Meal Replacements in Obesity Management: A Psychosocial and Behavioural Intervention and/or a Weight Loss Tool?

Background: The very low-calorie ketogenic diet (VLCKD) has been recently proposed as an appealing nutritional strategy for obesity management. The VLCKD is characterized by a low carbohydrate content (<50 g/day), 1–1.5 g of protein/kg of ideal body weight, 15–30 g of fat/day, and a daily intake of about 500–800 calories. Objectives: The aim of the current document is to suggest a common protocol for VLCKD and to summarize the existing literature on its efficacy in weight management and weight-related comorbidities, as well as the possible side effects. Methods: This document has been prepared in adherence with Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Literature searches, study selection, methodology development, and quality appraisal were performed independently by 2 authors and the data were collated by means of a meta-analysis and narrative synthesis. Results: Of the 645 articles retrieved, 15 studies met the inclusion criteria and were reviewed, revealing 4 main findings. First, the VLCKD was shown to result in a significant weight loss in the short, intermediate, and long terms and improvement in body composition parameters as well as glycemic and lipid profiles. Second, when compared with other weight loss interventions of the same duration, the VLCKD showed a major effect on reduction of body weight, fat mass, waist circumference, total cholesterol and triglyceridemia as well as improved insulin resistance. Third, although the VLCKD also resulted in a significant reduction of glycemia, HbA1c, and LDL cholesterol, these changes were similar to those obtained with other weight loss interventions. Finally, the VLCKD can be considered a safe nutritional approach under a health professional’s supervision since the most common side effects are usually clinically mild and easily to manage and recovery is often spontaneous. Conclusions: The VLCKD can be recommended as an effective dietary treatment for individuals with obesity after considering potential contra-indications and keeping in mind that any dietary treatment has to be personalized. Prospero Registry: The assessment of the efficacy of VLCKD on body weight, body composition, glycemic and lipid parameters in overweight and obese subjects: a meta-analysis (CRD42020205189).

Download Full-text

Weight loss trajectories and related factors in a 16-week mobile obesity intervention: A retrospective observational study (Preprint)

10.2196/preprints.29380 ◽

2021 ◽

Author(s):

Ho Heon Kim ◽

Young In Kim ◽

Andreas Michaelides ◽

Yu Rang Park

Keyword(s):

Machine Learning ◽

Weight Loss ◽

Effect Size ◽

Weight Change ◽

Average Weight ◽

Learning Approach ◽

Obesity Management ◽

Significant Difference ◽

Machine Learning Approach ◽

Cluster 2

BACKGROUND In obesity management, whether patients lose 5% or more of their initial weight is a critical factor in their clinical outcome. However, evaluations that only take this approach cannot identify and distinguish between individuals whose weight change varies and those who steadily lose weight. Evaluation of weight loss considering the volatility of weight change through a mobile-based intervention for obesity can facilitate the understanding of individuals’ behavior and weight changes from a longitudinal perspective. OBJECTIVE With machine learning approach, we examined weight loss trajectories and explored the factors related to behavioral and app usage characteristics that induce weight loss. METHODS We used the lifelog data of 19,784 individuals who enrolled in a 16-week obesity management program on the healthcare app Noom in the US during August 8, 2013 to August 8, 2019. We performed K-means clustering with dynamic time warping to cluster the weight loss time series and inspected the quality of clusters with the total sum of distance within the clusters. To identify the usage factors to determine clustering assignment, we longitudinally compared weekly usage statistics with effect size on a weekly basis. RESULTS Initial Body Mass Index (BMI) of participants was 33.9±5.9 kg/m2, and ultimately reached an average BMI of 32.0±5.7 kg/m2. In their weight log, 5 Clusters were identified: Cluster 1 (sharp decrease) showed a high proportion of weight reduction class between 10% and 15%—the highest among the five clusters (n=2,364/12,796, 18.9%)—followed by Cluster 2 (moderate decrease), Cluster 3 (increase), Cluster 4 (yoyo), Cluster 5 (other). In comparison between cluster 2 and cluster 4, although the effect size of difference in the average meal input adherence and average weight input adherence did not show a significant difference in the first week, it increased continuously for 7 weeks (Cohen’s d=0.408; 0.38). CONCLUSIONS With machine learning approach clustering shape-based timeseries similarity, this study identified 5 weight loss trajectories in mobile weight management app. Overall adherence and early adherence related to self-monitoring emerged as a potential predictor of these trajectories.

Download Full-text

A Comparison of Meal Replacements and Medication in Weight Maintenance after Weight Loss

Journal of the American College of Nutrition ◽

10.1080/07315724.2005.10719484 ◽

2005 ◽

Vol 24 (5) ◽

pp. 347-353 ◽

Cited By ~ 29

Author(s):

James D. LeCheminant ◽

Dennis J. Jacobsen ◽

Matthew A. Hall ◽

Joseph E. Donnelly

Keyword(s):

Weight Loss ◽

Weight Maintenance ◽

Meal Replacements

Download Full-text

Endoscopic Approaches to Obesity Management

Annual Review of Medicine ◽

10.1146/annurev-med-042320-125832 ◽

2021 ◽

Vol 73 (1) ◽

Author(s):

Russell D. Dolan ◽

Allison R. Schulman

Keyword(s):

Metabolic Disease ◽

Weight Loss ◽

Small Bowel ◽

Weight Regain ◽

Caloric Intake ◽

Annual Review ◽

Publication Date ◽

Obesity Management ◽

Surgical Interventions ◽

Treatment Of Obesity

The field of endoscopic bariatric and metabolic therapy has rapidly evolved from offering endoscopic treatment of weight regain following bariatric surgery to providing primary weight loss options as alternatives to pharmacologic and surgical interventions. Gastric devices and remodeling procedures were initially designed to work through a mechanism of volume restriction, leading to earlier satiety and reduced caloric intake. As the field continues to grow, small bowel interventions are evolving that may have some effect on weight loss but focus on the treatment of obesity-related comorbidities. Future implementation of combination therapy that utilizes both gastric and small bowel interventions offers an exciting option to further augment weight loss and alleviate metabolic disease. This review considers gastric devices and techniques including space-occupying intragastric balloons, aspiration therapy, endoscopic tissue suturing, and plication interventions, followed by a review of small bowel interventions including endoluminal bypass liners, duodenal mucosal resurfacing, and endoscopically delivered devices to create incisionless anastomoses. Expected final online publication date for the Annual Review of Medicine, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Download Full-text

Translation of Evidence to Clinical Practice for Use of Meal Replacements in Weight Loss and Obesity-lessons Learned from Research Studies

Journal of Nutrition & Food Sciences ◽

10.4172/2155-9600.1000541 ◽

2016 ◽

Vol 06 (05) ◽

Cited By ~ 2

Author(s):

Ching Li Lee ◽

Winnie SS Chee

Keyword(s):

Weight Loss ◽

Clinical Practice ◽

Lessons Learned ◽

Meal Replacements ◽

Research Studies

Download Full-text

Mental illness as a predictor of patient attendance and anthropometric changes: observations from an Australian publicly funded obesity management service

Australasian Psychiatry ◽

10.1177/1039856220953713 ◽

2020 ◽

pp. 103985622095371

Author(s):

Louise Brightman ◽

Alexandra Dunne ◽

Hsin-Chia Carol Huang

Keyword(s):

Mental Illness ◽

Weight Loss ◽

Depressive Disorders ◽

Psychotic Disorders ◽

Management Service ◽

Obesity Management ◽

Significant Weight Loss ◽

Retrospective Audit ◽

Schizophrenia Spectrum ◽

Clinically Significant

Objective: Obesity is associated with co-morbid mental illness. The Canberra Obesity Management Service (OMS) supports adults with severe obesity who have the psychosocial capacity to engage. This study will determine whether mental illness is a predictor of OMS attendance and anthropometric changes. Method: A retrospective audit was performed from July 2016 to June 2017. Baseline characteristics, attendance and anthropometrics were stratified according to the presence of mental illness. Outcomes included weight stabilisation and clinically significant weight loss. Descriptive analyses were performed. Results: Mental illness was present in 60/162 patients (37%). Attendance was similar for those with and without mental illness. Patients with mental illness had twice as many co-morbidities ( p = .001). Depressive disorders were most common ( n = 28, 47%). Anxiety, schizophrenia spectrum and other psychotic disorders, and trauma- and stressor-related disorders also featured. Weight stabilisation was achieved by 25 patients (66%) with mental illness and 25 (35%) without. Clinically significant weight loss was observed in 10 patients (26%) with and 26 (40%) without mental illness. Conclusion: The presence of mental illness did not impact OMS attendance or weight stabilisation. The higher rate of co-morbidities in those with mental illness highlights the challenges faced by this vulnerable population.

Download Full-text

Higher adherence to the Mediterranean Diet is associated with weight loss maintenance: the MedWeight study

Proceedings of The Nutrition Society ◽

10.1017/s0029665120002888 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Dimitrios Poulimeneas ◽

Katerina Zoupi ◽

Eirini Mamalaki ◽

Eirini Bathrellou ◽

Costas Anastasiou ◽

...

Keyword(s):

Physical Activity ◽

Weight Loss ◽

Mediterranean Diet ◽

Dietary Pattern ◽

Weight Loss Maintenance ◽

Activity Level ◽

Obesity Management ◽

Maximum Weight ◽

The Mediterranean ◽

Current Weight

AbstractIntroductionAdherence to the Mediterranean dietary pattern has been associated with numerous health benefits in non-communicable diseases, including obesity management. However, the associations of the Mediterranean Diet with weight loss maintenance remain to be evaluated.MethodsWe analyzed data from 500 participants (61% women) of the MedWeight study. Eligible volunteers were men and women 18–65 years old, reporting an intentional weight loss of at least 10%, starting from a BMI ≥ 25 kg/m2. Based on their current weight, participants were characterized as maintainers (current weight ≤ 90% of maximum weight), or regainers (current weight > 95% of maximum weight). Socio-demographics, lifestyle measurements and weight history were recorded. Dietary intake was assessed by 2 telephone 24-hour recalls. Adherence to the Mediterranean Diet was assessed with the MedDietScore (range 0–55, greater scores showing higher adherence). Physical activity levels were assessed with the International Physical Activity Questionnaire-short form. Results are expressed as means ± SD, frequencies (%) or Odds Ratio [OR; 95%Confidence Interval].ResultsCompared to regainers (31%), maintainers were younger (31.4 ± 10.0 vs. 36.6 ± 10.8 years, p < 0.001), had lower BMI (25.7 ± 4.3 vs. 31.4 ± 5.1 kg/m2, p < 0.001), and had greater initial body weight loss (25.5 ± 8.6% vs. 18.4 ± 6.9%, p < 0.001). Sex and years of formal education were not significantly different between maintainers and regainers (p > 0.05). Being in the highest MedDietScore quintile (vs. the lowest) was associated with 91% higher odds of being a maintainer [crude OR = 1.91; 1.05–3.45]. This association remained significant after adjusting for sex, age, physical activity level (METŸminutes/week) and energy intake (kcal/day) [adjusted OR = 2.01; 1.05–3.83].DiscussionHigher adherence to the Mediterranean Diet was independently associated with 2-fold increased likelihood of weight loss maintenance. Our results highlight the favorable effects of a prudent dietary pattern in long-term obesity management, as well as novel targets for diet planning during weight loss maintenance.

Download Full-text

PATIENT PERSPECTIVES ON OBESITY MANAGEMENT: NEED FOR GREATER DISCUSSION OF BMI AND WEIGHT-LOSS OPTIONS BEYOND DIET AND EXERCISE, ESPECIALLY IN PATIENTS WITH DIABETES

Endocrine Practice ◽

10.4158/ep-2019-0452 ◽

2020 ◽

Vol 26 (5) ◽

pp. 471-483 ◽

Cited By ~ 2

Author(s):

Sabrina Huq ◽

Supriya Todkar ◽

Sharon W. Lahiri

Keyword(s):

Bariatric Surgery ◽

Body Mass Index ◽

Weight Loss ◽

Body Mass ◽

Early Death ◽

Specific Weight ◽

Obesity Management ◽

Diet And Exercise ◽

Patients With Diabetes ◽

Chi Squared

Objective: To identify perceptions of obesity management in patients with and without diabetes. Methods: A 48-question survey was administered in 2018 to our Endocrinology Clinic's adult patients with a body mass index (BMI) ≥30 kg/m2. Chi-squared or Fisher's exact tests were used to compare variables between groups. Results: Of 146 respondents, 105 had diabetes and 41 did not. Most respondents were female (61.4%), African American (66.4%), and with an income <$50,000 (58.6%). Those with diabetes had significantly greater comorbidities of hypertension, high cholesterol, and arthritis. Over 90% in both groups agreed that obesity is related to hypertension, diabetes, heart disease, and early death. Only 48% were aware of their BMI, and only 30.5% with diabetes and 41.5% without diabetes perceived themselves to be obese. Over 60% in each group reported discussion of diet and exercise with their providers, whereas few in both groups reported referral to a formal weight-loss program (18.9%) or to a specialty that manages obesity (4.2%), or discussion of anti-obesity medications (11.2%) or bariatric surgery (8.4%). Reported concerns with anti-obesity medications and bariatric surgery included lack of knowledge and side effects or complications. Conclusion: These findings revealed excellent patient awareness of obesity as a health problem but misperception of obese status and unawareness of BMI. Presence of diabetes and other comorbidities did not result in greater discussion of weight-loss methods beyond diet and exercise. Increased patient education and discussion of specific weight-loss services, anti-obesity medications, and bariatric surgery are needed. Abbreviations: BMI = body mass index; DM = diabetes mellitus; HbA1c = hemoglobin A1c; HCP = healthcare provider

Download Full-text