The poor effectiveness of conventional dietary treatment may be improved by use of a meal replacement program. Incorporating meal replacements into traditional lifestyle interventions has been proven as a successful strategy for weight control in obese subjects.
Meal replacements are characterized by liquid formulas, powder formulations reconstituted with water or milk, or nutrition bars that are typically fortified with vitamins and minerals and with or without fiber. Meal replacements as a tool for weight management is very popular among people trying to lose weight. In a dietician-led program more than 60% of subjects chose meal replacements at least once daily as their preferred weight loss strategy .
In a typical meal replacement plan one or two full-energy meals are replaced by a low-energy, nutritionally balanced product, while one meal is prepared with prudent self-selected conventional food. Snacks are replaced by nutrition bars or a low-fat dairy product or a piece of fruit. A weight loss program with meal replacements in place of one or two daily meals has been shown to improve compliance with an energy-restricted diet in comparison with simply providing food plans .
A meal replacement plan has proven significantly more effective than conventional diet plans in obese subjects . The use of a meal replacement plan was also effective in overweight and obese subjects working in highstress jobs (police, hospital health professionals, flight crew members and firefighters). After 12 months of treatment, the study participants had lost 8.4% of their initial body weight and 1 year later 66% of the firefighters and aviation personnel had retained >80% of their weight loss at week 12 and half of these weighed less than at week 12 .
In a meta- and pooling analysis of 6 studies weight loss induced by a partial meal replacement plan at 3 months and at 1 year exceeded the weight loss induced by a conventional diet plan. The weight loss of those completing the study ranged between 2.61 and 4.35 kg (~3.7% of initial body weight) in the conventional energy-restricted diet group, and between 6.97 and 7.31 kg (~7.8%) in the meal replacement group. At the 1-year evaluation 64% of the subjects in the conventional diet group had dropped out compared to 47% of subjects in the meal replacement group . The magnitude of weight loss in the partial meal replacement group at 1 year was in the range of that often observed in effective pharmacologic weight control studies. Recently, in a review evaluating the role of meal replacements in obesity treatment, the conclusion was drawn that meal replacements are a valid alternative dietary strategy in the treatment of obesity and may aid long-term maintenance of weight .
A meal replacement plan has also proven effective in subjects with T2D. Weight loss with a liquid meal replacement plan was compared with an isocaloric energy-restricted diet. Maximum weight loss was achieved in both programs after 3 months and glycemic control improved in both groups of patients. However, at 1 year between the groups there were no significant differences in weight .
In another study with a meal replacement plan for 12 weeks subjects were randomized into three groups using either a meal replacement containing lactose, fructose, and sucrose, a meal replacement in which fructose and sucrose were replaced with oligosaccharides, or an exchange diet plan recommended by the ADA . Weight loss was significantly greater in the meal replacement groups than in the group with an exchange diet plan. During weight loss, there were reductions in glucose, insulin and HbAlc concentrations. In addition, the oral antidiabetic medications were reduced in some patients. Thus, it has been shown in this clinical study that meal replacements can be used safely as a part of a comprehensive treatment program for T2D patients.
In a meta- and pooling analysis , about 20% of the study population at baseline was diabetic. There was no difference in weight loss between diabetic and nondiabetic subjects at 3 months. However, patients with diabetes did not maintain their weight loss at 1 year to the same extent as nondiabetic subjects. These findings are consistent with earlier weight loss studies of diabetic patients that have also shown a reduced long-term weight loss compared to nondiabetic patients .
The long-term efficiency of a meal replacement plan based on soy-based meal replacements was evaluated in a randomized prospective study in type-2 diabetics. The study compared the effects of a meal replacement plan with the effects of an individualized diet plan, as recommended by the ADA . In this study, weight loss was achieved in both diet groups over the 12 months' study period. In the meal replacement group weight was reduced by 5.2 and 4.3 kg at 6 and 12 months, respectively; in the individualized diet plan group weight was reduced by 2.8 and 2.3 kg at 6 and 12 months, respectively. In the meal replacement group, glucose concentrations were lower than in the individualized diet group at 3, 6 and 12 months, respectively. The levels of HbA1c in the individualized diet group were reduced but were not significantly lower than at baseline; in contrast in the meal replacement group the mean HbA1c level was reduced and significantly lower than in the individualized diet group for the entire study period.
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