British Journal of Nutrition

Systematic Review

Very-low-energy diets and morbidity: a systematic review of longer-term evidence

Y. Mulhollanda1, E. Nicokavouraa1, J. Brooma1 and C. Rollanda1 c1

a1 Centre for Obesity Research and Epidemiology (CORE), Faculty of Heath and Social Care, Robert Gordon University, Aberdeen AB251HG, Scotland, UK


Evidence from the literature supports the safe use of very-low-energy diets (VLED) for up to 3 months in supervised conditions for patients who fail to meet a target weight loss using a standard low-fat, reduced-energy approach. There is, however, a need for longer-term outcomes on obesity and associated morbidities following a VLED. The present systematic review aims to investigate longer-term outcomes from studies using VLED, with a minimum duration of 12 months, published between January 2000 and December 2010. Studies conducted in both children and adults, with a mean/median BMI of ≥ 28 kg/m2 were included. PubMed, MEDLINE, Web of Science and Science Direct were searched. Reference lists of studies and reviews were manually searched. Weight loss or prevention of weight gain and morbidities were the main outcomes assessed. A total of thirty-two out of 894 articles met the inclusion criteria. The duration of the studies ranged from 12 months to 5 years. Periods of VLED ranged from 25 d to 9 months. Several studies incorporated aspects of behaviour therapy, exercise, low-fat diets, low-carbohydrate diets or medication. Current evidence demonstrates significant weight loss and improvements in blood pressure, waist circumference and lipid profile in the longer term following a VLED. Interpretation of the results, however, was restricted and conclusions with which to guide best practice are limited due to heterogeneity between the studies. The present review clearly identifies the need for more evidence and standardised studies to assess the longer-term benefits from weight loss achieved using VLED.

(Received July 21 2011)

(Revised April 13 2012)

(Accepted April 15 2012)

(Online publication July 17 2012)


c1 Corresponding author: Dr C. Rolland, email


Abbreviations: AHI, apnoea–hypopnoea index; BED, binge eating disorder; BMC, bone mineral content; BMD, bone mineral density; BP, blood pressure; CBT, cognitive behaviour therapy; CTX, C-terminal telopeptide of type I collagen; VLED, very-low-energy diet