior to long term behavioral modification education
and a healthy lifestyle plan.
• A need for rapid weight loss to reduce obesity
associated depression and increase client’s ability
to be more physically active during a lifestyle
intervention of weight loss and weight maintenance.
The 3 Day Challenge
As with any major dietary adjustment, the first few days on the Optifast VLCD program can
be difficult for the patient, and are commonly known as the 3 Day Challenge.
As the body transitions into ketosis, the patient my experience some transient side effects
such as: Fatigue, hunger, lack of concentration, nausea, headaches.
Typically, only mild ketosis occurs during the Optifast VLCD program and most symptoms
pass by days 4-6.
It is important to provide support for the patient during this period to encourage compliance
and commitment. It may help to assure the patient that these symptoms are common and
are typical side effects of weight loss.
Who should not use Optifast® VLCD™?
In general, people with acute heart disease, renal disease, hepatic disease, type 1 diabetes mellitus, a history of
eating disorders or overt psychosis should not use Optifast®. In certain situations Optifast® may be used in people
with such conditions but it is essential that a medical practitioner is consulted beforehand and health professionals
throughout the program carry out appropriate monitoring. Very low calorie diets are unsuitable for use by women
who are currently trying to conceive, are pregnant or those who are breastfeeding, and people under 18 or over
65 years of age.
The questions below assess your client’s suitability for Optifast®
QUESTIONS
YES/NO
WHEN TO REFER
1
Are you between 18 and 65 years?
If YES, Optifast® may be suitable
2
Are you pregnant, breastfeeding or
aiming to fall pregnant while on the diet?
If YES, Optifast® is unsuitable
3
Have you had a stroke or heart attack
within the last 12 months?
If YES, Optifast® is unsuitable
4
Do you have kidney or liver disease?
If YES, GP referral is recommended before starting
Optifast® (medication monitoring may be required)
5
Do you take medication for diabetes, high blood
pressure, high cholesterol, or heart disease?
If YES, GP referral is recommended before starting
Optifast® (medication monitoring may be required)
6
Do you take Warfarin or Lithium?
If YES, GP referral is recommended before starting
Optifast® (medication monitoring may be required)
ASSESSMENT CHECKLIST
ASSESSMENT
CRITERIA
DETAILS
RECOMMENDATION/COMMENTS
o
Age
Must be within 18 - 65 yrs
o
Current weight
o
Current height
o
BMI
BMI minimum of 30 to start,
or 27 with co-morbidities
o
Waist
Circumference
High risk is indicated by measurements
> 102cm for men and > 88cm for women
o
Blood pressure
o
Weight loss
goal (kg)
Note: Breaking down a large weight loss goal
into smaller steps can be more motivating
and less daunting
o
Client’s reasons
for losing weight
o
Optifast
phase selection
GUIDE TO PHASE SELECTION:
BMI 27 - 29 Transition Phase;
BMI >30 Intensive phase;
BMI > 40 Intensive Phase
+ extra Optifast® meal may be required
®
INFORMATION CHECKLIST
Now that you have identified the appropriate Optifast phase for your client,
it is important you provide them with the following information.
Case Study B
®
o
Optifast® explained
Explain how Optifast works and the principal of ketosis, including the
3 day challenge and what to expect regarding any minor side effects
o
Program explained
Discuss how the program works: Intensive phase = 3 Optifast® meals per day;
Transition phase = 2 Optifast® meals per day;
Maintenance phase = 1 Optifast® meal per day
Modifications made
Discuss any individual modifications to the program you have made
Which meals will be
their Optifast® meals
Talk through with your client which meal(s) they will replace with Optifast®.
Ensure that whichever meals they choose will fit in with their lifestyle.
o
Discuss additional
food allowances
2 L of water and 2 cups of low starch vegetables plus a teaspoon of oil are
essential for all Optifast® phases. Fruit is NOT permitted in the intensive phase,
but a small piece of fruit (providing 50-70 cals) is allowed in the Transition and
Maintenance Phase. Provide ‘Allowed Foods’ listing (downloadable from
www.obesitymanagement.com.au)
o
Water intake reminder
Emphasize 8 glasses / 2L of water or non calorie and caffeine free liquids per day
o
Discuss alcohol
Alcohol is not allowed in the Intensive phase and not recommended in the
Transition phase. If this is going to be too difficult, then 1-3 standard drinks
per week is the maximum.
o
Set weigh in date /
date for next visit
o
Enrol in OASIS™ support
program or refer them to the
www.optifast.com.au website.
Oasis is the Optifast® support program that is free to join and can provide
support with their weight loss in between seeing their dietitian
o
Long term weight loss
Adopting a healthy lifestyle including a low fat balanced diet, and regular
exercise is the key to long term health and wellness and maintaining weight loss
achieved with Optifast®
o
Discussed the advised medical
checks throughout the program
o
o
®
Health professionals can visit www.obesitymanagement.com.au to utilize an online version of this assessment checklist.
CASE STUDIES
Case Study A
• Patient age and BMI – 27 years, female, BMI – 38kg/ m2.
• Lifestyle & health issues – Poly Cystic Ovary Syndrome,
insulin resistance (not medicated), all other bloods
normal. Lives at home with 2 overweight parents, works
full time in a sedentary job and exercises 3hrs / week.
• No success with previous diets and very angry that she
was told 10 years ago by doctors that being overweight
and fertility problems were just a fact of PCOS.
• Started Optifast® intensive phase (3/day) as she was
very motivated to initiate weight loss as quickly as
possible. Lost 15kg in 3 months in conjunction with
an increase of exercise to 7 hours moderate exercise
per week, building up to more vigorous exercise.
• Lost a further 6 kg in the transition phase (2/day)
which was extended over 10 weeks up until the
Christmas period, and commenced the maintenance
phase (1/day) in the week of Christmas to allow dietary
flexibility for a further 6 weeks losing 1kg over this time.
• BMI was 30.4kg/m2 and a further 13kg weight loss was
still desired. Despite being relatively healthy over the
Christmas period and increasing exercise to 10 hours
per week, weight loss slowed.
• Therefore a 2nd intensive phase was introduced for a
further 12 weeks, with a weight loss of 10kg, transition
phase for a further 4 weeks with 3kg loss, and patient
has remained on 1 Optifast® meal per day with an
average of 5-7 hours of exercise per week.
• Total weight loss – 36kg – final BMI 26.2kg/m2
• Total length of the program – 44 weeks. Patient
remains on one Optifast® per day as she finds the
shake a convenient breakfast. She remains very
physically active and has learnt to cook for herself and
planning to move out with her new boyfriend.
• Patient outcomes on weight and health – Patient very
happy with results with improved self esteem, much
more energy and significantly reduced BMI (38kg/m2
to 26.2kg/m2).
• Patient age and BMI - 34 years, female, BMI – 42.3kg/m2.
• Lifestyle & health issues – Patient wants to start a family
as soon as possible but suffering from endometriosis.
Wanting to lose 33-43kg to improve chances of
conception. All blood tests normal.
• Ideally I would have liked this client to have started on
intensive phase due to age and time frame to lose
weight and fall pregnant. She had a very poor diet and
both her and her husband loathed cooking. I wanted to
use the intensive phase to provide time for education.
The patient tried a lifestyle plan for 2 months, but actually
gained weight.
• Started Optifast® on transition phase (2/day), as she
did not want to give up going out for dinner every night,
and was very resistant to learn to cook even simple meals.
Patient was provided education on making better
choices at restaurants and reducing alcohol intake
significantly while on Optifast®. She was very motivated
to lose weight, but not motivated to change her evening
habit of eating out at night.
• Patient used Optifast® for 9 months, replacing any meal
that she ate at home (1-3/day), and was disciplined
when using Optifast® to replace meals. She managed
to increase her exercise to 5-7 hours per week and lost
34kg over this time.
• Many psychological issues came up at this time:
anxiety about having a baby, fear of change of lifestyle
etc. This started to affect her weight and patient
regained 4kg in one month.
• She was referred to a psychologist, and although
Optifast® was stopped, (with only an occasional one
for breakfast) lifestyle education was continued and
exercise helped greatly with weight maintenance
thoughout this time.
• Three months later, patient announced she was
8 weeks pregnant, and now wanted to prevent
excessive weight gain throughout her pregnancy
by supplementing one meal per day with Optifast®.
Through consultation with experts on Optifast®
and obstetricians, it was decided that this is safe
practice during her pregnancy, as long as the rest
of her diet was balanced and contained enough
carbohydrates and other nutrients. Fish oil and
pregnancy vitamins were also recommended to
continue throughout the pregnancy for mental and
physical health reasons, and psychological visits
continued monthly throughout the pregnancy.
• Patient delivered a healthy baby weighing 3.6kg.
Breastfeeding was successful for 6 months.
Patient remained on 1 Optifast® per day while
breastfeeding, plus a regular healthy diet, and
remained on the vitamin supplements.
• Patient has lost 14kg since the birth over 9 months
and remains on 1 Optifast® meal and 2 light meals
per day. Current BMI 30kg / m.
Case Study C
• Patient age and BMI - 38 years, male, BMI – 38.8kg/ m2.
• Lifestyle & health issues – Patient was previously very
fit & healthy. He was very motivated to lose weight
and loved healthy eating, cooking & exercise. Patient
explained he had just got “lazy” and drank a lot of
alcohol and has a sedentary job. Lives with wife who is
supportive of lifestyle change. Had tried Sibrutramine
as prescribed by GP, with no success. No medical
problems, all blood tests normal.
• Optifast® intensive phase was started due to the quantity
of weight required to lose, and the patient’s extreme
motivation to succeed. The traditional Optifast® program
was followed, with recipes provided to increase variation
of starch free vegetables, and more vegetables given
than the traditional plan (about 4-5 cups per day).
• Lost 28kg in the first 4 months (3 months intensive,
1 month transition) then a further 4 kg in 3 months on
transition phase. Patient then commenced a regular
healthy diet with occasional alcohol consumption.
• Exercise program was developed and patient
continues to exercise 5-8 hours per week.
• Maintained a lifestyle plan for 10 months, and
maintained weight to within 1 kg over this time.
• During a 6 week holiday he gained 6kg, then lost 3kg
with regular diet and exercise over the next 2 months.
• Patient stopped consultations and regained 8kg
in 6 months.
• Recommenced consultations and recommenced
Optifast® transition phase for 2 months, losing 6kg, and
then has adopted a healthy lifestyle plan to maintain
weight to within 1kg over last 6 months
• Patient is now reviewed every 3-4 months.
Current BMI – 29.9kg/ m 2.
Pre-Operative Weight Loss Protocol
Key benefits
of pre-surgical weight loss
Obesity has been linked with an increased risk of some surgical
and post-surgical complications in patients requiring surgery.2
1. Reduced visceral fat levels
& liver size
2. Reduced operative risks
3. Improved exposure and view
of anatomical markers
4. Reduced pre-existing
metabolic abnormalities
5. Patients more sensitive to
post-operative requirements
6. Improved peri-operative outcomes
7. Reduced operating time,
reduced post-operative risks
8. Reduced dose of anesthetics
9. Reduced hospital costs
10. More hospital availability
11. Improvement of physical
function & mobility in the
post-operative phase
Surgical intervention by way of bariatric surgery can result in
substantial weight loss that is sustained over the long term when
combined with education, ongoing monitoring and patient support.
However, features of severe obesity can increase the complexity of
the bariatric surgical procedure and may increase the pre-operative
risks of surgery.
Pre operative weight loss is therefore desirable to optimise the safety
of surgery in obese patients scheduled for bariatric surgery.
A short term intensive treatment program with the Optifast® VLCD™
program prior to bariatric surgery has been shown to produce
effective weight loss and improved health outcomes, and is
associated with good adherence to treatment.
Refer to the Optifast® VLCD™Pre-Operative Protocol for more details
Products and costs:
The Optifast® VLCD™ program offers a wide range of choice in the form of shakes, soups, bars and desserts:
Shakes: vanilla, chocolate, strawberry, coffee
Soups: chicken and mixed vegetable
Bars: chocolate, berry crunch, cappuccino
Dessert: chocolate and lemon crème dessert
Affordable and Accessible
The Optifast® VLCD™ program is extremely cost
effective, at around $2.50 to $3.40 per meal,
which is often less expensive than a standard meal.
Additional Patient Support:
For ongoing support, there are many resources available to clients through the Optifast® OASIS™ website. OASIS™
stands for Optifast® Advice Support & Inspiration Source, and contains a wide variety of resources for both
clients and health professionals. Clients can register for a free membership of the OASIS™ program online at
www.optifast.com.au
Resources for clients include:
• Recipes – for all phases of the program
• Newsletters & fact sheets
• Online weight loss tracking and calculations
• Helpful hints on dealing with cravings,
exercise and lifestyle change
• Online members forum
Health Professional Resources:
Health professionals can visit www.obesitymanagement.com.au for the following resources:
Online patient assessment tool & checklist
Downloadable resources such as co-morbidity guidelines & clinical protocol
For more information contact Nestlé Healthcare Nutrition:
Nestlé Healthcare Nutrition
Phone : 1800 671 628 (Toll Free)
Email: [email protected]
For more information refer to www.obesitymanagement.com.au
References: 1. Stewart S, Tikellis G, Carrington C, Walker K, O’Dea K. Australia’s future ‘Fat Bomb’: A Report on the long-term consequences of Australia’s expanding waistline on
cardiovascular disease. April 2008, Baker IDI Heart and Diabetes Institute, Melbourne, Australia. 2. NHMRC 2006. Clinical Practice Guidelines for the Management of Overweight and
Obesity in Adults, National Health & Medical Research Council, Canberra, September 2003. 3. Drawert S (1996) Changes in Glucose, Blood Pressure and Cholesterol with Weight Loss
in Medically Obese Patients. Obesity Research 4(S1):67S. 4. Metz JA, Stern JS, Kris-Etherton P, Reusser ME, Morris CD, Hatton DC et al. A randomized trial of improved weight loss with a
prepared meal plan in overweight and obese patients: impact on cardiovascular risk reduction. Arch Intern Med 2000;160(14):2150–8. 5. Quinn Rothacker D. Five-year self-management
of weight using meal replacements: comparison with matched controls in rural Wisconsin. Nutrition 2000;16(5):344–8. 6. Dunn AL, Marcus BH, Kampert JB, Garcia ME, Kohl HW 3rd,
Blair SN. Comparison of lifestyle and structured interventions to increase physical activity and cardiorespiratory fitness: a randomized trial. JAMA 1999;281(4): 327–34. 7. Pratt M. Benefits
of lifestyle activity vs structured exercise. JAMA 1999;281(4): 375–6. 8. Smolander J, Blair SN, Kohl HW 3rd. Work ability, physical activity, and cardiorespiratory fitness: 2-year results from
Project Active. J Occup Environ Med 2000;42(9):906–10.
OPTIFAST® VLCD™ is for the dietary management of obesity.
Food for special medical purpose must be used under medical supervision.
Nestlé Healthcare Nutrition, 20-24 Howleys Road, Notting Hill VIC 3168, Australia. Nestlé Healthcare Nutrition, 12-16 Nicholls Lane, Parnell,
Auckland, New Zealand. Australia: 1800 671 628 (toll free) New Zealand: 0800 607 662 (toll free) www.optifast.com.au ®Reg. Trademark of
Société des Produits Nestlé S.A.