Pharmacy Diabetes

DPR-session-3-Practical and psycho-social issues


Before starting, advise each participant to:

  • Purchase enough VLED product to last at least the first week of the program, but preferably to last two weeks, if they can afford it.
  • Consume all perishable foods that are not permitted on Phase 1 of the program (3 VLED sachets per day), or
  • Safely store them in a secure place so that they will not be tempted to consume them when following the program.
  • Advise family and friends what they are doing and ask them not to offer any foods or drinks that are not permitted on the program.
  • Avoid places where there are limited food and drink choices (e.g., pubs).
  • Aim to do things that are non-food related like going to the movies, playing a sport or other physical activities, for social gatherings.


  • If they are doing the program with other people, plan it so that they all start on the same day (preferably on the weekend, to help deal with “keto flu”).
  • If there are other members of the family who are living with the participant who are not following the VLED program, ask them to eat at a different time so that they are not tempting the participant with their food.
  • VLED programs are generally much easier than most people anticipate. The first 2–3 days are the most challenging.
  • The initial 2–3 weeks often perceived as easier than expected with regard to levels of hunger and getting used to the VLED programme.
  • This changes midway through the program, when participants get used to the regimen and start to get bored.
  • This can be overcome with more experimentation with flavours and by putting the length of the VLED phase into a time perspective.
  • Emphasize that it is only a short period in their life that will potentially result in long-lasting health benefits, including pre-diabetes / type 2 diabetes remission/reversal.
  • Physical and social environments, together with emotional states and availability of self-regulatory skills are the most important factors affecting adherence.
  • Feelings of sadness, loneliness or stressful experiences affect participants’ willpower and increase the attractiveness of a temptation.
  • Awareness, weighing of pros and cons of giving in, conscious deliberation and often self-talk and reminding the person of their goals are crucial to behaviour-regulation in tempting situations.
  • Preparation including cooking soups and vegetables in batches and freezing them, so that they are ready to eat after coming home from work; planning portions for the day; and carrying water and vegetables in pockets or bags help with cravings.
  • Avoidance of activities related to snacking (e.g. watching television); places where there is a lack of choice of healthier food options (e.g. pubs); and avoidance of eating with others (e.g. work lunches) also helps.
What about social events?
What about alcoholic drinks?
  • Alcoholic drinks provide extra energy (kJs) which will counter-act the weight loss process.
  • They increase urination which may lead to dehydration, and
  • Can affect blood electrolyte levels which can cause serious health problems.
  • They should therefore be avoided at all cost.
Disordered eating

Some health professionals fear that VLEDs will create or exacerbate disordered eating

  • Randomized controlled trials investigating the adverse effects of dieting have been conducted using a wide range of participants.
  • All of these studies have reported on extended periods of intentional dieting without long-term adverse psychological or behavioural effects.
  • Some of these studies reported improvement of overeating and binge eating coupled with weight loss or prevention of weight gain following intentional dietary restriction.
  • None of these studies reported increased eating-disorder symptoms following a period of energy restriction or intentional dieting.
  • For example, Raymond and colleagues examined the factors associated with the diagnostic outcome of obese adults (average age 39.3 years) with and without binge eating disorder (BED), 1 year after completing a VLED program.
  • Participants included 63 individuals with BED, 36 individuals with subthreshold BED, and 29 individuals with no binge eating symptoms.
  • Diagnoses before and after VLED were obtained using the Structured Clinical Interview for DSM-IV. The severity of psychiatric symptoms was assessed using various rating scales.
  • Average weight loss over the 24 weeks of VLED consumption was 16.8 kg and at 1 year it was 10.2 kg.
  • Fifty-six percent (n = 36) of the participants who met criteria for BED at baseline did not meet diagnostic criteria 1 year later.
  • None of the baseline factors were statistically associated with outcome. None of the baseline factors examined determined which individual would retain the BED diagnosis or whose symptoms would improve.
Food cravings
  • Defined as intense desires or longings for a particular substance, are reported frequently in the general population.
  • It is commonly believed that dieting produces food cravings, due to either energy deficits and/or to the psychological feeling of deprivation. However, there is little evidence to support this belief.
  • Harvey and colleagues compared changes in self-reported cravings experienced by 93 obese participants with type 2 diabetes who were randomly assigned to behavioural treatment programmes which used either:
    • a balanced, low- energy diet (LED) of 1,000-1,200 Calories/day throughout, with all foods allowed in moderation, or
    • a programme which included a 12-week period of a VLED
  • There were significant decreases in cravings for all types of foods over the 20 weeks of the study for both the VLED and the LED conditions.
  • However, VLED consumers reported greater decreases in their cravings for foods than did participants in the LED group.
Quality of life
  • Increasing degree of obesity is associated with compromised health related quality of life, especially physical functioning.
  • Randomised controlled trials indicate that VLED programmes provide improvement in:
    • physical functioning,
    • bodily pain,
    • social functioning,
    • obesity-related psychosocial problems, and
    • general health.