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Min J, Kim SY, Shin IS, Park YB, Lim YW. The Effect of Meal Replacement on Weight Loss According to Calorie-Restriction Type and Proportion of Energy Intake: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Acad Nutr Diet 2021; 121:1551-1564.e3. [PMID: 34144920 DOI: 10.1016/j.jand.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Portion control is a useful component of weight reduction interventions and meal replacement (MR) plans represent a promising strategy for portion control. Research performed with pooled data on the effect of MR plans according to various characteristics of MR interventions remains scarce. OBJECTIVE Our aim was to assess the effects of MR-based diets compared with food-based diets on weight loss, according to calorie-restriction types and energy intake proportions from MR. METHODS Electronic databases (Cochrane Central Register of Controlled Trials, PubMed, Embase, and Research Information Sharing Service) were searched for randomized controlled trials on weight loss results of MR-based calorie-restricted diets compared with food-based calorie-restricted diets from January 2000 to May 2020. Standardized mean differences (Hedges' g) from all study outcomes were calculated using a random-effects model. Heterogeneity was quantified by Q test and I2. Publication bias was assessed using a funnel plot and a trim and fill method. Both interventions (MR and control) were separated into very-low-energy diets and low-energy diets (LEDs). A meta-analysis of variance was conducted by dividing patient-related factors and treatment-related factors into subgroups. In multivariable meta-regressions, background variables were selected first, after which main independent variables were included. RESULTS Twenty-two studies involving 24 interventions and 1,982 patients who were overweight or obese were included. The effect size in which MR-based LED was compared with food-based LED for weight loss was small, favoring MR (Hedges' g = 0.261; 95% CI 0.156 to 0.365; I2 = 21.9; 95% CI 0.0 to 53.6). Diets including ≥60% of total daily energy intake from MR had a medium effect size favoring MR with regard to weight loss among the groups (Hedges' g = 0.545; 95% CI 0.260 to 0.830; I2 = 42.7; 95% CI 0.0 to 80.8). CONCLUSIONS The effect of MR-based LED on weight loss was superior to the effect of food-based LED, and receiving ≥60% of total daily energy intake from MR had the greatest effect on weight loss.
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Peos JJ, Norton LE, Helms ER, Galpin AJ, Fournier P. Intermittent Dieting: Theoretical Considerations for the Athlete. Sports (Basel) 2019; 7:sports7010022. [PMID: 30654501 PMCID: PMC6359485 DOI: 10.3390/sports7010022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/05/2019] [Accepted: 01/11/2019] [Indexed: 12/28/2022] Open
Abstract
Athletes utilise numerous strategies to reduce body weight or body fat prior to competition. The traditional approach requires continuous energy restriction (CER) for the entire weight loss phase (typically days to weeks). However, there is some suggestion that intermittent energy restriction (IER), which involves alternating periods of energy restriction with periods of greater energy intake (referred to as ‘refeeds’ or ‘diet breaks’) may result in superior weight loss outcomes than CER. This may be due to refeed periods causing transitory restoration of energy balance. Some studies indicate that intermittent periods of energy balance during energy restriction attenuate some of the adaptive responses that resist the continuation of weight and fat loss. While IER—like CER—is known to effectively reduce body fat in non-athletes, evidence for effectiveness of IER in athletic populations is lacking. This review provides theoretical considerations for successful body composition adjustment using IER, with discussion of how the limited existing evidence can be cautiously applied in athlete practice.
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Affiliation(s)
- Jackson James Peos
- The University of Western Australia (UWA), The School of Human Sciences, Crawley Campus, WA 6009, USA.
| | | | - Eric Russell Helms
- Auckland University of Technology, Sports Performance Institute New Zealand (SPRINZ) at AUT Millennium, Auckland 0632, New Zealand.
| | - Andrew Jacob Galpin
- California State University, Biochemistry and Molecular Exercise Physiology Laboratory, Centre for Sport Performance, Fullerton, CA 92831, USA.
| | - Paul Fournier
- The University of Western Australia (UWA), The School of Human Sciences, Crawley Campus, WA 6009, USA.
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Sumithran P, Prendergast LA, Haywood CJ, Houlihan CA, Proietto J. Review of 3-year outcomes of a very-low-energy diet-based outpatient obesity treatment programme. Clin Obes 2016; 6:101-7. [PMID: 26841953 DOI: 10.1111/cob.12135] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/09/2015] [Accepted: 12/11/2015] [Indexed: 01/31/2023]
Abstract
Obesity is a complex disorder that requires a multidisciplinary treatment approach. This review evaluated 3-year outcomes of a very-low-energy diet (VLED)-based programme at a tertiary hospital multidisciplinary weight management clinic. Medical records of all patients who agreed to undertake the VLED programme and who did not undergo bariatric surgery during the 3-year follow-up period were examined. Baseline data collection included demographic and anthropometric characteristics, childhood onset of obesity and co-existing medical conditions. Weight was modelled using a linear mixed effects analysis. Logistic regression analyses were used to model the probability of continuing to attend the clinic and to identify pre-treatment factors associated with longer duration of attendance. Data from 1109 patients were included. A total of 231 patients (19.2%) were still attending the clinic 3 years after their initial appointment. Mean weight loss among patients who attended the clinic for 3 years was 6.4 kg (3.5%, 95% confidence interval [CI] 2.8, 4.2%). People who were prescribed pharmacotherapy maintained greater weight loss at 3 years (7.7% vs. 2.3% without pharmacotherapy, 95% CI for difference 3.9, 7.0%). People who had an onset of obesity in childhood, who had co-existing hypertension or coronary artery disease, and who did not currently smoke were more likely to continue to attend the clinic for up to 3 years. In summary, in an outpatient weight management clinic, patients who undertook a VLED-based programme and continued in follow-up achieved a clinically significant weight loss at 3 years, particularly if pharmacotherapy was used for weight loss maintenance.
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Affiliation(s)
- P Sumithran
- Austin Health Weight Control Clinic, Heidelberg Repatriation Hospital, Heidelberg, Vic., Australia
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Vic., Australia
| | - L A Prendergast
- Department of Mathematics and Statistics, La Trobe University, Bundoora, Vic., Australia
| | - C J Haywood
- Austin Health Weight Control Clinic, Heidelberg Repatriation Hospital, Heidelberg, Vic., Australia
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Vic., Australia
| | - C A Houlihan
- Austin Health Weight Control Clinic, Heidelberg Repatriation Hospital, Heidelberg, Vic., Australia
| | - J Proietto
- Austin Health Weight Control Clinic, Heidelberg Repatriation Hospital, Heidelberg, Vic., Australia
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Vic., Australia
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Intermittent Moderate Energy Restriction Improves Weight Loss Efficiency in Diet-Induced Obese Mice. PLoS One 2016; 11:e0145157. [PMID: 26784324 PMCID: PMC4718562 DOI: 10.1371/journal.pone.0145157] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 11/10/2015] [Indexed: 11/19/2022] Open
Abstract
Background Intermittent severe energy restriction is popular for weight management. To investigate whether intermittent moderate energy restriction may improve this approach by enhancing weight loss efficiency, we conducted a study in mice, where energy intake can be controlled. Methods Male C57/Bl6 mice that had been rendered obese by an ad libitum diet high in fat and sugar for 22 weeks were then fed one of two energy-restricted normal chow diets for a 12-week weight loss phase. The continuous diet (CD) provided 82% of the energy intake of age-matched ad libitum chow-fed controls. The intermittent diet (ID) provided cycles of 82% of control intake for 5–6 consecutive days, and ad libitum intake for 1–3 days. Weight loss efficiency during this phase was calculated as (total weight change) ÷ [(total energy intake of mice on CD or ID)–(total average energy intake of controls)]. Subsets of mice then underwent a 3-week weight regain phase involving ad libitum re-feeding. Results Mice on the ID showed transient hyperphagia relative to controls during each 1–3-day ad libitum feeding period, and overall ate significantly more than CD mice (91.1±1.0 versus 82.2±0.5% of control intake respectively, n = 10, P<0.05). There were no significant differences between CD and ID groups at the end of the weight loss or weight regain phases with respect to body weight, fat mass, circulating glucose or insulin concentrations, or the insulin resistance index. Weight loss efficiency was significantly greater with ID than with CD (0.042±0.007 versus 0.018±0.001 g/kJ, n = 10, P<0.01). Mice on the CD exhibited significantly greater hypothalamic mRNA expression of proopiomelanocortin (POMC) relative to ID and control mice, with no differences in neuropeptide Y or agouti-related peptide mRNA expression between energy-restricted groups. Conclusion Intermittent moderate energy restriction may offer an advantage over continuous moderate energy restriction, because it induces significantly greater weight loss relative to energy deficit in mice.
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Seimon RV, Roekenes JA, Zibellini J, Zhu B, Gibson AA, Hills AP, Wood RE, King NA, Byrne NM, Sainsbury A. Do intermittent diets provide physiological benefits over continuous diets for weight loss? A systematic review of clinical trials. Mol Cell Endocrinol 2015; 418 Pt 2:153-72. [PMID: 26384657 DOI: 10.1016/j.mce.2015.09.014] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 01/14/2023]
Abstract
Energy restriction induces physiological effects that hinder further weight loss. Thus, deliberate periods of energy balance during weight loss interventions may attenuate these adaptive responses to energy restriction and thereby increase the efficiency of weight loss (i.e. the amount of weight or fat lost per unit of energy deficit). To address this possibility, we systematically searched MEDLINE, PreMEDLINE, PubMed and Cinahl and reviewed adaptive responses to energy restriction in 40 publications involving humans of any age or body mass index that had undergone a diet involving intermittent energy restriction, 12 with direct comparison to continuous energy restriction. Included publications needed to measure one or more of body weight, body mass index, or body composition before and at the end of energy restriction. 31 of the 40 publications involved 'intermittent fasting' of 1-7-day periods of severe energy restriction. While intermittent fasting appears to produce similar effects to continuous energy restriction to reduce body weight, fat mass, fat-free mass and improve glucose homeostasis, and may reduce appetite, it does not appear to attenuate other adaptive responses to energy restriction or improve weight loss efficiency, albeit most of the reviewed publications were not powered to assess these outcomes. Intermittent fasting thus represents a valid--albeit apparently not superior--option to continuous energy restriction for weight loss.
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Affiliation(s)
- Radhika V Seimon
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown NSW 2006, Australia
| | - Jessica A Roekenes
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown NSW 2006, Australia
| | - Jessica Zibellini
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown NSW 2006, Australia
| | - Benjamin Zhu
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown NSW 2006, Australia
| | - Alice A Gibson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown NSW 2006, Australia
| | - Andrew P Hills
- Centre for Nutrition and Exercise, Mater Research Institute, The University of Queensland, South Brisbane QLD, 4101, Australia
| | - Rachel E Wood
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Neil A King
- Queensland University of Technology (QUT), Institute of Health and Biomedical Innovation and School of Exercise and Nutrition Sciences, Brisbane, QLD 4059, Australia
| | - Nuala M Byrne
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Amanda Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Camperdown NSW 2006, Australia.
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Haas WC, Moore JB, Kaplan M, Lazorick S. Outcomes from a medical weight loss program: primary care clinics versus weight loss clinics. Am J Med 2012; 125:603.e7-11. [PMID: 22624685 DOI: 10.1016/j.amjmed.2011.07.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 07/18/2011] [Accepted: 07/24/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Few studies have focused on weight loss programs implemented in community-based primary care settings. The objective of this analysis was to evaluate the effectiveness of a weight loss program and determine whether physicians in primary care practices could achieve reductions in body weight and body fat similar to those obtained in weight loss clinics. METHODS Analyses were performed on chart review data from 413 obese participants who underwent weight loss at a primary care (n=234) or weight loss (n=179) clinic. Participants received physician-guided behavioral modification sessions and self-selected a diet plan partially or fully supplemented by meal replacements. A repeated-measures analysis of covariance was conducted with age and sex serving as covariates; significance was set at P≤.05. RESULTS In 178 subjects (43%) completing 12 weeks of the program, primary care clinics were as effective as weight loss clinics at achieving reductions in body weight (12.4 vs 12.1 kg) but better with regard to reduction in body fat percentage (3.8% vs 2.7%; P≤.05). Regardless of location, participants completing 12 weeks lost an average of 11.1% of their body weight. Participants selecting full meal replacement had greater reductions in weight and body fat percentage (12.7 kg, 3.5%) compared with participants selecting a partial meal replacement plan (8.3 kg, 2.3%). CONCLUSION Primary care physicians can successfully manage and treat obese patients using behavioral modification techniques coupled with meal replacement diets.
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Affiliation(s)
- William C Haas
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Weight management by phone conference call: a comparison with a traditional face-to-face clinic. Rationale and design for a randomized equivalence trial. Contemp Clin Trials 2012; 33:1044-55. [PMID: 22664647 DOI: 10.1016/j.cct.2012.05.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 05/18/2012] [Accepted: 05/19/2012] [Indexed: 11/21/2022]
Abstract
State-of-the-art treatment for weight management consists of a behavioral intervention to facilitate decreased energy intake and increased physical activity. These interventions are typically delivered face-to-face (FTF) by a health educator to a small group of participants. There are numerous barriers to participation in FTF clinics including availability, scheduling, the expense and time required to travel to the clinic site, and possible need for dependent care. Weight management clinics delivered by conference call have the potential to diminish or eliminate these barriers. The conference call approach may also reduce burden on providers, who could conduct clinic groups from almost any location without the expenses associated with maintaining FTF clinic space. A randomized trial will be conducted in 395 overweight/obese adults (BMI 25-39.9 kg/m(2)) to determine if weight loss (6 months) and weight maintenance (12 months) are equivalent between weight management interventions utilizing behavioral strategies and pre-packaged meals delivered by either a conference call or the traditional FTF approach. The primary outcome, body weight, will be assessed at baseline, 6, 12 and 18 months. Secondary outcomes including waist circumference, energy and macronutrient intake, and physical activity and will be assessed on the same schedule. In addition, a cost analysis and extensive process evaluation will be completed.
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Furlow EA, Anderson JW. A Systematic Review of Targeted Outcomes Associated with a Medically Supervised Commercial Weight-Loss Program. ACTA ACUST UNITED AC 2009; 109:1417-21. [PMID: 19631049 DOI: 10.1016/j.jada.2009.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 02/20/2009] [Indexed: 11/24/2022]
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