Feasibility of a partial meal replacement plan for weight loss in low-income patients

Developing and Piloting a Novel Ranking System to Assess Popular Dietary Patterns and Healthy Eating Principles

A multitude of weight loss diets exist. However, no one diet has been proven to be superior, despite their claims. Resultingly, this creates confusion amongst consumers and conflicting nutrition messages. The aim of the ranking system was to evaluate a range of dietary pattern’s nutrition profile and financial costs, as well as their potential long-term sustainability and associated adverse effects. Nutrition profile is typically the focal point of weight loss diets with less attention focused towards other factors that may affect their suitability. Five popular diets (Keto, Paleo, Intermittent Fasting, Optifast, and 8 Weeks to Wow) and two energy restricted healthy eating principles (Australian Guide to Healthy Eating and the Mediterranean Diet) were compared for diet quality, cost, adverse effects, and support for behaviour change. In general, healthy eating principles scored more favourably compared to popular weight loss diets in all categories. Lower carbohydrate diets tended to score lower for diet quality due to restricting multiple food groups, had more associated adverse effects and did not encourage behaviour change compared to the other weight loss diets. Optifast was the only weight loss diet to receive a negative score for cost. There should be considerations when undertaking a change to dietary patterns beyond nutrition profile. Diets indeed vary in terms of diet quality, and in addition can be costly, incur adverse effects, and disregard behaviour change which is important for sustainable weight loss and maintenance. This ranking system could create a reference point for future comparisons of diets.

Developing and implementing a new methodology to test the affordability of currently popular weight loss diet meal plans and healthy eating principles

Background

Weight loss diets continue to rise in popularity; however, the associated costs are seldom reported. Certain weight loss diets may be unaffordable and differ from their traditional nutrition composition to include non-conventional premium products. In contrast, healthy eating principles such as the Australian Guide to Healthy Eating (AGHE) and the Mediterranean Diet (MedDiet) place an emphasis on fresh produce and staple foods but are sometimes thought to be unaffordable. A new methodology was piloted to assess the cost of weight loss diets using seven meal plans.

Methods

Seven meal plans were analysed to quantify the absolute grams required of all ingredients across seven days and multiplied by the cost of the ingredient per gram to determine the total cost of each ingredient based on unit size and price. The weekly grocery shopping cost was determined through summation of all ingredients and their entire unit size to compare weekly costs.

Results

Weekly meal plans (absolute grams) cost between $93-193AUD. The AGHE meal plan was the least expensive and 8 Weeks to Wow was the most expensive. Weekly grocery shopping of entire units cost between $345-$625AUD, over $100AUD greater than the spending of an average Australian ($237AUD/week).

Conclusions

The financial feasibility for long-term sustainment of weight loss diets may be questionable for groups including low-income earners and low socioeconomic status. Further, when dietary patterns are adapted for weight loss, or followed by consumers, deviations from foundational principles tend to occur which may influence overall cost.

Weight Loss Experiences of African American, Hispanic, and Non-Hispanic White Men and Women with Type 2 Diabetes: The Look AHEAD Trial

OBJECTIVE

The aim of this study was to characterize weight loss, treatment engagement, and weight control strategies utilized by African American, Hispanic, and non-Hispanic white participants in the Action for Health in Diabetes (Look AHEAD) Intensive Lifestyle Intervention by racial/ethnic and sex subgroups.

METHODS

Weight losses at 1, 4, and 8 years among 2,361 adults with obesity and type 2 diabetes randomized to intervention (31% minority; 42% men) are reported by subgroup. Multivariable models within subgroups examine relative contributions of treatment engagement variables and self-reported weight control behaviors.

RESULTS

All subgroups averaged weight losses ≥ 5% in year 1 but experienced regain; losses ≥ 5% were sustained at year 8 by non-Hispanic white participants and minority women (but not men). Session attendance was high (≥ 86%) in year 1 and exceeded protocol-specified minimum levels into year 8. Individual session attendance had stronger associations with weight loss among Hispanic and African American participants than non-Hispanic white participants at 4 years (P = 0.04) and 8 years (P = 0.001). Daily self-weighing uptake was considerable in all subgroups and was a prominent factor associated with year 1 weight loss among African American men and women. Greater meal replacement use was strongly associated with poorer 1-year weight losses among African American women.

CONCLUSIONS

Experiences of minority men and women with diabetes in lifestyle interventions fill important gaps in the literature that can inform treatment delivery.

Role of the family doctor in the management of adults with obesity: a scoping review

OBJECTIVES

Obesity management is an important issue for the international primary care community. This scoping review examines the literature describing the role of the family doctor in managing adults with obesity. The methods were prospectively published and followed Joanna Briggs Institute methodology.

SETTING

Primary care. Adult patients.

INCLUDED PAPERS

Peer-reviewed and grey literature with the keywords obesity, primary care and family doctors. All literature published up to September 2015. 3294 non-duplicate papers were identified and 225 articles included after full-text review.

PRIMARY AND SECONDARY OUTCOME MEASURES

Data were extracted on the family doctors' involvement in different aspects of management, and whether whole person and person-centred care were explicitly mentioned.

RESULTS

110 papers described interventions in primary care and family doctors were always involved in diagnosing obesity and often in recruitment of participants. A clear description of the provider involved in an intervention was often lacking. It was difficult to determine if interventions took account of whole person and person-centredness. Most opinion papers and clinical overviews described an extensive role for the family doctor in management; in contrast, research on current practices depicted obesity as undermanaged by family doctors. International guidelines varied in their description of the role of the family doctor with a more extensive role suggested by guidelines from family medicine organisations.

CONCLUSIONS

There is a disconnect between how family doctors are involved in primary care interventions, the message in clinical overviews and opinion papers, and observed current practice of family doctors. The role of family doctors in international guidelines for obesity may reflect the strength of primary care in the originating health system. Reporting of primary care interventions could be improved by enhanced descriptions of the providers involved and explanation of how the pillars of primary care are used in intervention development.

A novel stepped-care approach to weight loss: The role of self-monitoring and health literacy in treatment outcomes

OBJECTIVES

The aims of the current study were twofold: 1) examine the effectiveness of an innovative three-step, stepped-care behavioral weight loss treatment, and 2) examine factors that contribute to poor weight loss outcomes and the need for more intensive treatment.

METHODS

The total sample for the study consisted of 53 individuals (87% female) with M_BMI=35.6, SD_BMI=6.4. A three-step, stepped-care treatment approach was implemented over six months. Step 1 included the Diabetes Prevention Program manual adapted for self-administration augmented with monitoring technology shown to facilitate weight loss and participant accountability and engagement. Participants who were unsuccessful at achieving established weight loss goals received stepped-up treatments in 2-month increments beginning at month 2. The stepped progression included the addition of meal replacement at Step 2 and individual counseling concurrent with meal replacement at Step 3.

RESULTS

Un-stepped and once stepped participants lost a clinically significant amount of weight (i.e., >5%), while twice stepped participants lost an insignificant amount of weight. Twice stepped participants were significantly lower in health literacy and self-monitoring frequency.

CONCLUSIONS

In this investigation, approximately 60% of the participants were able to lose a clinically significant amount of weight utilizing a minimally intensive intervention with little additional support. Regular self-monitoring and high health literacy proved to be significant correlates of success.

Evidence-based obesity treatment interventions for Latino adults in the U.S.: a systematic review

CONTEXT

Latinos have one of the highest prevalences of obesity in the U.S. Efforts to address U.S. Latino health have expanded to include obesity prevention and treatment initiatives. The objectives of this review were to (1) conduct a systematic review of obesity-related treatment interventions targeting U.S. Latino adults and (2) develop evidence-based recommendations to inform culturally relevant strategies for obesity treatment targeting U.S. Latino adults.

EVIDENCE ACQUISITION

Obesity treatment interventions, published between 1990 and 2010, were identified through a systematic search of electronic databases conducted between January 2010 and December 2011. Details of the screening process and selection/exclusion criteria are reported in the Guide to Obesity Prevention in Latin America and the U.S. (GOL) parent study.

EVIDENCE SYNTHESIS

Of the 325 studies identified in the GOL parent study, 105 met the inclusion criteria, and 22 involved obesity treatment interventions for Latinos and were included in the present review. The 22 studies were evaluated (between January 2010 and December 2011) for strength of study design and execution; effect sizes were also estimated for treatment effects on obesity-related outcomes. Interventions for physical activity or diet behavioral changes with strong or sufficient evidence included (1) community-based, culturally relevant, RCTs, and non-randomized controlled trials; (2) church-based interventions; and (3) promotora-led interventions.

CONCLUSIONS

Most interventions targeted physical activity and/or diet behavioral modification in Latinas and were led by bicultural/bilingual professionals. Potential key intervention settings include community clinics/centers and churches. Although there was limited literature on obesity treatment interventions for U.S. Latinos, the review findings provide valuable insight to researchers and practitioners involved in obesity treatment for U.S. Latino adults.

An interventional pilot study on obesity among low-income patients using a computer-based weight management module

Primary care physicians infrequently address lifestyle modification with their obese patients, among whom those of lower economic means are disproportionately represented. To enhance patients’ access to education on lifestyle modification, a clinic-based computer kiosk was installed at our residency clinic for the purpose of healthy lifestyle education. While posttest scores improved and were maintained after completion of lifestyle modification education, body mass index (BMI) was essentially unaffected. Computer-based education without intensive counseling on lifestyle modification appears ineffective in reducing BMI amongst obese patients of lower economic means. Accountable care organization-sponsored health coaching may represent a potential means by which intensive counseling is accomplished among such patients.

Meal Replacement Beverage Twice a Day in Overweight and Obese Adults (MDRC2012-001)

This open label, single arm, prospective, interventional, weight loss trial evaluated a meal replacement beverage (Right Size^® Smoothie) used to replace breakfast and lunch each day for 12 weeks (7 clinic visits) as part of a calorie-restricted diet in overweight and obese adults. A total of 155 individuals were screened, 55 enrolled and 28 completed this 12 week study. Subjects were obese (mean weight: 206 pounds and BMI: 32.7 kg/m²) and the mean age was 40 years including 42 (76.4%) female and 13 (23.6%) male volunteers. The modified Intent to Treat and Completer groups lost an average of 10.6 and 13.8 pounds and reduced their average BMI by 1.7 and 2.2 kg/m² respectively during this 12 week trial. The Per Protocol group lost 15.2 pounds and 2.4 kg/m² and the Optimal Weight Loss group lost 18.5 pounds and 2.9 kg/m². Using the Satiety Labeled Intensity Magnitude scale (SLIM) questionnaire, subjects reported feeling relatively hungry before they consumed the beverage, then feeling relatively full 15 minutes following the beverage with the sensation of some fullness lasting more than 2 hours and then feeling relatively hungry again at 3 hours after consuming the beverage. Study subjects reported significant improvements in physical functioning, general health, vitality and mental health as well as increased cognitive restraint of eating, reduced disinhibition and reduced hunger during the trial. The study beverages were well tolerated and no Serious Adverse Events (SAE) reported. This study suggests the study beverage aids in weight loss by helping to curb hunger during a reduced calorie diet program.

Reducing excessive gestational weight gain: lessons from the weight control literature and avenues for future research

Excessive gestational weight gain is a prevalent problem and an independent predictor of future obesity in both mothers and offspring. Intervention research to prevent excessive gestational weight gain is still in its infancy but results to date have been quite modest. Research in weight control outside of pregnancy over the past 30 years has been more robust and identified several key components of effective programs, including use of caloric restriction, daily diet self-monitoring, self-weighing, behavior therapy and ongoing patient-provider contact. The aim of this article is to summarize intervention components shown to be effective in promoting successful weight control outside of pregnancy and explore potential applications in pregnancy. Available evidence suggests that the strategies shown to be effective for weight control outside of pregnancy may also promote better weight control in pregnancy, but several lines for future investigation remain.

Losing weight without dieting. Use of commercial foods as meal replacements for lunch produces an extended energy deficit

High-protein liquid meal replacements have proven to be effective in reducing caloric intake and body weight. Recently, substituting high fiber breakfast cereals for the more expensive high-protein drinks has been found to be equally effective to reduce weight. The following study tested the hypothesis that the mechanism responsible for the reduced intake was not the dietary composition of the meal replacement, but the controlled portion sized meals. Seventeen volunteers ate all of their meals and snacks from foods provided by the research unit from Monday to Friday for five consecutive weeks. For the first week, all participants selected their food from a buffet where each food was weighed before and after eating. For the next two weeks, half of the group selected their lunch by choosing one food from a selection of six commercially available portion controlled foods. They could eat as much as they wished at other meals or snacks. For final weeks four and five, the conditions were reversed for the two groups. Consuming the portion controlled lunches resulted in about a 250 kcal reduction in energy intake. More importantly, no sign of caloric compensation was evident across the 10 days of testing, an observation substantiated by a significant loss of body weight. The results suggest that the mere substitution of one smaller portioned meal each day is sufficient to cause reduction in daily energy intake and a significant amount of weight.

Efficacy of low-calorie, partial meal replacement diet plans on weight and abdominal fat in obese subjects with metabolic syndrome: a double-blind, randomised controlled trial of two diet plans - one high in protein and one nutritionally balanced

BACKGROUND

Little is known about the relative efficacy of high-protein vs. conventional diet plans that include partial meal replacements on body fat loss in obese subjects with metabolic syndrome.

OBJECTIVE

We aimed to evaluate the efficacy of two low-calorie diets with partial meal replacement plans-a high-protein plan (HP) and a nutritionally balanced conventional (C) plan-on reducing obesity in obese subjects with metabolic syndrome.

DESIGN

In a 12-week, double-blind study, we randomised 75 participants to either the HP- or the C-plan group. We recorded key metrics at 0 and 12 weeks.

RESULTS

The overall mean weight loss was 5 kg in the HP-plan group and 4.9 kg in the C-plan group (p = 0.72). Truncal fat mass decreased 1.6 kg in the HP-plan group (p < 0.05) and 1.5 kg in the C-plan group (p < 0.05), while whole body fat mass decreased 2.5 kg in the HP-plan group (p < 0.05) and 2.3 kg in the C-plan group (p < 0.05). Between-group losses did not differ significantly for truncal (p = 0.52) or whole body (p = 0.77) fat mass. Among subjects with > or = 70% dietary compliance, however, truncal and whole body fat mass decreased more in the HP-plan group (Delta 2.2 kg and Delta 3.5 kg respectively) than in the C-plan group (Delta 1.3 kg and Delta 2.3 [corrected] kg respectively) (p < 0.05).

CONCLUSION

The HP- and C-plans had a similar effect on weight and abdominal fat reduction, but the HP-plan was more effective in reducing body fat among compliant subjects.

Barriers to obesity treatment

Obesity, one of the most prevalent health problems in the Western world, is a chronic and progressive condition. Therefore, as with other chronic diseases, patients with obesity require lifelong treatment. Long-term efficacy and effectiveness of obesity treatments is notoriously poor. This may in part be attributable to the substantial barriers that undermine long-term obesity management strategies. These can include lack of recognition of obesity as a chronic condition, low socioeconomic status, time constraints, intimate saboteurs, and a wide range of comorbidities including mental health, sleep, chronic pain, musculoskeletal, cardiovascular, respiratory, digestive and endocrine disorders. Furthermore, medications used to treat some of these disorders may further undermine weight-loss efforts. Lack of specific obesity training of health professionals, attitudes and beliefs as well as coverage and availability of obesity treatments can likewise pose important barriers. Health professionals need to take care to identify, acknowledge and address these barriers where possible to increase patient success as well as compliance and adherence with treatments. Failure to do so may further undermine the sense of failure, low self esteem and self efficacy already common among obese individuals. Addressing treatment barriers can save resources and increase the prospect of long-term success.

Crenças e influências sobre dietas de emagrecimento entre obesos de baixa renda

A obesidade tornou-se uma epidemia carente de controle imediato, principalmente entre pobres, mulheres e pessoas de baixa escolaridade. A OMS solicita e vários estudos corroboram que estudos esclarecedores sobre os comportamentos psicológicos e sociais interferentes na aderência terapêutica aos regimes devem ser encorajados. Este estudo usou a Teoria da Ação Racional - TAR, de M. Fishbein, em Psicologia Social, e comparou duas séries de entrevistas abertas (em 2001 e 2005) que eliciaram as crenças positivas (vantagens) e negativas (desvantagens) sobre fazer dieta entre obesos de baixa renda de João Pessoa, Paraíba, além dos referentes (pessoas de opinião influente) destes pacientes quanto a segui-la. Os resultados de 2001 foram corroborados em 2005, revelando o medo das doenças relacionadas à obesidade e a vontade de sentir mais saúde e leveza de corpo. Mães, filhos e principalmente o cônjuge aparecem como apoiadores do regime. Ressaltou-se que não bastaria força de vontade, mas também reflexão e construção de habilidades de controle, apropriação e modificação das condições de vida. Preocupações estéticas não foram prioritárias. Estas informações podem fomentar melhores resultados na aderência terapêutica.

Assessment of comorbid conditions in veteran patients after Roux-en-Y gastric bypass

BACKGROUND

The present study assessed the degree to which comorbid conditions improved after bariatric surgery in veteran patients.

METHODS

A retrospective review of 55 patients (age 49.1 +/- 1.2, body mass index 49.3 +/- 1.2 kg/m2; 62% male) who underwent open Roux-en-Y gastric bypass surgery at the Dallas Veterans Administration Medical Center was performed. Univariate and multivariate analyses were used to determine factors associated with outcomes.

RESULTS

There were 17 minor (8 patients with anastomotic ulcer, 5 patients with hernia, 1 patients with cholecystitis, 1 patients with a wound infection, and 2 patients with seroma) and 4 major (3 patients with pulmonary embolism and 1 patients with gastrojejunostomy leak) complications. Univariate analysis demonstrated that body mass index was associated with increased length of hospital stay but not with morbidity. Age was not associated with length of hospital stay or morbidity. There was improvement in 91% of patients affected with diabetes mellitus, in 89% with hypertension, in 80% with dyslipidemia, and in 62% with obstructive sleep apnea.

COMMENTS

Roux-en-Y gastric bypass results in a marked amelioration or elimination of obesity-related comorbid conditions in veteran patients. Morbidity and mortality are within acceptable rage for these patients with substantial comorbidities.

Are meal replacements an effective clinical tool for weight loss?

Clinical trials show partial meal replacement products to be safe, acceptable and effective when used as part of an overall low-energy diet.