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Meal Replacements

When are they appropriate?

In primary care settings, obesity and overweight can be approached with a variety of techniques.  A weight loss of just 10% may improve health risks associated with disproportionate body weight.2 Rather than focusing on high weight loss goals, we need to help patients accept a modest and reasonable weight change that can be realistically achieved.1

Although outward appearance is the main motivating factor for many patients, it is critical to emphasize health benefits over outward results. Help patients set lifestyle goals that are achievable and beneficial, and work to destigmatize weight loss motivators that are mainly cosmetic.1

The Nutrition Care Process developed by the American Dietetic Association (ADA) can help. This systematic approach includes nutrition assessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring and evaluation.1 Each of these steps is important in weight management. The expertise of a registered dietitian is a valuable resource.1 You can locate a dietitian in your area by visiting www.eatright.org and entering the patient's zip code in the 'Find A Dietitian' tool.

Caloric Deficits for Weight Loss

The ADA has published a position paper on weight management.1 It advises choosing a low-energy yet nutritious diet in an environment that provides palatable, energy-dense foods.1 Weight loss occurs when patients reduce their calorie intake by 500 to 1,000 kcals per day with or without exercise. Exercise can assist in weight loss, but it is the caloric deficit that will produce weight loss of ½ to 1 pound per week.

Meal replacements can be a useful strategy for patients trying to lose weight, as long as complete nutrients and calories are considered.1 Meal replacements can help eliminate problematic food choices or complex meal planning for the first few months of attempted weight loss.1 For some patients, it is an easy "autopilot" way to get started on a path to weight loss. After weight loss is achieved, patients can go back to using meal replacements when they feel themselves slipping into weight gain.

Monitor patients' health closely while meal replacements are used. Deficits in vitamins, minerals and fluid are possible and can create unhealthy behaviors and severe health consequences.

A Little History

We first began hearing about meal replacements with publication of the original Atkins Diet in the early 1970s. This diet requires patients to enter ketosis by limiting carbohydrate intake. Studies have shown that medically supervised ketogenic diets can be safe and effective for rapid weight loss.

Several randomized, controlled trials of meal replacement diets have concluded that they can be effective.3 One study found that obese patients who adhered to structured meal replacement plans lost more weight at 12 weeks (-7% vs. 4% of initial body weight) and 1 year (-7% to 8% vs. 3% to 7%) than patients who followed a conventional diet plan. One-year dropout rates among patients on the structured meal replacement plan were significantly less than among patients on the conventional diet plan (47% vs. 64%).3 It is important to note that the weight loss efficacy of structured meal replacement plans in severely obese patients has not been adequately studied.1

The greatest clinical concern is that a strategy of meal replacements may mean a dependence on artificial nutrients.1 These strategies may also prevent patients from learning how to select real foods appropriately.

Conclusions

The ADA states that meal replacements may be used for patients who have difficulty with self-selection or portion control, as long as these replacements are part of a comprehensive weight management plan. The ADA recommends substituting one or two daily meals or snacks with meal replacements. For patients falling into the overweight or obese category, a meal replacement for one meal per day may enhance initial weight loss. But be sure the patient makes a gradual transition to normal foods. Meal replacements can be helpful as a go-to for patients who slip back into weight gain after goals are achieved.

For more information on meal replacements, read the following studies:

  • Ashley JM, et al. Nutrient adequacy during weight loss interventions: a randomized study in women comparing the dietary intake in a meal replacement group with a traditional food group. Nutr J. 2007;6:12.
  • Stull AJ, et al. Liquid and solid meal replacement products differentially affect postprandial appetite and food intake in older adults. J Am Diet Assoc. 2008;108(7):1226-1230.
  • Noakes M, et al. Meal replacements are as effective as structured weight-loss diets for treating obesity in adults with features of metabolic syndrome. J Nutr. 2004;134(8):1894-1899.
  • Heymsfield SB, et al. Weight management using a meal replacement strategy: meta and pooling analysis from six studies. Int J Obes Relat Metab Disord. 2003;27(5):537-549.           
  • Rothacker DQ, et al. Liquid meal replacement vs. traditional food: a potential model for women who cannot maintain eating habit change. J Am Diet Assoc. 2001;101(3): 345-347.

 Robyn Kievit is a family nurse practitioner, a registered dietitian and a certified specialist in sports dietetics. She operates a private nutrition practice in Boston and is on staff at Emerson College. E-mail your nutrition and weight loss questions to robyn@robynkievit.com or visit her website at www.robynkievit.com. On Facebook and Twitter, search for nutritionmentor.

 References

1. Seagle HM, et al. Position of the American Dietetic Association: weight management. J Am Diet Assoc. 2009;109(2):330-346.

2. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Obes. Res. 1998;6(Suppl 2):51S-209S.

3. Adult Weight Management Evidence-Based Nutrition Practice Guideline. American Dietetic Association Evidence Analysis Library website. http://www.adaevidencelibrary.com/topic.cfm?cat=2798. Accessed Feb. 14, 2011.

 


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