2.1. Identification of VLED Brands in Australia

Brands of VLEDs available in Australia were identified from several sources. Firstly, we identified all pharmacies within a 15 km radius of the Sydney Central Business District using www.findapharmacy.com.au. Names of the pharmacies and phone numbers were exported, listed alphabetically, and two authors (Alice A. Gibson and Zilvia G. Y. Cheng) telephoned every second pharmacy on the list (n = 300). Persons answering the phone were then greeted and asked, “which brands of weight loss shakes does your pharmacy stock?” The term ‘weight loss shakes’ was used as it was thought that not all pharmacy staff would be familiar with the terms VLED or meal replacement, and that this term would thus allow us to determine the full range of available products, from which we would later identify those that were eligible for inclusion in this study. In addition, we searched online pharmacy websites, and Google searches were also performed, using the following keywords ‘very low energy diet’, ‘very low calorie diet’, ‘VLED’, ‘VLCD’, ‘weight loss shake’ and ‘meal replacement’. Online searches were complemented with approximately 24 “in person” visits by Alice A. Gibson and Zilvia G. Y. Cheng to major pharmacy retailers, as well as personal communication [51] by Janet Franklin with specialist obesity clinicians via the Dietitians Association of Australia Obesity interest group email forum.

Once all potentially eligible brands were identified, we excluded products from brands that did not meet our definition of a VLED. To be defined as a VLED, the manufacturer’s instructions had to result in a diet that provided less than 3350 kJ per day and replaced all main meals (i.e., total diet replacement) [4]. Therefore, products that could only be used as partial meal replacements were excluded. We considered excluding one brand, Vita Diet, as the instructions on their website for the “Medical Vita Diet Weight Loss Program” were to consume two meal replacement products per day, with a third meal of protein and vegetables (i.e., partial meal replacement). However, in the information listed for some products (shakes and soups) in the Vita Diet range, the website contained the statement “Can be used a VLCD (Very Low Calorie Diet) shake”. Therefore we decided to include this brand as this statement suggests to a clinician or client that the products are suitable as a total diet replacement.