BACKGROUND: Obesity is constantly growing worldwide, representing a serious concern also for healthcare costs. Current anti-obesity pharmacological strategies, although effective, represent a significant cost for the patient. Similarly, very low energy ketogenic therapy (VLEKT) protocols with replacement meals also have high costs. OBJECTIVES: The objective of this study was to estimate the average costs of a VLEKT protocol with replacement meals compared with those of isocaloric diets with fresh foods. METHODS: VLEKTs with replacement meals and fresh foods were developed considering an ideal young woman and man with grade II obesity (BMI ≥ 35.0 kg/m RESULTS: On a monthly basis, VLEKT with fresh food had an average cost of EUR 253.44 and EUR 295.67, while VLEKT with replacement meals had an average cost of EUR 434.91 and EUR 535.99, for the woman and man, respectively. CONCLUSIONS: Although more expensive than a common diet, VLEKT should be seen not only as a dietary method for losing weight, but as a non-pharmacological, medicalized nutritional therapy, useful for managing various conditions, even those not directly related to obesity. Like a drug therapy, VLEKT requires the use of specific products that entail a higher cost, to be borne by the patient, but whose benefits should be emphasized, which go beyond weight loss and concern general health, thus considering them as a targeted nutritional strategy.