Supplemented fasting as a large-scale outpatient program

Summary

This 1977 JAMA paper documents one of the earliest large-scale outpatient applications of the protein-sparing modified fast. Vertes, Genuth, and Hazelton at Case Western Reserve / Cleveland Clinic ran 519 severely obese outpatients through a supervised supplemented fasting program based on the protein-sparing principle Bistrian and Blackburn had recently established. The headline outcomes: 78 percent of patients lost a minimum of 18.2 kg (40 lb) during treatment. The overall weight-loss rate averaged 1.5 kg per week — 1.3 kg/week for women, 2.1 kg/week for men, reflecting the typical sex difference in baseline lean mass and metabolic rate. Most patients maintained normal daily activities throughout treatment with no serious adverse effects reported. The paper was a major demonstration that a structured very-low-calorie protocol with high-quality protein supplementation could be delivered safely in primary-care settings without the inpatient hospitalization that earlier total-fasting protocols required. It established the operational model that subsequent commercial and clinical PSMF programs (Optifast, HMR, the modern Cleveland Clinic protocol) would adopt.