WASHINGTON — What is a safe, drug-free, and effective method for treating obesity and its comorbidities in patients with diabetes or those who are at risk for it? Tell them to try prepackaged, nutritionally balanced, and calorie-controlled meal replacements.
“Meal replacements are considered state-of-the-art dietary treatment for overweight and obesity. They produce double the weight loss of traditional weight loss plans and they improve long-term maintenance,” Anne Daly said at the annual meeting of the American Association of Diabetes Educators.
The benefits extend beyond weight loss, with data showing improved metabolic outcomes in patients with diabetes and other cardiovascular risk factors, said Ms. Daly, a certified diabetes educator and registered dietitian who is cofounder of the Springfield (Ill.) Diabetes and Endocrine Center.
Meal replacements have been used in several major clinical trials sponsored by the National Institutes of Health, including the Diabetes Prevention Program (DPP), Action for Diabetes in Health (Look AHEAD), and Reach Out to Enhance Wellness in Older Survivors (RENEW). Meal replacement is also mentioned in the 2007 Nutrition Position Paper of the American Diabetes Association, and is supported by the American Dietetic Association's Evidence Analysis Library, which cites eight randomized clinical trials in which patients who replaced between one and three meals a day lost 2.5–3.0 kg more than those who followed traditional low-calorie diets, about 7% from baseline.
A “meal replacement” is any prepackaged food product—such as shakes, soups, puddings, entrees, or snack bars—that is portion controlled, calorie controlled, and high nutrition. They are used to replace an entire meal or snack with the aim of reducing calorie intake and promoting weight loss. Typically, they contain about 150–300 calories, 10–45 g carbohydrate, 10–20 g protein, and 3–9 g fat per serving. With certain meal plans, patients are encouraged to supplement the packaged foods with fresh fruits and vegetables (within prescribed carbohydrate limits for diabetic patients).
Ms. Daly's facility has had a 20-year relationship with a Boston-based company called Health Management Resources (HMR), which provides weight-loss management program services in addition to shelf-stable packaged foods that patients can buy on-site (www.hmrprogram.com
However, she said, “This is not a sales pitch for HMR. Everything I say is applicable to anything out there that is a meal replacement. Try them all, taste them, and see which ones you and your patients like.” Examples of well-known meal-replacement brands available in stores include Lean Cuisine, Healthy Choice, and Slimfast, while commercial weight-loss programs that sell packaged foods, such as Jenny Craig and Medifast, also fall under the heading.
Meal replacements provide a simple way to structure meal planning, with no calorie “mysteries.” They achieve both portion control and predictable weight loss, while decreasing “decision anxiety” among patients who are uncertain about what they should and shouldn't eat. “Patients do better when you tell them what to do, rather than what not to do,” Ms. Daly said.
Full meal replacement can be less costly for patients than what they're already spending on food. The U.S. Department of Agriculture estimates that the average American spends about $101 per week on food, while the HMR regimens range in cost from $73 to $92 per week.
And that's not counting the savings in medical costs. In a 12-week study of 75 patients with type 2 diabetes treated with oral agents only (of whom 57 completed the study), those randomized to receive one of two meal-replacement regimens lost more weight (6.4% and 6.7% vs. 4.9% of total body weight) than did those who followed a traditional exchange diet plan. Fasting glucose, total cholesterol, and LDL cholesterol levels were all significantly reduced among the meal-replacement patients as well (Obes. Res. 2001;9 [suppl. 4]:341S-7).
In a more recent study of 118 patients who each lost more than 100 pounds using meal replacements and increased physical activity, medications for comorbidities were discontinued in 66% at a cost savings of $100/month per patient. The patients, whose weight loss averaged 61 kg in 44 weeks, maintained a 30-kg weight loss at 5 years by continuing to replace at least one meal and one snack per day, while they were allowed unlimited fruits and vegetables (Am. J. Clin. Nutr. 2007;86:301–7).
Data from HMR on 1,000 patients show similar results. Over a 2-year period, patients lost an average of 43 pounds, with a 14% reduction in total cholesterol/HDL cholesterol level, 25% in triglycerides, and 10% in fasting glucose. Systolic blood pressures dropped an average of 8 mm Hg, and diastolic by 6 mm Hg. Approximately 21% of patients came off at least one medication.