New Direction: a medically-supervised Very Low Calorie Diet (VLCD)

 

The New Direction© Program is a medically-supervised Very Low Calorie Diet (VLCD) which utilizes a meal replacement product exclusively to meet an individual’s nutritional needs; no food is consumed while on this program. Depending on an individual’s starting weight, age, gender and activity level, a calorie “prescription” is determined—most usually 600-800 kcal/day for women, 800-1000 kcal/day for men. The meal replacement product is a medically-formulated, low-calorie, low-carbohydrate meal replacement product with high biologic-value (HBV) protein. The meal replacement product also functions to minimize side effects typically experienced with food-based VLCDs.  No extra vitamins/minerals are needed; each meal replacement provides 33% of the Daily Value for vitamins and minerals.

Most people would be concerned about physical hunger while on a VLCD. However, the low-carbohydrate content of the meal replacement promotes a mild level of ketosis (typically by Day 3 or 4 after starting) which is associated with decreased hunger and cravings. Ketosis is a metabolic state where fat stores are being used as the primary fuel source as carbohydrate intake is restricted. To maintain ketosis while on the VLCD, it is important to avoid extra sources of carbohydrate during that time period. Ketosis is associated with potential side effects listed below, however, medical monitoring and management helps minimize side effects. No travel outside of the country while on this program.

If considering bariatric surgery, one should be aware this program provides a NON-SURGICAL option for rapid weight loss and medical improvements WITHOUT the potential short and long-term risks associated with surgery.
 

If you are diabetic, please see the link below which describes the particular benefits of rapid weight loss, medication reductions and cost savings with a VLCD program.
 

Helping Diabetics Reduce Medications & Improve Quality of Life
 

Additional Resources:


American Society of Bariatric Physicians' Position Statement on Use of VLCDs

http://www.asbp.org

 

Basic Qualification Criteria:

21 years of age

BMI of 30 or a BMI of 27 with medical risks

BMI calculator for adults:
http://www.cdc.gov/nccdphp/dnpa/bmi/bmi-adult.htm

Program Elements:

Average weight loss rate of 3-5 pounds weekly; women typically in the lower range and men in the upper range.

Exclusive use of meal replacement product to create a safer (compared to food-based) VLCD, mild ketosis, consistent weight loss results and avoidance of nutritional deficiencies.  

 WeeklyWWeekly medical monitoring is required and provided by our nursing staff who monitor blood pressure, weight changes, and potential side effects.which may include dizziness, fatigue, constipation, diarrhea, gallstones and hair loss. A monthly physician exam and labs are conducted by our supervising physicians while on New Direction. An EKG is repeated with every fifty pounds of weight loss.

Physician review of blood glucose logs and adjustment of medications throughout the weight loss phase is included as medical monitoring. Patients have access to our physicians by pager, if necessary, after hours and on weekends.

Group clinic/class conducted by staff:

  • Registered and Licensed Dietitian with and Advanced Level 2 Certificate of Training in Adult Weight Management with the American Dietetic Association
  • Behaviorists—Individuals who have master’s degrees in counseling, in social work or licensed counselors
  • Exercise Classes conducted by ACE-certified Personal Trainer (American Council on Exercise)
  • Referrals for adjunctive therapy with psychologists or counselors, if indicated
  • NEW for 2012: clinic/clas options midday, evening and early morning, as enrollment needs indicate

 

Program Structure:

Screening Phase consists of a medical exam, in-depth behavioral interview, nutritional questionnaire and exercise questionnaire. Labs and an EKG are done as part of the medical screening. Contraindications for this program include liver or kidney disease, Type 1 diabetes, active ulcers or inflammatory bowel disease, bulimia, psychiatric disorders, pregnant or breastfeeding women and children or adolescents.

Weight Loss Phase consists of consumption of meal replacements in variety of flavors and textures: chocolate, vanilla, strawberry, pineapple apricot, lemon, hot cocoa, mocha, chocolate pudding, vanilla pudding, lemon pudding, cream of chicken soup, cream of tomato soup and cheddar-broccoli soup. Each flavor come packaged as a powder which is mixed with water or any other non-calorie liquid. Recipes are also provided where the product could be cooked to consume as pancakes, muffins, crepes, etc.

A word about meal replacements—while “tools” such as meal replacements, have been shown to be helpful in weight management, they are likely to be ineffective as a “single solution” without additional education and training. During the phase of meal replacement use, our staff’s focus is on helping an individual become more aware of the emotional, psychological and environmental reasons for overeating. Participants also discover skills, behaviors, attitudes and resources which will support new lifestyle changes for balanced, healthy eating and living. A long-term weight management plan will include whole grains, fruits, vegetables, low-fat protein sources and regular exercise, in addition to the use of meal replacement products IF helpful specific to an individual’s needs.

Adapting or Transition Phase is a series of four weeks of guided, structured meal plans which accomplishes a gradual transition from meal replacements to a full-food plan.

Indirect Calorimetry Test and an Individual Appointment is conducted before entering the maintenance phase to confirm calorie needs before entering the maintenance phase.

 

NEW FOR 2012! JCMG’s Weight Treatment Center is offering a new program for the Maintenance Phase which builds on the skills introduced during the weight loss phase and incorporates practical applications based on the latest research regarding weight maintenance success. It is also important to JCMG’s Weight Treatment Center that clients are offered value for their investment of time and dollars. The S.T.A.R.® program (Steps To Avoid weight Regain) will be offered in 12-week sessions, resulting in a lower overall cost than the previous six-month (24-week) maintenance program. Further, those clients who would prefer to attend for a longer period of time or at a frequency of their own choosing will be able to do so at a reduced cost. A minimum of three months' participation in the reducing phase is a prerequisite.


A participant’s weight is assessed by zones—Green Safety Zone, Yellow Caution Zone or Red Correction Zone—which then direct how frequently one should attend after the initial 12-week course. Research indicates that a two-year focus on practicing new behaviors and skills is consistent with optimal success

On-going Support is offered with a free monthly support group meeting and a free weekly weigh-in clinic every Monday. Some individuals find it helpful to meet with our staff one-on-one at least monthly for additional support and monitoring.

Goal Weight Determination is unique to each individual. Most of the people with whom we work have intial BMIs which range 30-60. Most often goal weights fall into a BMI range of 25-30 or, in some cases, a reduction of 20-30% from initial weight. It is not the intent of this program to create an ideal BMI but to help reduce medical risk through weight reduction.

Program Costs will vary depending on individual calorie needs, the amount of weight to lose and the number of weeks on New Direction. All interested applicants are encouraged to attend an information meeting so that they are full informed about program options and fees. Once enrolled in the program, fees are collected weekly. There are no hidden charges or advance fees associated with our program. An itemized receipt will be mailed to each participant weekly.

Please consider that the cost of meal replacements is a “transferred” cost which replaces grocery purchases plus restaurant dining. In most cases, people will spend less on the VLCD program compared to normal weekly grocery and restaurant purchases! Also important to consider is the “saved” cost of insulin and/or other medications which may be reduced or discontinued secondary to the rapid rate of weight loss associated with this particular approach.

In most cases, an individual may choose New Direction initially and then transition into our second program--the Outlook program--when they are ready to begin utilizing food on a daily basis while losing weight.

Please note: Insurance reimbursement is not typical for weight loss programs even if your physician has advised you to lose weight. Due to increasing awareness of obesity, though, some employers groups or insurers may begin to consider and include this type of benefit. Please check your Benefit Summary handbook for language referring to obesity treatment or weight loss programs; if such a benefit IS included, please provide notification at time of application. In most cases, if bariatric surgery is a covered benefit, then the physician's appointments and labs on the VLCD program may be covered, too.
 

For those who do not have insurance coverage, you could save tax dollars through reimbursement from a cafeteria plan or Health Savings Accounts (HSA) for unreimbursed medical expenses. The IRS requires a BMI equal to or greater than 30. In most cases, expenses related to appointments, diagnostic tests and class fees qualify; the costs for meal replacement products DO NOT qualify.
 

So, how do you get started?

We suggest all interested applicants attend a free monthly information session which offers a discussion and review of the New Direction program in greater detail. Registration is required; please call 556-5774.

If you decide New Direction is the right program for you, please call our office to request application forms to complete. Once returned to our office and reviewed, you will be contacted to set up your screening appointments. This process usually takes one to two weeks before a “start” appointment is set.

New Direction® Weight Control System is a registered trademark of ROBARD.

Additional Resources:


American Society of Bariatric Physicians’ Position Statement on Use of VLCDs


http://www.asbp.org