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How to lose, maintain healthy weight, by studies

By Chukwuma Muanya
05 September 2019   |   3:02 am
Do you have potbelly? Are you having difficulties walking up the stairs? Is your Body Mass Index (BMI) more than 25 or beyond 30 kg/m2? If the answer is yes, then you are overweight or rather obese. You need help

Lemons. Photo-credit_Greek Boston

Do you have potbelly? Are you having difficulties walking up the stairs? Is your Body Mass Index (BMI) more than 25 or beyond 30 kg/m2? If the answer is yes, then you are overweight or rather obese. You need help.

BMI is calculated as weight in kilogrammes divided by height in metres squared (kg/m2). BMI defines people as overweight (pre-obese), if their BMI is between 25 to 30 kg/m2, and obese when it is greater than 30 kg/m2.

Why does someone with BMI of more than 30 kg/m2 need help urgently? Obesity has been associated with all types of cancers, stroke, heart diseases, diabetes, arthritis, infertility, erectile dysfunction, kidney damage to mention but a few, which eventually leads to decreased life expectancy.

What is the solution? Weight loss. But losing weight does not come easy. In fact, there is no fast and safe route to shedding some kilogrammes.

Until now, conventional medicine has proposed several methods such as gastric bypass surgery and anti-obesity medications. But they come at a very high cost in terms of adverse side effects and most often than not the patients regain the lost weight.

But natural medicine has provided cheap, accessible and safe solutions to shedding kilogrammes and maintaining a healthy weight.

Top on the list are regular exercises combined with dieting such as keto-diet (high in fat and protein and low in carbohydrates); a herbal combination of lemon, black seed and nutgrass; corn silk extract; sweet potato wastewater, African bush mango seed extract, beans, and turmeric; zobo, bitter melon and bitter leaf among others.

Why exercise is more critical than diet to maintain weight loss

*Morning physical activity may offer most benefits than the afternoon, evening routines

A new study from the University of Colorado Anschutz Health and Wellness Center (AHWC) at the CU Anschutz Medical Campus, United States (US) revealed physical activity does more to maintain substantial weight loss than a diet.

The study was published in the journal Obesity.

The findings reveal that successful weight-loss maintainers rely on physical activity to remain in energy balance (rather than chronic restriction of dietary intake) to avoid weight regain. In the study, successful weight-loss maintainers are individuals who maintain a reduced body weight of 30 pounds or more for over a year.

Key findings include: The total calories burned (and consumed) each day by weight-loss maintainers was significantly higher (300 kcal/day) compared with that in individuals with normal body weight controls but was not significantly different from that in the individuals with overweight/obesity.

Notably, of the total calories burned, the amount burned in physical activity by weight-loss maintainers was significantly higher (180 kcal/day) compared with that in both individuals of normal body weight and individuals with overweight/obesity. Despite the higher energy cost of moving a larger body mass incurred by individuals with overweight/obesity, weight-loss maintainers were burning more energy in physical activity, suggesting they were moving more.

This is supported by the fact that the weight-loss maintainer group also demonstrated significantly higher levels of steps per day (12,000 steps per day) compared to participants at a normal body weight (9,000 steps per day) and participants with overweight/obesity (6,500 steps per day).

Meanwhile, in a study, people who worked out before noon lost more weight, on average, than those who typically exercised after 3 p.m.

According to a new study of workouts and waistlines, people who exercise in the morning seem to lose more weight than people completing the same workouts later in the day.

The findings help shed light on the vexing issue of why some people shed considerable weight with exercise and others almost none, and the study adds to the growing body of science suggesting that the timing of various activities, including exercise, could affect how those activities affect us.

So, for the new study, which was published in July in The International Journal of Obesity, the researchers uncovered a few other, possibly relevant differences between the morning and late-day exercisers. The early-exercise group tended to be slightly more active throughout the day, taking more steps in total than those who worked out later. They also ate a bit less, although the difference amounted to barely 100 calories per day on average. Overall, such differences were barely discernible.

Lemon, black seed and nutgrass induce weight loss
Researchers have demonstrated how lemon, black seed, and nutgrass could be effectively used to induce weight loss owing to their anti-obesity effects.

The study titled, Anti-Obesity Efficacy of Selected Plants Against Progesterone Induced Obesity, was published in the International Journal of Pharmacy and Biological Sciences.

The study evaluated the anti-obesity efficacy of Citrus limon (lemon), Nigella sativa (black seed) and Cyperous rotundus (nutgrass) against progesterone-induced obesity in female BALB/C mice. Progesterone was administered subcutaneously, and plant extracts were given orally for 28 days. Food intake and body weight gain were monitored regularly and lipid profile, neurotransmitters (serotonin and dopamine) that play key role in energy homeostasis were analysed.

The results suggest among the three plants, Citrus limon, and Nigella sativa showed better reduction in the levels of circulating free fatty acids, lipid profile resulting in decreased food intake and body weight gain in female BALB/C mice in comparison with progesterone treated group followed by Cyperous rotundus at dose of 400mg/kg body weight (bw). Thus, these plants can be considered as an effective treatment in management of obesity owing to their potential anti-obesity effect.

Cyperous rotundus is commonly called nutgrass. It is called ayaare and goje in Fula-Fulfulde; ayaa-ayaa, giragiri, girigiri and gwaigwaya in Hausa; nu in Kanuri; and ishoho i toho in Tiv.

The Indian researchers concluded: “ In general, the culmination with the present results we suggest that three different plant extract possess anti-obesity efficacy against progesterone-induced obesity model. From this study Citrus limon at 400mg/kg BW, Nigella sativa 400mg / kg BW followed by

Cyperus rotundus 400mg/kg BW exhibited significant anti-obesity activity.

“Oral administration of these extracts reduced the level of circulating lipids resulting in the decrease of food intake and body weights in female BALB/C mice, which bearing close resemblance to human obesity. Thus, it can be considered as an effective treatment in the management of obesity owing to its potential anti-obesity effect.”
High maysin corn silk extract reduces body weight and fat deposition

Researchers have demonstrated the effects and mechanisms of action of high maysin corn silk extract on body weight and fat deposition in experimental animals.

The study published in the journal Nutrition Research and Practice is titled “High maysin corn silk extract reduces body weight and fat deposition in C57BL/6J mice fed high-fat diets.”

A total of 30 male C57BL/6J mice, four-weeks-old, were purchased and divided into three groups by weight using a randomized block design. The normal-fat (NF) group received seven per cent fat (diet weight basis), the high-fat (HF) group received 25 per cent fat and 0.5 per cent cholesterol, and the high-fat corn silk (HFCS) group received high-fat diet and high maysin corn silk extract at 100 mg/kg body weight through daily oral administration. Bodyweight and body fat were measured, and mRNA expression levels of proteins involved in adipocyte differentiation, fat accumulation, fat synthesis, lipolysis, and fat oxidation in adipose tissue and the liver were measured.

After experimental diet intake for eight weeks, body weight was significantly lower in the HFCS group compared to the HF group, and kidney fat and epididymal fat pad weights were significantly lower in the HFCS group compared to the HF group. In the HFCS group, CCAAT/enhancer-binding protein-β, peroxisome proliferator-activated receptor-γ1 (PPAR-γ1), and PPAR-γ2 mRNA expression levels were significantly reduced in the epididymal fat pad, whereas cluster of differentiation 36, lipoprotein lipase, acetyl-CoA carboxylase-1, sterol regulatory element-binding protein-1c, pyruvate dehydrogenase kinase, isozyme-4, glucose-6-phosphate dehydrogenase, and stearoyl-CoA desaturase-1 mRNA expression levels were significantly decreased in liver and adipose tissues. In the HFCS group, mRNA expression levels of AMP-activated protein kinase, hormone-sensitive lipase, and carnitine palmitoyltransferase-1 were elevated.

The researchers concluded: “It can be concluded that high maysin corn silk extract inhibits expression of genes involved in adipocyte differentiation, fat accumulation, and fat synthesis as well as promotes expression of genes involved in lipolysis and fat oxidation, further inhibiting body fat accumulation and body weight elevation in experimental animals.”
Zobo potent in the treatment of obesity with an evident reduction in body weight

Researchers have critically examined the effects of Hibiscus sabdariffa (roselle/zobo) extract (HSE) on various parameters associated with the development of obesity such as; the effect of HSE on body weight, the effect of HSE on lipid accumulation, cholesterol metabolism and plasma parameters, the inhibitory effect of HSE on pancreatic lipase, and the effect of HSE on adipocyte differentiation/adipogenesis.

The study published in the journal Molecules is titled “Beneficial Effects of Natural Bioactive Compounds from Hibiscus sabdariffa L. on Obesity.”

This review has gathered reports on the various anti-obesity effects of H. sabdariffa bioactive compounds in cell and animal models, as well as in humans. Available toxicology information on the consumption of H. sabdariffa revealed that its toxicity is dose-dependent and may cause an adverse effect when administered over a long period of time. Reports have shown that H. sabdariffa derived bioactive compounds are potent in the treatment of obesity with an evident reduction in body weight, inhibition of lipid accumulation and suppression of adipogenesis through the PPARγ pathway and other transcriptional factors.

Recently, natural bioactive compounds such as flavonoids and phenols have been reported to be effective in the treatment of obesity. Bioactive compounds in edible plants such as epigallocatechin gallate (EGCG) from green tea, nobiletin from citrus peel, curcumin from turmeric, resveratrol, pterostilbene from berries and anthocyanins from H. sabdariffa have been reported for their anti-obesity potential in both in-vivo and in-vitro studies.

The researchers concluded: “Results have consistently reported that HSE consumption reduces body weight, lipid accumulation and total cholesterol metabolism in both animal and human studies. Its effectiveness in inhibiting pancreatic lipase and on adipocyte differentiation has also been frequently reported, thus confirming its therapeutic potential in obesity management.

“Since clinical and animal studies have shown H. sabdariffa bioactive compounds to be effective in combating obesity, its regulated use as an active ingredient incorporated into diets at safe dosage is suggested.

“The inconsistency of available studies on specific bioactive compounds responsible for anti-obesogenic properties of H. sabdariffa, as well as effective and safe doses, makes it necessary to carry out further studies for a more unanimous report.”

Novel bitter melon extract show metabolic, anti-obesity effects
Oil extracts from the seeds of bitter melon (Momordica charantia) may help reduce body weight, suggests a new study from China.

The novel bitter melon extract was found to be a rich source of conjugated linolenic acid (CLnA, cis9, trans11, trans13-18:3) and of conjugated linoleic acid (CLA, cis9, trans11-18:2), and data from an animal feeding study indicated a potent anti-obesity effect.

Writing in the Journal of Nutrition & Intermediary Metabolism, the researchers reported that supplementing a high-fat diet with 10 grams per kilogramme of the novel bitter melon extract led to significantly lower body weights than animals only receiving the high-fat diet.

This dose of bitter melon extract was also associated with a lower degree of obesity, but lower doses did not have any significant effects.

“This beneficial effect was partially interpreted as the increased lipid metabolism, and leptin also participated in the overall regulating process,” ​they wrote. “This is a detailed exploration of bitter melon extract’s anti-obesity effect, facilitating the rational use of this herbal plant to address this increasingly severe issue, obesity.”​
Bitter leaf caused significant weight loss

Researchers have shown how concentrations of the extracts of the leaves of bitter leaf/Vernonia amygdalina (VA- AEVA and MEVA) caused significant weight loss in rats. They said the observed weight loss might have been due to loss of
Adipose/fat tissues as internal organs were not adversely affected.

The study titled “Obesity potentials of aqueous and methanol extracts of Vernonia amygdalina” was published in the African Journal of Traditional Complementary and Alternative Medicine.

The study investigated the anti-obesity potentials of aqueous and methanol extracts of Vernonia amygdalina in a rat model in which obesity was induced using a high-fat diet.

Forty-two Wistar rats were randomised into seven groups of six rats each. One group served as the Normal Control group and obesity was induced in the other six groups. One of the six groups each served as Positive Control and Negative Control while the four test groups were designated AEVA100, AEVA500, MEVA50, and MEVA200, respectively. The study lasted for

12 weeks after which standard protocols were followed for all analyses and determinations.

The results show that both AEVA and MEVA at the tested concentrations resulted in significant weight loss (without affecting internal organs negatively), and significant improvement in some metabolic markers of obesity in the test rats compared to the negative control rats. MEVA 200 had the greatest anti-obesity effect while MEVA 50 was the least effective. The entire test extracts compared well with Orlistat used as the positive control drug on all counts.

The Nigerian researchers concluded: “The observed weight-loss benefits of AEVA and MEVA are attributable to the rich milieu of phytochemicals found in Vernonia amygdalina. Further studies to unlock the mechanisms through which the observed weight loss is mediated are warranted.”

The researchers concluded: “In conclusion, the anti-obesity potentials of an aqueous and a methanol extract of Vernonia amygdalina were studied in high-fat diet-induced obesity of rats. Both extracts resulted in significant weight loss and significant improvement in some metabolic markers of obesity in the test rats compared to the negative control rats. The extracts closely mimicked the action of the standard drug, Orlistat.

“The observed effects are likely as a result of the rich chest of phytochemicals present in VA. An investigation into the mechanism(s) of action of the extracts is nonetheless warranted, and is ongoing in our laboratory.”

Black pepper could help in the battle against obesity
Black pepper could help in the fight against obesity, new research suggests. Piperonal, a compound in the seasoning, was found to ‘significantly’ reduce the harmful effects of a high-fat diet when fed to rats. In the Indian study, those given it as a supplement for six weeks had a lower body weight, body fat percentage, and blood sugar levels as well as stronger bones compared to animals fed fatty foods only and no pepper.

The study was published in the journal Nutrition and Metabolism. In a separate study, the United Kingdom (U.K.) researchers at Imperial College London discovered mutations in a gene related to obesity and have suggested “obesity is not always gluttony’. Interestingly, the Indian researchers believe piperonal may counteract some of the genes that are associated with being severely overweight.

Both teams hope their findings can produce a new treatment for obesity, rates of which have nearly tripled worldwide since 1975. Botanically called Piper nigrum, Black pepper belongs to the plant family, Piperaceae. Local names are unknown. The fruits and seeds are used to cure dyspepsia (indigestion), diarrhea, cholera, piles, urinary problems, boils, rheumatism, toothaches, and headaches.

Extract of wild mango seed shows promise in obesity treatment
Can eating Ogbono soup help overweight persons shed some kilos, reduce abdominal fat, lower their cholesterol and chances of developing diabetes, heart diseases, cancer, stroke, kidney failure, high blood pressure?

A study published in Lipids in Health and Disease suggests that an extract derived from the seed (Ogbono) of West African mango may help overweight people shed kilogrammes, lower their cholesterol and chances of developing degenerative diseases.

Researchers in other studies found that the fruit of Irvingia gabonensis could be used to reduce abdominal fat, and stop diarrhea and ulcer. Lab research has shown that extracts from the plant’s seed may inhibit body fat production, through effects on certain genes and enzymes that regulate metabolism.

A person is said to be obese when the ratio of the weight in kilogrammes over the height in square metres, that is the Body Mass Index (BMI), is more than 30; overweight when the BMI is between 25 and 30; and healthy weight when the BMI is between 20 and 25. The seed of Irvingia gabonensis is the basic ingredient of the popular tasty delicacy, Ogbono soup. The fruit looks like a mango, but leaves a bitter after taste. The seed, slimy when it touches water, is used in cooking Ogbono soup.

Botanically called Irvingia gabonensis, West African mango or Wild mango is a fruit commonly eaten in Nigeria, and indeed the whole of West Africa. It is also called native mango, bush mango, dika nut tree, and dika bread tree. In Nigeria, it is pekpeara in Nupe; ugiri (tree or fruit) or ogbono (kernel or seed) in Igbo; oro (the tree) or aapon (the kernel) in Yoruba; ogwi (the tree or fruit) in Benin; goron or biri in Hausa; uyo in Efik.

Aloe vera juice for weight loss?
People looking for quick weight-loss solutions sometimes turn to herbal products, such as those containing Aloe vera. Although these products may produce short-term weight loss, they are not likely to result in permanent weight loss and may have a number of side effects, according to the Cleveland Clinic. Most studies on Aloe vera and weight loss have used Aloe vera gel or supplements rather than Aloe vera juice, so it may not have the same effects.

An animal study published in Obesity Research & Practice in December 2008 showed a potential for plant sterols found in Aloe vera to improve body composition. In the study, obese rats given these plant sterols had lower levels of abdominal fat after 35 days than rats not given these sterols. This effect may also occur in people. A small preliminary study published on September 2013 in Nutrition found that obese people with diabetes or pre-diabetes who took an Aloe vera gel complex for eight weeks lost more weight and body fat than those not given this supplement. Larger long-term studies are needed to verify these effects.

Sweet potato wastewater, African bush mango seed extract, beans, turmeric validated
Japanese researchers have found that proteins in the starchy sweet potato wastewater suppress appetite and contain sweet potato peptide (SPP). SPP is produced by enzyme digestion of proteins in the water during the boiling process.

The researchers in a study published in the journal Heliyon found that after 28 days, mice fed high levels of the protein were found to have lost weight, and the experts said the results could be replicated in humans.

Japanese researchers fed two groups of mice high-fat diets, giving one higher level of SPP.

After 28 days the animals were weighed and their liver mass and fatty tissue levels measured. Cholesterol and triglyceride levels were also taken, as well as leptin, which controls hunger.

Experts from the National Agriculture and Food Research Organisation, Tsukuba, also collected adiponectin measurements, which measures metabolic syndrome.

They found the mice given higher levels of SPP had significantly lower body weight. While they also discovered the animals had lower cholesterol, triglyceride, leptin and adiponectin levels.

Also, a study claims legumes like beans and peas are the best way to stave off hunger pains. Scientists fed a group of men either fiber-rich vegetarian patties or protein-heavy veal and pork patties. They found those who ate legumes at 12 percent fewer calories at their next meal.

The study published in the scientific journal Food & Nutrition is one of the first to compare how meat and legumes affect our hunger levels.

As a result, there has been scarce scientific evidence to support claims that vegetables help maintain weight loss. In the study, 43 young men were served three different meals, mainly consisting of patties. Some had patties filled with beans and peas, others with veal and pork.

When participants ate a protein-rich meal based on beans and peas, they consumed 12 percent fewer calories in their next meal than if they had eaten a meat-based meal.

The authors added that their study provides welcome evidence to support a vegetable-based diet, given that meat production is a far greater burden on our climate than vegetable cultivation.

Also, a United States (U.S.) study had found that eating turmeric-flavoured meals could be the best way to shedding excess kilos. Turmeric is a local spice commonly used for culinary. It resembles ginger with its near-yellow colour. It has been effectively used in pain, wounds, diabetes and heart disease.

Turmeric, an Asian spice cultivated in Nigeria and found in many curries, has a long history of use in reducing inflammation, healing wounds and relieving pain, preventing diabetes and heart failure, but can it induce weight loss?

According to results from the animal model study by U.S. Agricultural Research Service (ARS)-funded scientists and colleagues, a compound in turmeric stopped the spread of fat tissues in the animal models.

The study published in the Journal of Nutrition theorised that dietary curcumin could stall the spread of fat-tissue by inhibiting new blood vessel growth, called angiogenesis, which is necessary to build fat tissue.

Curcumin is a bioactive component in curry and turmeric that has been consumed daily in Asian countries for centuries without reported toxic effects.

Turmeric is a spice that comes from the root of Curcuma longa, a member of the ginger family, Zingiberaceae.

In Nigeria, it is called atale pupa in Yoruba; gangamau in Hausa; nwandumo in Ebonyi; ohu boboch in Enugu (Nkanu East); gigir in Tiv; magina in Kaduna; turi in Niger State; onjonigho in Cross River (Meo tribe).

Eating earlier in the day aids weight loss by curbing appetite
New research confirms that shifting mealtimes to a smaller window, earlier in the day can aid weight loss. It also reveals that weight loss from this type of meal schedule is likely due to appetite and hunger hormone reduction, rather than calorie burning.

A paper that features in the journal Obesity describes a trial that shows how the timing of meals influences metabolism.

The authors wrote: “Eating in sync with circadian rhythms by eating early in the daytime appears to reduce body weight and improve metabolic health.”

However, they add that it is not clear which mechanisms could be driving “these weight loss effects.”

Therefore, the new study is the “first randomized trial to determine how meal timing affects 24-hour energy metabolism when food intake and meal frequency are matched.”

The researchers compared two groups of people who ate the same three meals per day for four days but with different timings: the early time-restricted feeding (eTRF) schedule and the control schedule.

A total of 11 men and women completed the trial: six in the eTRF group and five in the control group. To qualify for the trial, participants had to be in good health, aged between 25 and 45 years, and carrying excess weight.

The eTRF group breakfasted at 8:00 a.m. and ate their last meal of the day at 2:00 p.m. They then fasted for around 18 hours before breakfast the next day.

The control group also breakfasted at 8:00 a.m. but their last meal of the day was at 8:00 p.m. Therefore, they fasted for around 12 hours before breakfast the next day.

The authors likened the control schedule “to the median reported breakfast and dinner times for American adults.”

On the fourth day, the participants underwent a battery of tests in a respiratory chamber to measure their metabolism. The measures included calories burned and the amount of fat, carbohydrates, and proteins burned.

The participants rated various aspects of appetite — such as hunger, desire, and capacity to eat, and fullness — by indicating their perception of these measures on a visual sliding scale.

From blood and urine samples that the participants gave in the morning and evening, the team was also able to assess levels of hunger hormones.

The results showed that calorie-burning did not differ much between the groups. However, those on the eTRF schedule had lower levels of the hunger hormone ghrelin and reported improvement in some facets of appetite.

Burned more fat
The findings also reveal that the eTRF group appeared to have burned more fat over a 24-hour period.

Speculating on why eTRF could promote fat burning, the team suggests that eating the last meal of the day in the afternoon could help the body switch from burning carbohydrates to burning fat for energy.

However, the researchers caution that the findings on fat burning are preliminary and call for a longer study to verify and confirm whether strategies such as eTRF can help people shed body fat.

Keto dieters maintained ketosis and lost weight in a three-month study
A new study has researchers hopeful that a ketogenic diet could prove useful in the military, where obesity is an ongoing challenge, both in terms of recruiting soldiers and keeping them fit for service.

The Ohio State University, United States, the study included 29 people, most of whom were members of the campus ROTC. For three months, 15 of the participants followed a ketogenic diet and a comparison group of 14 peers ate their normal diet.

Ketogenic diets are low in carbohydrates and emphasize moderate consumption of protein, with fat consumed to satiety. They aim to create a state of nutritional ketosis — which occurs when the body burns fat, rather than carbohydrates, for energy. The ketogenic diet is often used to control seizures in epilepsy and also is being studied and applied in a variety of other areas, including endurance sports and diabetes management.

In the study, which appears in the journal Military Medicine, participants on the keto diet lost an average of almost 17 pounds and were able, with the support of counselors, to maintain ketosis for 12 weeks. As a group, they lost more than five percent of their body fat, almost 44 percent of their belly, or visceral, fat and had a 48 percent improvement in insulin sensitivity — a marker that predicts the risk of diabetes.

The comparison group of participants, who consumed diets that were at least 40 percent carbohydrates (based on food diaries they kept), experienced none of those changes.

The ketogenic diets in the study included no caloric restrictions, just guidance about what to eat and what to avoid. Carbs were restricted to about 30 to 50 grams daily, with an emphasis on nuts and non-starchy vegetables. Food was also provided, either as groceries, the keto dieters could use to prepare meals themselves or as pre-prepared frozen meals.

Keto diet participants had near-daily check-ins during which they reported blood ketone measurements from a self-administered finger-prick test and received feedback, usually through text messages, from the research team. Ketosis was defined as a blood concentration of ketones, chemicals made in the liver, between 0.5 and 5.0 mM (millimolar).

Both groups, whose schedules included regular resistance training, showed comparable physical performance levels at the end of the study. This was important because it’s difficult to lose weight without losing some lean muscle mass and physical function.

The study results come with caveats. The group that followed the ketogenic diet chose to be in the test group, something that scientists call self-selection. Studies in which participants are randomized are preferred, but the research team said they wanted to do this pilot study in a group eager to adhere to the diet. The keto group also had a higher average body mass index at the start of the study — 27.9 versus 24.9 in the comparison group — meaning they had more fat to lose.
Obesity treatment by very low-calorie-ketogenic diet at two years: reduction in visceral fat and on the burden of disease

A study published in the journal Endocrine concluded: “In conclusion, a very low-calorie-ketogenic diet was effective 24 months later, with a decrease in visceral adipose tissue and a reduction in the individual burden of disease.”

The study aimed to evaluate the long-term effect of a very low-calorie-ketogenic (VLCK) diet on excess adiposity. An especial focus was set on visceral fat mass and the impact on the individual burden of disease. A group of obese patients (n = 45) were randomly allocated in two groups: either the very low-calorie-ketogenic diet group (n = 22), or a standard low-calorie diet group (n = 23).

Both groups received external support. Adiposity parameters and the cumulative number of months of successful weight loss (five or 10 per cent) over a 24-month period were quantified. The very low-calorie-ketogenic diet-induced less than two months of mild ketosis and significant effects on body weight at six, 12, and 24 months. At 24 months, a trend to regress to baseline levels was observed; however, the very low-calorie-ketogenic diet induced a greater reduction in body weight (−12.5 kg), waist circumference (−11.6 cm), and body fat mass (−8.8 kg) than the low-calorie diet (−4.4 kg, −4.1 cm, and −3.8 kg, respectively).

Interestingly, a selective reduction in visceral fat measured by specific software of dual-energy x-ray absorptiometry (DEXA)-scan (−600 g vs. −202 g) was observed. Moreover, the very low-calorie-ketogenic diet group experienced a reduction in the individual burden of obesity because of a reduction in disease duration. Very low-calorie-ketogenic diet patients were 500 months with five per cent weight loss vs. the low-calorie diet group (350 months). In conclusion, a very low-calorie-ketogenic diet was effective 24 months later, with a decrease in visceral adipose tissue and a reduction in the individual burden of disease.”