Weight management using a meal replacement strategy: Meta and pooling analysis from six studies

Obesity Research Center, St Luke's-Roosevelt Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA.
International Journal of Obesity (Impact Factor: 5). 05/2003; 27(5):537-49. DOI: 10.1038/sj.ijo.0802258
Source: PubMed


Although used by millions of overweight and obese consumers, there has not been a systematic assessment on the safety and effectiveness of a meal replacement strategy for weight management. The aim of this study was to review, by use of a meta- and pooling analysis, the existing literature on the safety and effectiveness of a partial meal replacement (PMR) plan using one or two vitamin/mineral fortified meal replacements as well as regular foods for long-term weight management.
A PMR plan was defined as a program that prescribes a low calorie (>800<or=1600 kcal/day) diet whereby one or two meals are replaced by commercially available, energy-reduced product(s) that are vitamin and mineral fortified, and includes at least one meal of regular foods. Randomized, controlled PMR interventions of at least 3 months duration, with subjects 18 y of age or older and a BMI>or=25 kg/m(2), were evaluated. Studies with self-reported weight and height were excluded. Searches in Medline, Embase, and the Cochrane Clinical Trials Register from 1960 to January 2001 and from reference lists identified 30 potential studies for analysis. Of these, six met all of the inclusion criteria and used liquid meal replacement products with the associated plan. Overweight and obese subjects were randomized to the PMR plan or a conventional reduced calorie diet (RCD) plan. The prescribed calorie intake was the same for both groups. Authors of the six publications were contacted and asked to supply primary data for analysis. Primary data from the six studies were used for both meta- and pooling analyses.
Subjects prescribed either the PMR or RCD treatment plans lost significant amounts of weight at both the 3-month and 1-year evaluation time points. All methods of analysis indicated a significantly greater weight loss in subjects receiving the PMR plan compared to the RCD group. Depending on the analysis and follow-up duration, the PMR group lost approximately 7-8% body weight and the RCD group lost approximately 3-7% body weight. A random effects meta-analysis estimate indicated a 2.54 kg (P<0.01) and 2.43 kg (P=0.14) greater weight loss in the PMR group for the 3-month and 1-y periods, respectively. A pooling analysis of completers showed a greater weight loss in the PMR group of 2.54 kg (P<0.01) and 2.63 kg (P<0.01) during the same time period. Risk factors of disease associated with excess weight improved with weight loss in both groups at the two time points. The degree of improvement was also dependent on baseline risk factor levels. The dropout rate for PMR and RCD groups was equivalent at 3 months and significantly less in the PMR group at 1 y. No reported adverse events were attributable to either weight loss regimen.
This first systematic evaluation of randomized controlled trials utilizing PMR plans for weight management suggests that these types of interventions can safely and effectively produce significant sustainable weight loss and improve weight-related risk factors of disease.

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Available from: Steven B Heymsfield, Dec 15, 2014
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    • "Consumption of pre-packaged, portion controlled, calorie-controlled meal replacements to substitute for some meals and snacks has been shown to enhance weight loss outcomes [22] [23] [24]. Although meal replacement foods usually are provided at no cost to patients [22] [23] [24], supplying products free of charge over an extended period is unsustainable for the health care system. Therefore, we will examine a more scalable variation: we will recommend the use of meal replacements to half of the participants and provide an introductory free one week supply. "
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    ABSTRACT: Background: Obesity-attributable medical expenditures remain high, and interventions that are both effective and cost-effective have not been adequately developed. The Opt-IN study is a theory-guided trial using the Multiphase Optimization Strategy (MOST) to develop an optimized, scalable version of a technology-supported weight loss intervention. Objective: Opt-IN aims to identify which of 5 treatment components or component levels contribute most meaningfully and cost-efficiently to the improvement of weight loss over a 6 month period. Study design: Five hundred and sixty obese adults (BMI 30-40 kg/m(2)) between 18 and 60 years old will be randomized to one of 16 conditions in a fractional factorial design involving five intervention components: treatment intensity (12 vs. 24 coaching calls), reports sent to primary care physician (No vs. Yes), text messaging (No vs. Yes), meal replacement recommendations (No vs. Yes), and training of a participant's self-selected support buddy (No vs. Yes). During the 6-month intervention, participants will monitor weight, diet, and physical activity on the Opt-IN smartphone application downloaded to their personal phone. Weight will be assessed at baseline, 3, and 6 months. Significance: The Opt-IN trial is the first study to use the MOST framework to develop a weight loss treatment that will be optimized to yield the best weight loss outcome attainable for $500 or less.
    Contemporary Clinical Trials 05/2014; 38(2). DOI:10.1016/j.cct.2014.05.007 · 1.94 Impact Factor
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    • "Meal replacement has been used for weight loss as a successful strategy.[47] Its advantages are, easier adherence, reduced food choices, as well as controlled calorie and nutrient content, but it may be boring for a long period.[34] "
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    Journal of research in medical sciences 03/2014; 19(3):268-275. · 0.65 Impact Factor
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    • "One challenge in adherence to any dietary prescription is consuming foods of an appropriate portion size to meet the prescribed dietary goals, as weighing and measuring all foods and beverages consumed is burdensome to participants.45 Using meal replacements (eg, liquid shakes, meal bars) assists with portion control and may increase success at reducing intake to assist with weight loss.46–50 Besides assisting with portion control, meal replacements may aid in reducing energy intake by increasing the structure of the diet and enhancing the ease of pre-planning meals and snacks, an important behavioral strategy. "
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