Article

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

Columbia University, New York, New York, United States
International Journal of Obesity (Impact Factor: 5). 05/2003; 27(5):537-49. DOI: 10.1038/sj.ijo.0802258
Source: PubMed

ABSTRACT

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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    • "While health professionals agree that even a modest loss of 5–10% of one's weight is beneficial (e.g., Diabetes Prevention Program Research Group, 2004; Centers for Disease Control and Prevention, 2012; Look AHEAD Research Group, 2014), most accounts of weight-loss programs' effectiveness show that the majority of participants do not even achieve this goal (e.g., Heshka et al., 2003; Appel et al., 2011). The few interventions that have higher success records typically include intensive lifestyle change and/or meal replacement (e.g., Heymsfield et al., 2003; Diabetes Prevention Program Research Group, 2004; Befort et al., 2010; Look AHEAD Research Group, 2014). In other words, higher costs are involved in achieving stronger effects. "
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    • "Overthe-counter products such as slim-Fast, Met-Rx, and Atkins Nutritionals contain about 200 calories per serving, in addition to a dose of vitamins and minerals sufficient to replace one to two meals a day. These are available in ready-to-drink cans or in powder packets and mixed with water or milk[7,8]. "

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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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