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.

Additionally:

• 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.

• 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.

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.

• 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.

• 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.