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[Correspondence] VLCD for weight loss and remission of type 2 diabetes?

In the DiRECT trial, Michael Lean and colleagues (Feb 10, p 541)1 report diabetes remission after very low calorie diets (VLCDs). Numerous studies of VLCDs have shown diabetes improvement and remission, but much of the effect, as this trial confirms, is correlated to weight loss.2 Unfortunately, weight loss from VLCD with behavioural therapy has proven to be unsustainable in 1-year to 5-year follow-up studies.3 Metabolic adaptation driving regain in response to caloric restriction is well documented, supporting the paradigm that weight regain after VLCD is more related to energy regulatory mechanisms than willpower.