At PHD Weight Loss and Nutrition we are proud of our approach grounded in evidence-based nutrition and behavior modification. We are occasionally asked why we don’t use adjuncts like stimulants or hormones to aid in weight loss and maintenance. While the simple answer is we don’t feel like they lead to sustainable successful weight maintenance we are always looking for ways to help our clients and ultimately our society to be healthier.
With that goal in mind, I have looked into many adjuncts to weight loss. Some are clearly gimmicks but some seem to persist in medical and non-medical obesity treatment approaches. One common adjunct that persists is the use of hCG and a very low-calorie diet. The persistence of this approach and support of medical professionals motivated me to look deeper into this treatment to determine if it is something that the literature supports, and we should encourage.
What is hCG? HCG is an acronym for Human Chorionic Gonadotropin a hormone that is normally secreted by the cells that surround the embryo of a pregnant woman. It is not normally present in non-pregnant females or males. HCG was brought to the public eye by Dr. Simeons, an endocrinologist, who published an article and a book in 1954 proposing hCG as an adjunct based on observations from his practice.
The hCG treatment was paired with a very low-calorie diet of 500 calories per day and was thought to help curb hunger to help weight loss and preserve lean muscle mass to improve maintenance. This hypothesis was not proven and no studies were published demonstrating the benefits prior to the acceptance of the technique as a popular method for medical weight loss.
After over 20 years of treatment, studies that both challenged the hypothesis as well as demonstrated some concerning risks were finally published. This 1976 double-blind placebo controlled study demonstrated no benefit to adding hCG to the low-calorie diet. The largest in the series of studies looked at over 200 patients in 1976 demonstrating no difference in weight lost, fat distribution, feelings of hunger, or changes in mood. Three studies were published in 1977 including an inpatient placebo-controlled study, a second placebo controlled double-blinded crossover study and a third study of similar design that failed to identify benefit of hCG injection over placebo. This overwhelming body of literature led to a 1983 review that condemns the use of hCG in no uncertain terms and lists potential complications that include:
- Edema (swelling)
- Complications with ovaries requiring surgery
- Multiple pregnancies and premature/still births
- Blood clots with potential for embolus and death
However, as often happens with medical therapies hCG seems to have come in and out of favor as a weight loss treatment option. A second wave of literature was published in response to what was likely a resurgence of both medical and ancillary health care providers using this approach. This wave included a 1990 comparative study, and a 1995 meta-analysis each finding no benefit of hCG over placebo. 20 years later another review published in 2016 demonstrated the same findings in response to the persistent use of the hormone for weight loss despite the lack of evidence and increasing concerns for risks including a hypothesis that links use to cancer.
So, what does the evidence say? hCG combined with a very low-calorie diet will result in weight loss if followed closely. However, there does not appear to be any benefit of adding hCG to a very low-calorie diet. I have already written on severe calorie restriction and why weight loss through this approach is not sustainable. You can view that full post here. The summary is that this approach leads to a severely reduced basal metabolic rate which makes maintenance nearly impossible.
HCG does not prevent this metabolic adaptation or help in any other way. None of the studies listed above look at long-term weight loss maintenance. If they did, I suspect we would see a very high failure rate due to the low-calorie approach and no hormonal benefit from hCG. There is no reason to add hCG to a very low-calorie diet and no reason to participate in a very low-calorie diet, to begin with!
In conclusion, hCG diets have been shown to provide no benefit over calorie restriction alone. There is no difference in changes in lean muscle mass, hunger, or even weight loss. Severe calorie restriction has been proven to fail if you follow participants into maintenance.
Weight loss approaches must be paired with a metabolic shift that allows for fat burn and behavioral therapy that focuses on patterns of eating and relapse. I cannot recommend hCG diets and feel that they will put you at risk, cause metabolic damage and make subsequent weight loss and maintenance more difficult in the future.
Supporting your Performance, Health, Diet, PHD
Douglas E Lucas, DO
Chief Science Officer
PHD Weight Loss and Nutrition