who has used the diet as a sole source of nutrition for
several weeks. For the first time one realises that vast
quantities of food are not indispensable to life. It
trains you to live without having food continually on
your mind and the experience has a beneficial effect on
most people.’’Research and general acceptance
Proponents of the Cambridge diet claim that it is
scientific and has been subjected to clinical research,
however, there are no recent studies in mainstream
medical journals specific to this diet. The British Cam-
bridge diet website cites research papers from the late
1990s on VLCDs as a group, most of them concerning
studies conducted in England, Sweden, and Finland.
In addition, neither the two British researchers who
originally developed the diet nor the American scien-
tist who reformulated the British products for the
American market in 1984 began their careers as weight
reduction experts. John Marks was trained as a psy-
chiatrist and published a number of books in psycho-
logical medicine, dependence as a clinical
phenomenon, and the misuse of benzodiazepine tran-
quilizers as well as editing an encyclopedia of psychia-
try. He wrote a book on the use of vitamins in medical
practice in 1985, one year before the book he co-auth-
ored with Alan Howard on the Cambridge diet.
Robert Nesheim, the American physician credited
with reformulating the original Cambridge diet prod-
ucts for the American market, began as a researcher in
agricultural medicine. Dr. Nesheim acted as chief ofresearch and development at the Quaker Oats Com-
pany until he retired in 1983. He believed in promoting
products on the basis of taste, convenience, and cost.
Opinion is somewhat divided among medical and
health care professionals on the subject of VLCDs as a
group of weight reduction regimens, with European
researchers tending to be more favorable to these
plans than physicians in North America. The first
report of the National Task Force on the Prevention
and Treatment of Obesity on these diets noted that
‘‘:Current VLCDs are generally safe when used under
proper medical supervision in moderately and severely
obese patients (body mass index30) and are usually
effective in promoting significant short-term weight
loss.... [but] long-term maintenance of weight loss
with VLCDs is not very satisfactory and is no better
than with other forms of obesity treatment.’’
In general, researchers in the United States and
Canada maintain that VLCDs are not superior in any
way to conventional low-calorie diets (LCDs). One
Canadian study reported in 2005 that a history of
weight cyclingtended to lower the health benefits
that obese patients could receive from VLCDs, while
a 2006 study carried out at the University of Pennsyl-
vania in Philadelphia found that the use of liquid meal
replacement diets (LMRs) with a daily calorie level of
1000–1500 calories ‘‘provide[d] an effective and less
expensive alternative to VLCDs.’’ The American Acad-
emy of Family Practice (AAFP), a professional associ-
ation of primary care physicians, discourages the use of
VLCDs in general, and categorizes the Cambridge diet
in particular as a liquid ‘‘fad diet.’’ The only study that
reported that VLCDs are ‘‘one of the better treatment
modalities related to long-term weight-maintenance
success’’ was completed in the Netherlands in 2001.
The Dutch researchers added, however, that an active
follow-up program, including behavior modification
therapy or cognitive behavioral therapy and exercise,
is essential to the long-term success that they reported.Resources
BOOKS
Howard, Alan, ed.Nutritional Problems in Modern Society.
London: J. Libbey, 1981.
Marks, John.The Vitamins: Their Role in Medical Practice.
Lancaster, UK, and Boston: MTP Press, 1985.
Marks, John, and Alan Howard.The Cambridge Diet: A
Manual for Practitioners. Lancaster, UK, and Boston:
MTP Press, 1986.
PERIODICALS
Gilden Tsai, A., and T. A. Wadden. ‘‘The Evolution of Very-
Low-Calorie Diets: An Update and Meta-Analysis.’’
Obesity(Silver Spring) 14 (August 2006): 1283–1293.QUESTIONS TO ASK YOUR
DOCTOR Have any of your patients ever tried the
Cambridge diet? If so, how much weight did they
lose? How long did they maintain the weight
loss?
Have you ever supervised anyone on the
‘‘Physician-Monitored’’ form of this diet?
Do you know of anyone who has ever had health
problems or adverse effects from following the
‘‘Regular’’ or ‘‘Fast Start’’ versions of the
Cambridge diet?
Have you read any of the research studies
published about this diet? If so, what is your
opinion of their findings?
In your opinion, is cognitive behavioral therapy
a helpful addition to a VLCD?Cambridge diet