A forty-day-550 calorie diet in the treatment of obese outpatients.

All obese patients who were referred to the Endocrinological Outpatient Clinic of the Tel-Hashomer Hospital between July 1957 and July 1958 were treated according to the following plan unless they were less than eighteen years of age, or it was thought that they would not be able to follow the plan because of low intelligence. No other plan of treatment was proposed to any patient during this period. The diet was that proposed by Simeons’ and consisted of only two meals daily. Each meal consisted of: (1) 100 gm. of lean meat (veal, beef), chicken or fish, weighed raw, served grilled or boiled, (2) one normal serving of fresh seasonal vegetables, boiled or raw, (3) one rusk weighing 10 gm., (4) half a lemon, (5) an apple or orange or 60 gm. of other fresh fruit (below 15 per cent carbohydrate content). Meals were taken at whatever time preferred by the patients, but patients were not allowed to save part of the meal for later consumption. In addition patients were allowed unlimited quantities of salt, pepper and water, as well as tea and coffee (unsweetened and without milk) during and between the meals. It was impressed upon them that strict adherence to the diet was essential. This diet furnishes about 500 to 600 calories daily. Patients were not informed of the caloric value of this diet nor were they allowed to substitute caloric equivalents. The diet was prescribed for forty consecutive days. Patients were told that they could expect a weight reduction of about 10 kg. (22 pounds). They were not seen during the dieting period, but were instructed to continue their usual occupations and accustomed way of life. After forty days they were re-examined. Those who were still overweight and in need of a second course were instructed to preserve the attained weight: they were told to eat three meals a day and to weigh themselves daily, regulating food intake so as to avoid weight gain. Again, patients were not told to “count calories.” After two months they were put on a second course. Of the forty-five patients, five completed two or more courses; several others are now in their second course. In accordance with Simeon’s plan,’ 125 units (0.25 ml.) of gonadotropin (Antuitrin 5, Parke, Davis & Co.) were given daily to thirty-nine of the patients; fourteen others received daily injections of saline. Patients were told that weight reduction would be due to the diet but that injections would help to curb their appetites. The injections were given at home by a nurse. RESULTS