1. Multi-site randomised controlled trial for colorectal cancer surgical patients using virtual VLCD Clinic clinics.

2. Implementation of Rapid Surgical Very Low Calorie Diet (RSVP) Pathway across four major hospitals in Southeast Queensland

3. Safety and efficacy of preoperative VLCD in Colorectal Cancer Surgery

4. Longer-term outcomes and perspectives of patients after undertaking intenstive VLCD prior to surgery

This is an emerging and sometimes uncomfortable question in our field.

For decades, dietitians have been cautious about recommending intentional weight loss for people with active cancer - and rightly so. The risk of malnutrition and loss of lean mass is real, and nutrition care has traditionally focused on maintaining strength through treatment and recovery (think ERAS +/- Prehabilitation for malnourished/frail patients).

But things are changing.

In colorectal and other cancer surgeries, there’s growing evidence that carefully managed pre-operative weight loss can be safely done - potentially lowering risk and making operations safer and technically easier.

Many surgeons are already recommending weight loss through Very Low Calorie Diets (VLCDs) or GLP-1 medications - with or without a dietitian’s involvement.

That raises an important question for our profession:

👉 Do we step in to guide safer, evidence-based approaches that preserve lean mass and nutritional status?

Or

👉 Do we step back, holding to the historical stance that weight loss and cancer don’t mix?

Our team is currently conducting research (publication coming soon!) showing that a carefully monitored VLCD before colorectal cancer surgery can indeed be safe and achieve meaningful weight loss - supporting better surgical preparation without compromising nutritional status.

As more patients present for cancer surgery with obesity or metabolic dysfunction, this dilemma is only growing. Perhaps it’s time for our profession to lean into the nuance - finding ways to optimise, not just nourish, before surgery.