Dr. Philip Bazire

Weight management

Doctor Information

Disclaimer: Please note, the information on this page is directed at trained medical professionals and may sometimes be difficult to interpret without medical training. An incorrect interpretation of this information could be harmful under certain circumstances. Treatments should not be performed without adequate medical assessment. Please contact Dr Bazire on info@nutritiondoc.co.uk if you would like to receive further information.

Concept Studies and Summaries

(Highlighted in yellow = study performed by PronoKal or with PronoKal’s sponsorship/participation)

Rapid Weight Loss

The association between rate of initial weight loss and long-term success in obesity treatment. 

Int J Behav Med. 2010 September; 17(3): 161–167. doi:10.1007/s12529-010-9092-y.

Examination of long-term weight management success according to rate of initial weight loss (fast, moderate, slow). The intervention period was 6 months with a 1-year follow-up. Mean weight loss in the fast group was 2.6 times the loss in the slow group. The fast group was 5 times more likely to achieve a >10% weight loss at 18 months than the slow group. The authors conclude that fast initial weight loss has both short- and long-term advantages.

Initial weight loss is the best predictor for success in obesity treatment and sociodemographic liabilities increase risk for drop-out. 

Patient Educ Couns. 2010 Jun;79(3):361-6. doi: 10.1016/j.pec.2010.02.006

The strongest factor for predicting outcome was initial weight loss.

Myths, presumptions and facts about obesity.

N Engl J Med. 2013 Jan 31;368(5):446-54. doi: 10.1056/NEJMsa1208051

Review article that debunks certain myths about obesity, especially the ideas that patients should only set “realistic” goals and that rapid initial weight loss is associated with poorer outcomes than slow, gradual weight loss.

Diet Efficacy

Comparison of a Very Low Calorie ketogenic diet with a standard low-calorie diet in the treatment of obesity 

Endocrine 2014 Dec; 47(3): 793-805. DOI 10.1007/s12020-014-0192-3

Comparison of the PronoKal diet with a low-calorie diet – results at 1 year. The mean initial BMI was 35.1 in both groups. Mean weight loss was 20kg with the PronoKal diet at 4 months vs 6 kg with the low-calorie diet. At 1 year, 89% of PronoKal patients maintained a weight loss > 10% vs only 35% of those on the low-calorie diet. Lean mass loss was around 10% with the PronoKal diet vs 27% with the low-calorie diet.

Obesity treatment by Very Low Calorie ketogenic diet at two years - reduction in visceral fat and on the burden of disease.

Endocrine 2016 Dec; 54(3): 681-690. DOI 10.1007/s12020-016-1050-2

The 24-month follow-up of the above study. This study showed maintenance of the benefit at 2 years.

Body composition changes after Very Low Calorie ketogenic diet in obesity evaluated by three standardized methods.

J Clin Endocrinol Metab. doi: 10.1210/jc.2016-2385.

DEXA, plethysmography and bioimpedance were used to evaluate of body composition after a 4-month Very Low Calorie ketogenic diet intervention (PronoKal Method). The weight loss achieved with this VLCKD was 20.2 kg, of which nearly 85% was fat mass, targeting especially the metabolically more active visceral fat. There was a good correlation between the analytical methods.

Multidisciplinary Team and Medical Supervision

Safety and Results approach. Diabetes, Metabolic Syndrome and Obesity:

Targets and Therapy 2016:9 37–46

Trials based on the most recent protocols of lifestyle modification, with a prolonged extended treatment after the weight loss phase, have shown promising long-term weight loss results. The obesity physicians maintain a primary role in engaging patients, in team coordination and supervision, and in managing the complications associated with obesity. This data should stimulate the adoption of a lifestyle modification-based approach for the management of obesity, featuring a non-physician lifestyle counsellor (also called “lifestyle trainer” or “healthy lifestyle practitioner”) as a pivotal component of the multidisciplinary team.

Safety

Acid-base safety during the course of a Very Low Calorie ketogenic diet.

Endocrine (2017) 58:81–90. DOI: 10.1007/s12020-017-1405-3

The ketosis induced by a Very Low Calorie ketogenic diet is mild, with no clinically significant changes in blood glucose, blood pH, anion gap or plasma bicarbonate. From an acid-base point of view, the VLCKD can be considered safe.

Risk Reduction

The incidence of co-morbidities related to obesity and overweight: A systematic review and meta-analysis.

BMC Public Health2009; 9:88 https://doi.org/10.1186/1471-2458-9-88

Meta-analysis of 89 studies. Both overweight and obesity are associated with the incidence of multiple co-morbidities including type 2 diabetes, cancer and cardiovascular diseases. (Since the publication of this study, the strength of the relationship between being overweight, obesity, and associated diseases has continually increased.)

Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis.

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4849

Meta-analysis of 52 RCTs. Likely reduction in premature all-cause mortality in adults with obesity.

Elderly

Challenges in Treatment of Obesity in the Elderly. 

Endocrinol Metab Int J 2017, 5(5)

Highlights the need to focus on body composition and age-related loss of lean mass and bone tissue (higher risk of sarcopenic obesity). Weight loss in overweight and obese elderly improves functional status and QoL. Diets should include 1.2-1.5 g protein/kg body weight, often not achieved by a standard low-calorie diet. Calorie restriction with increased protein intake associated with increased long-term survival in obese sarcopenic elderly. Describes benefit of hydroxymethylbutyrate (metabolite of leucine) to improve protein synthesis.

Basal Metabolic Rate (BMR)

Resting metabolic rate of obese patients under Very Low Calorie ketogenic diet.

Nutrition & Metabolism (2018) 15:18. DOI 10.1186/s12986-018-0249-z

Shows that the rapid and sustained weight loss induced by a Very Low Calorie ketogenic diet (PronoKal) does not produce the expected reduction in basal metabolic rate and that this is probably due to the preservation of lean mass.

Type 2 Diabetes Mellitus

Revealing the molecular relationship between type 2 diabetes and the metabolic changes induced by a very low carbohydrate, low-fat ketogenic diet.

Nutrition & Metabolism 2010, 7:88

Molecular network analysis shows the effect of the ketogenic diet on the insulin resistant pathway to be a plausible explanation for the improvement observed in type 2 DM. Ketone bodies can block specific cytokines and improve the inflammatory environment.

VLCKD vs Bariatric Surgery

Assessment of the Body Composition and the Loss of Fat-Free Mass through Bioelectric Impedance Analysis in Patients Who Underwent Open Gastric Bypass.

The Scientific World Journal, Volume 2014, Article ID 843253 (5 pages), http://dx.doi.org/10.1155/2014/843253

Changes in body composition after gastric bypass. At 6 months, the significant loss of total body weight (29%) was associated with a 20% loss of lean mass and a low serum albumin, suggesting possible malnutrition.

Bariatric Surgery: Bad to the Bone, Parts 1 and 2. 

Integr Med (Encinitas). 2016 Mar;15(1):48-54 and Integr Med (Encinitas). 2016 Apr; 15(2): 35–46.

Usefulness of Very Low Calorie protein diets in patients with partial failure after bariatric surgery (Poster in Spanish presented at the Spanish Society of Obesity [SEEDO]) Evidence of effectiveness of VLCD with normal protein delivery in patients who present weight regain after bariatric surgery.

Review of increased risk of osteoporosis after bariatric surgery. Highlights nutritional deficiencies after bariatric surgery. Need for focus on selecting nutrient-dense foods (especially the bone-building nutrients)

VLCKD vs Anti-Obesity Medications

Beyond lifestyle interventions: exploring the potential of anti-obesity medications in the UK.

Clin Obes. 2018 Jun;8(3):211-225. doi: 10.1111/cob.12248

Review of anti-obesity medications. Includes a review of tier 1-2-3-4 treatments, citing only non-intensive dietary methods (weight losses of 5%-10%). NICE does not consider most AOMs to be effective in the long term or that the risks outweigh the benefits. Poor adherence with Orlistat. Important gap between efficacy in clinical trials and effectiveness in the real world.

Ketogenic Diet for Weight Loss

Ketogenic Diet for Obesity: Friend or Foe? 

Int. J. Environ. Res. Public Health 2014, 11, 2092-2107; doi: 10.3390/ijerph110202092

Review of ketogenic diets, concluding that they can be useful in weight management, particularly as they control hunger and improve fat metabolism. Hunger control and the more varied modern ketogenic diets favour adherence. Renal function must be monitored and the transition back to a normal diet must be well controlled. Recommend medical control.

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