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The Evidence for the Rainier Medical Program



Rainier Medical offers a medical intervention known as a very low calorie diet using a medically formulated liquid diet transitioning to an active weight regain prevention (maintenance) program. Today, I offer some of the research evidence on which it is based. We have heard a lot about basing things on science in the news lately. In medicine, there are evidence based practices, or those based on research, and non evidence based practices. When available, evidence based is best. You might think that every time you get a treatment recommended to you that it is evidence based, but that is not always possible for various reasons. The last time I heard the statistic, it was about 17% for the percentage of care that was actually evidence based. I won't venture into the reasons why it is not higher here. Following is a summary I made, in lay terms, of a review article on the role of these diets, their outcomes, safety, and a discussion on perhaps using them in a more widespread fashion. There is a link to the free full text article available to the public in the International Journal of Obesity.


The following is paraphrased from a review article. A review article is an article in which the authors have taken into account all the individual peer-reviewed articles and synthesized them. The statements in parentheses are my own and not part of the article.


Review: Weight losses with low-energy formula diets in obese patients with and without type 2 diabetes: systematic review and meta-analysis


Introduction

Type 2 diabetes mellitus (T2DM) is closely linked to diabetes and is the main contributor to rising healthcare costs (which individuals bear more and more with high deductibles and co-insurance plans). Most individuals with T2DM have a BMI>25 and about half have a BMI>30. With a BMI>35, 20% of all men and 11% of all women have known diabetes. (Many people have diabetes and do not know it. Men have more complications with a given amount of excess weight than women, even though studies show that more women are trying to lose weight than men.)

Although previous guidelines have retained a 5-10% weight loss target, with the increasing severity of obesity, new guidelines set target of >15-20% weight loss for those with BMI > 35 or BMI>30 with serious medical complications such as T2DM. (This is crucial as most anti-obesity medications have less expected weight loss than this.) Since the current medical treatment of obesity in usual care patterns rarely shows this amount of weight loss, some guidelines are simply recommending bariatric surgery (But, is there a better way than conventional current treatment?).