Assessing feasibility and factors associated with uptake and adherence to a very low-calorie diet to achieve 10% weight loss in adults with advanced non-alcoholic fatty liver disease

Purpose: Clinical guidelines recommend weight loss to manage non-alcoholic fatty liver disease (NAFLD), however many find dietary behavior change to initiate and sustain weight loss a significant challenge. We aimed to determine whether a very low-calorie diet (VLCD) is an acceptable and feasible approach to achieve and maintain 10% weight loss in adults with clinically significant NAFLD. Following completion of the 8-12 week VLCD, we interviewed participants to identify factors associated with uptake and adherence.

Methods: 23/30 participants who were enrolled in a pilot study of the VLCD (~800 kcal/day) took part in a semi-structured qualitative interview. Interviews were audio recorded, transcribed verbatim and thematically analyzed.

Results: 30 adults agreed to participate in the pilot study and 27 (90%) completed the VLCD intervention. 20 (67%) were retained at 9-month follow-up. The VLCD was acceptable and feasible to deliver. 34% of participants achieved and sustained 10% weight loss, 51% achieved 7% weight loss, and 68% achieved 5% weight loss. Five main themes were identified from post-intervention semi-structured interviews. A desire to achieve rapid weight loss to improve liver health and prevent disease progression was the most salient facilitator to uptake. Early and significant weight loss; accountability to clinicians; personalized feedback and the desire to receive positive reinforcement from a consultant were facilitators to adherence. Practical and emotional support from friends and family members were important for self-regulation. Irregular working patterns that prevented attendance at appointments were barriers to adherence and completion of the intervention.

Conclusions: A VLCD offers an acceptable and feasible treatment option for NAFLD to enable a sustainable 10% weight loss that can improve liver health, cardiovascular risk, and quality of life. Uptake and adherence rely on early and rapid weight loss. Personalized feedback and positive reinforcement in the clinical setting, combined with ongoing social and practical support from friends and family members is important for self-regulation. Findings highlight the importance of intensive behavioral support during the early stages of dietary behavior change using a VLCD approach.