RFO Program
from the University of California, Los Angeles

2. MODIFIED VLCD DIET OR LOW CALORIE DIET
For those who wish to lose weight rapidly but want to eat some food as well as for some patients who have already lost an appreciable amount of weight on the VLCD program, we offer a modified VLCD program. This consists of three to four packets per day of supplement plus one planned meal. The meal for each day is worked out between the patient and the dietician, and may consist of a prepackaged, low calorie meal or a home cooked meal. The success of this program depends largely on pre-panning of specific meals rather than "choices of anything of four hundred calories or less". In this program as in the VLCD program, selected patients may require small amounts of appetite-suppressant medication. Vital signs are recorded weekly and laboratory determinations and electrocardiograms are obtained serially.

3. DIET BEHAVIORAL PROGRAM (DO)
This program is most suitable for patients who wish to lose less than thirty pounds, for those who do not wish to take appetite-suppressant drugs and for more severely obese people who do not wish to participate in the VLCD program but would rather lose weight more gradually while learning to change their behavior to a long-term healthy lifestyle. This program involves frequent meetings in person or by telephone with a registered dietician.

As described previously, the dietician and the patient mutually plan a reduced, calorie diet calculated for a weight loss of approximately one percent of the patient's body weight per week. Individual diets may be modified frequently, depending upon rate of weight loss and other factors. Concomitantly, patients are encouraged to attend the weekly seminars and conferences in the behavior modification program and /or the psychology support groups. Research clearly shows that: a) people who cannot seem to lose weight by dieting on their own have much greater success in a group environment with behavior modification and b) motivated patients do as well with this type of program as with appetite-suppressant drugs. Vital signs are recorded weekly and laboratory determinations and electrocardiograms are obtained serially.

As with all of our modalities, patients are free to switch to VLCD, LCD or ASP if they so desire.

4. APPETITE-SUPPRESSANT DRUG PROGRAM (ASP)
The RFO Program has been a pioneer in evaluating the short- and the long-term use of appetite-suppressant drugs. Since obesity tends to be a chronic disorder, similar to high blood pressure and diabetes, is is postulated that, like these disorders, in many patients chronic drug therapy is indicated. Whether this is possible and completely safe is not yet certain.

The drugs approved for weight loss by the FDA are either serotonergic, i.e., they raise serotonin levels to increase satiety and reduce food intake, or noradrenergic, i.e. they raise the blood levels of noradrenaline and suppress appetite. The serotonergic drugs, fenfluramine and noradrenergic drugs are phentermine, diethylpropion, mazindol and phenylopropanolamine. Each of these drugs was approved for release by the FDA based upon clinical studies showing that they reduced calorie intake and caused weight loss when compared to a placebo.

In 1992 a four-year study supported by the National Institute of Health (NIH) was published from the University of Rochester School of Medicine. This study of 121 patients showed that by combining the serotonergic drug, fenfluramine, and the noradrenergic drug, phentermine, each drug could be given in smaller doses than when prescribed individually, and equivalent weight loss resulted with fewer side effects. The patients were carefully monitored with serial laboratory values and electrocardiograms. There were no serious side effects or morbidity. Rapid weight loss took place over a six-month period and weight loss was maintained for up to four years.

Immediately after publication of these research studies, the RFO Program tried to replicate these results with much larger number of patients. In a one-year follow-up of several hundred patients, our results exceeded those of the University of Rochester group. The average weight loss at the end of one year was twenty percent of initial body weight, and continuous weight loss did not stop at six months. We attribute these better results to our ability to frequently adjust doses of medication when indicated and to more frequent patient contact with physicians, dieticians and therapists than was possible at the University of Rochester.

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