All-liquid diet: too extreme?

Glenn Page hasn't chewed solid food -- not so much as a carrot -- in the five months he has embraced a hospital-endorsed diet of chocolate and vanilla shakes to lose weight. So far, his drastic steps toward better health have led to his shedding 81 pounds and counting.

This Wayne County assistant prosecutor's wife and four children are adhering to a partial liquid diet, eating fruits, vegetables and a few other low-calorie foods as well as sipping shakes. In all, the family has lost 261 pounds -- more weight than any of the 24 teams still participating in the yearlong Detroit News Weight-Loss Challenge, which commenced in January.

While weight-loss experts agree liquid diets melt pounds away quickly, they disagree whether the drinks are a good route to longterm better health. Most dietitians insist slower is better when it comes to weight loss, because healthy eating and exercise habits take time to adopt, and weight lost quickly is generally quickly regained. The best diet, they say, is one that can be adhered to for a lifetime.

"I personally feel (liquid diets are) not a great way for weight loss," says Sujata Chaddha Jhaveri, a self-employed dietitian in Troy. "Weight loss has always been about a change in lifestyle. As long as they're on very strict supervision they do fine, but the moment they're left on their own, the moment they come off of that and starting eating normal food, in no time they gain it back. And it comes back with a vengeance."

Proponents of liquid diets -- especially the high-protein supplements used by many hospitals -- say rapid weight loss is the best motivator for those who need to shed serious pounds. And some new studies suggest those on low-calorie liquid diets can keep weight off effectively with the right training.

"When you lose weight slowly, you're less likely to stay with the plan, because it's too frustrating," says Pat Jurek, supervisor of the St. Joseph Mercy Hospital's Center for Health Management and dietitian for the Page family. "This works."

As a dietitian who used to stress all-food plans, Jurek says she watched too many of her clients struggle without getting close to their weight-loss goals. "How many people start a diet, never finish it and fail?" she points out.

Yet, it's tough to forget the famous television moment in 1989 when talk show host Oprah Winfrey wheeled a wagon full of fat before her audience to represent the 67-pounds she had dropped from her Optifast liquid diet. Months later, as a nation watched, she gained the weight back and more. Rapid weight loss and regain, experts say, can wreak havoc on one's metabolism, making further attempts at weight loss even tougher.

"That was a setback for the very low calorie diet programs," Dr. James Anderson, professor of medicine and clinical nutrition at the University of Kentucky in Lexington, says of Oprah's liquid diet experience. "Many programs just went out of business after that."

However, Anderson says very low-calorie or liquid diets have undergone a significant makeover since the 1980s. Most today consist of protein-packed 800-1,000 calories, instead of the 500-600 calorie diets that left patients feeling deprived.

A proponent of such diets, -- including the 800-calorie liquid diet of Health Management Resources shakes that Glenn Page follows -- Anderson says his studies show patients who lose weight quickly can keep it off more effectively than those who follow an all-food diet and slowly adopt better eating habits. Patients on liquid diets typically add low-calorie foods to the supplements after 12-20 weeks, he says.

One research trial Anderson conducted, published in a 2001 American Journal of Clinical Nutrition, followed patients in traditional food-based weight-loss/nutrition classes versus patients using very low calorie liquid supplements and taking such classes. After five years, those on the liquid diets had lost more weight and had maintained four times as much weight loss as the traditional dieters.

In addition, Anderson says of the 192 patients he's following at the University of Kentucky's Weight Management Program who used liquid diets, 71 percent have kept off an average of 61 pounds for 2.5 years.

Yet, many in the weight-loss field aren't convinced liquid diets are as successful longterm.

"I have great respect for Dr. Anderson's work," says Fred Stransky, former director of the Meadow Brook Health Enhancement Institute and professor emeritus at Oakland University. "But if you look at the majority of research, long, slow reductions in weight are the most successful. ... People who lose weight rapidly tend not to keep it off."

Stransky, a doctor who lectures to primary care doctors about the importance of dealing with obesity, advocates a low-fat, high-fiber diet (25 grams of each daily) for weight-loss patients and stresses the importance of exercise (an hour of daily aerobic activity is ideal, he says).

"I think (a liquid diet is) a last-chance approach for people who are in a desperate situation," Stransky says. "For the vast majority of Americans, they have to consider behavior change rather than the liquid diet approach."

John Foreyt, director of the Behavioral Medicine Research Center at the Baylor College of Medicine in Houston, also downplay's Anderson's research.

"It's not randomized control trials, it's just case studies," he says, adding the dangers of liquid diets are that people tend to think they can go back to old habits once the weight is off. "The evidence isn't in that these (liquid diets) work long-term, unless you make the lifestyle changes," he says.

However, Jurek says behavior modification classes are a key part of the Center for Health Management's liquid diet program. The Page family and all the center's clients take weekly classes, learning how they'll eat and continue to exercise once they're back on a mostly food diet. Health educators talk to their clients weekly and help them plan everything from how they'll fit more vegetables into their diet to how they'll budget time to buy and cook them. The center recommends taking 18 months of maintenance classes after dieters have hit their goal weights.

Weight-loss experts agree patients eligible for an all-liquid diet must be at least 30-40 pounds overweight and must be under a doctor's supervision. Jurek says her clients can stay on an all-liquid diet for up to a year. They typically add grocery store foods to the diet whenever they're ready or when they're struggling to stick to supplements.

Once at an optimal weight, many of Jurek's clients continue to use supplemental shakes, high-protein bars and special entrees in combination with a food diet to help them maintain their weight indefinitely, she says.

Meanwhile, Glenn Page says his weight-loss has changed his life. Under a doctor's supervision, he's stopped taking medication for high cholesterol and high blood pressure, and has cut back on his diabetes medications.

"It doesn't bother me at all," he says of not eating regular foods. "The shakes are very good, and they keep you full, so it's not a question of being hungry."

He plans to lose 20 more pounds before adding fruits, veggies and other foods to his plate. And while he admits he's worried about going back to the choices a food-based diet requires him to make, he's feeling confident and proud of his and his family's success. They have already met more than 60 percent of their yearlong weightloss goal of 390 pounds.

"I feel tremendously better," Glenn Page says. "When I had this big belly, just turning over in bed was a chore."

Today, he rides a bike and plays soccer and basketball with his kids and walks at least 40 minutes day. Pre-diet, just walking up the stairs had been difficult.

"I think we wanted to change completely," says his wife, Barbara Page, who has lost 59 pounds. "I really feel we will never go back to the way we were."