Pretreatment eating patterns of severely obese patients (n = 209) were investigated as predictors of attrition from a very low calorie diet. Subjects who ate three meals per day prior to the program were significantly more likely to complete the 6 month program than were those who reported skipping breakfast and consuming most of their calories in the evening. Those w h o ate mainly in the evening dropped out most frequently during the fasting phase of the program, possibly indicating an inability to conform to the requirements of a supplemented fast.
Recent research indicates that very low calorie diets (VLCD) of 400-800 calories per day produce rapid weight loss, usually 3-4 lbs a week or more . On these diets, participants who are typically 30% or more above ideal weight (Blackburn, Lynch, & Wong, 1986) consume only highquality protein, often in the form of a liquid supplement for 3 or more months while under medical supervision.
Behavior modification, exercise instruction, and nutritional information may also be included in the program. The rapid weight loss on these diets often ameliorates some of the serious health problems associated with severe obesity such as hypertension, type I1 diabetes, and hyperlipidemia (Wadden, Stunkard, & Brownell, 1983; Hovel1 et al., 1988).
Many dieters skip breakfast and consume most of their calories in the evening. Although not necessarily indicative of a serious eating disorder, this eating pattern, however, may contribute to the failure to complete a VLCD in that it involves an "on-off" pattern of eating. According to a study by , such persons might be predicted to do well during the fast, the "off"