Christopher Case, MD, offers this diet to patients who are looking for an opportunity to lose weight and turn around their vital signs in a concise, efficacious manner.


By: John Parkinson, Clinical Content Coordinator, DiabetesCare.net 

As a majority of type 2 diabetes patients are dealing with some level of obesity, weight loss should be a common discussion between patients and their doctors. With so many methods to lose weight, the questions become which diet do you offer patients and can your practice offer an environment of support where patients can lose weight safely and effectively? 

Like many other medical providers in the U.S., Christopher Case, MD, is seeing more type 2 patients. As many of these patients are presenting with unhealthy lipid profiles, high systolic blood pressure, and other concerning measures, he takes an aggressive yet safe therapy approach in helping these patients with a quick and efficacious treatment.

Dr. Case uses a Very Low Calorie Diet (VLCD) to treat this patient population. After patients are able to lose a substantial amount of weight, they are then reintroduced to foods typically bought at the market and taught lifestyle change behaviors such as portion control and consuming the right amount of nutrients.

In addition to offering the program to patients who are morbidly obese, Dr. Case will also employ the VLCD in patients who may have 50-75 pounds to lose or those who need to lose just 20-30 pounds.

Dr. Case is an endocrinologist at the Jefferson City Medical Group and Medical Director of the Weight Treatment Center in Jefferson City, MO. In his practice, Dr. Case treats individuals with diabetes, obesity, osteoporosis, cholesterol disorders, and diseases of the thyroid, adrenal and pituitary glands. He has conducted many research projects and is well published. He is a member of the American Association of Clinical Endocrinologists (AACE), Endocrine Society, and the International Society for Clinical Densitometry (ISCD). Dr. Case is also a member of DiabetesCare.net's Healthcare Advisory Board.

Dr. Case has found that the VLCD used with medical supervision in his comprehensive practice offers the benefits of helping patients remain safe and get the necessary assistance from other medical providers—like dietitians, educators, and exercise specialists—needed to lose weight.

DiabetesCare.net sat down with Dr. Case to discuss how he uses the VLCD in his practice and why providers may want to consider adding the VLCD to their practice offerings.

DiabetesCare.net: Can you provide an overview of your diabetes patient base you are seeing right now?

Case: I see more type 2s; probably 80 percent of my patients are type 2s and the remaining 20 percent are  type 1s.

DiabetesCare.net: What are you doing in terms of clinical treatment for type 2s?

Case: For a newly diagnosed type 2 patient who presents and is critical or in more of a life-threatening stage with their symptoms, they would generally be treated with insulin. If a patient is stable, we prescribe a few oral medicines, and emphasis diet, exercise, and provide a referral to a diabetes education program.

DiabetesCare.net: You use the VLCD in your practice. Can you provide an overview of what this diet is?

Case: It is a diet that consists of 600-800 daily calories. The bulk of the calories are protein-based and the diet is very limited in carbohydrates. This allows the person to go into a form of ketosis, which may enable a satiety factor where patients have very little hunger.

The medical supervision is needed to ensure safety and ongoing follow-up just to make sure the person’s complying with therapy and remaining within safe values in terms of health metrics.

In addition, it is important to have other medical specialties involved in patient care in this program, so we employ dietitians, behaviorists, and exercise specialists to aid patients with their weight loss.

With medical supervision, the very low calorie diet is very safe. And most of the time, it is incredibly effective.

DiabetesCare.net: What are you looking for in terms of clinical metrics in who might be potential candidates for the VLCD?

Case: At our practice, we have several different patient types. Some may be quite ill—taking many medicines and taking many doses of insulin. On the other hand, I saw two type 2 patients today who weren’t taking any medicine. They didn’t need much in the way of medical monitoring.

However, I don’t believe there is necessarily anything at presentation for patients who have type 2 diabetes or are prediabetic that they need to show clinically to do the program.

We did a study here a few years ago, where the take home message was a person’s quality of life was drastically improved with weight loss. A person who has diabetes will improve while on a VLCD, because the average person is going to mentally and physically feel better.

All stages of diabetes can be treated with a low calorie diet. For example, patients who are on insulin and you expect them to remain on it after being on a VLCD can be participants in the program.

Even patients with type 1 diabetes could go on some form of a low-calorie diet.

DiabetesCare.net: When can you start to see some positive results in terms of patients’ metrics (blood pressure, lipids, etc.)?

Case: Day one you can start to see results and improvements. If you want to see an improvement with cholesterol, for example, you could see an improvement within a week or two. With blood pressure there will be an improvement within a week. 

In that quality of life study I mentioned a few moments ago, we arbitrarily picked four weeks. Without a doubt, we could say at four weeks that people physically and mentally felt better. Whether or not the quality of life improves before that is hard to say, but within four weeks it certainly does.

Of course, glucose improves quickly—within a day or two.

DiabetesCare.net: Are there any challenges to delivering this type of diet?

Case: With comprehensive patient education and experience from medical providers, the challenges are minimized. We provide a lot of information up front about what to expect and how to do it. Most patients that are presenting in our program are highly motivated and have heard about VLCDs from a friend or relative, so they are often familiar with what is expected in order to participate.

By the time the person has made the decision to follow the program, they are really quite comfortable. We let them know the diet they are going to be doing is very different. We tell them that in the first few days they may have more hunger, less vigor, or energy. However, most people overcome that right away. For the motivated patient the challenges are few.

Dr. Case is one of 24 expert speakers presenting at the 7th Annual Obesity Treatment and Prevention Conference at the Hyatt Regency Baltimore on the Inner Harbor. This year's conference, takes place July 23-25, offers healthcare providers 25.25 continuing education units, networking opportunities, and a chance to learn how to incorporate obesity treatment as a business model into their practices. Take advantage of the final discount deadline (May 1) and to learn more, visit www.obesity-conference.com.