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

International Journal of Obesity volume 27, pages 537–549 (2003)Cite this article

Abstract

OBJECTIVE: 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.

DESIGN: A PMR plan was defined as a program that prescribes a low calorie (>800≤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≥25?kg/m2, 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.

RESULTS: 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 ∼7–8% body weight and the RCD group lost ∼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.

CONCLUSION: 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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Acknowledgements

Design of study: Steven B Heymsfield, Henry I Frier; analysis of data: Carla AJ van Mierlo, CM van der Knaap, Moonseong Heo; writing the manuscript: Steven B Heymsfield, Carla AJ van Mierlo, Henk CM van der Knaap, Moonseong Heo, Henry I Frier; providing significant advice or consultation: Steven B Heymsfield, Carla AJ van Mierlo, Henk CM van der Knaap, Moonseong Heo, Henry I Frier; administrative support and supervision: Steven B Heymsfield, Henry I Frier. Dr Heymsfield is a member of the Slim·Fast Nutrition Institute, a non profit organization that reviews and supports nutrition-related investigator-initiated research.

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Authors and Affiliations

  1. Obesity Research Center, St Luke's-Roosevelt Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA

    S B Heymsfield & M Heo

  2. Unilever Health Institute and Knowledge and Information Sciences, Unilever Research and Development Vlaardingen, The Netherlands

    C A J van Mierlo & H C M van der Knaap

  3. SlimFast Foods Corporation, West Palm Beach, FL, USA

    H I Frier

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  1. S B Heymsfield
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Correspondence to S B Heymsfield.

Appendix

Appendix

Studies excluded from the traditional meta-analysis with the reason for exclusion are summarized in Table 7.

Table 7 Table a1
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Heymsfield, S., van Mierlo, C., van der Knaap, H. et al. Weight management using a meal replacement strategy: meta and pooling analysis from six studies. Int J Obes 27, 537–549 (2003). https://doi.org/10.1038/sj.ijo.0802258

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