Comparative effectiveness of a portion-controlled meal replacement program for weight loss in adults with and without diabetes/high blood sugar

Meal replacement therapy for obesity and diabetes remission: efficacy assessment and considerations of barriers and facilitators to adherence among U.S. individuals with low economic resources

Individuals in the United States with lower economic resources face a disproportionate burden of obesity and co-morbid conditions. This review summarizes the efficacy of MR programs for the treatment of obesity and diabetes and alerts clinicians to potential barriers and facilitators to the uptake of such programs so they may tailor their prescriptive approach. Implementation of effective behavioral and lifestyle interventions for obesity and diabetes in low-income settings is fraught with barriers and under-studied. The dearth of data on the use of MR programs in populations with low economic resources highlights a key area for future investigation.

Importance of early weight loss and other predictors of lower weight loss in a commercial program: A secondary data analysis

Objective

There is substantial inter-individual variability in response to weight loss interventions and emerging evidence suggests that weight loss during the early weeks of an intervention may be predictive of longer-term weight loss. This secondary analysis of data from a commercial program therefore examined 1) the associations between early weight loss (i.e., week 4) with final visit weight loss and duration on the program, and 2) other predictors of lower weight loss at final visit.

Methods

Client charts of adults with overweight or obesity (N = 748) were analyzed. Clients were stratified into categories of weight loss at the week 4 (< and ≥2%, 3% and 4%) and final visits (< and ≥5% and 10%). Multivariate logistic regression was used to assess predictors of <5% and <10% final visit weight loss.

Results

The odds ratios for losing <5% or <10% of weight at the final visit were higher (49.0 (95% CI: 13.84, 173.63) and 20.1 (95% CI: 6.96, 58.06)) for clients who lost <2% or <3% compared to those who lost ≥2% or ≥3% at week 4. Other predictors of not losing a clinically relevant amount of weight included female sex, use of higher calorie meal plans and shorter time in the program, among others. Those who lost ≥2% at week 4 also had a significantly greater percent program completion (109.2 ± 75.2% vs. 82.3 ± 82.4, p < 0.01) compared with those who did not meet the 2% threshold.

Conclusions

Lower 4-week weight loss was identified as a strong predictor of not losing a clinically relevant amount of weight. These results may be useful for the early identification of individuals who can be targeted for additional counseling and support to aid in attaining weight loss goals.

Efficacy and safety of a specific commercial high-protein meal-replacement product line in weight management: meta-analysis of randomized controlled trials

BACKGROUND

Protein is suggested to be the nutrient providing the most satiety and is frequently used in meal-replacement products to achieve weight loss. Commercial products such as Herbalife high-protein (HP) products have been studied in various clinical trials, but controversy remains regarding their efficacy and safety.

METHODS

We searched the PubMed, Center for Clinical and Translational Research (CCTR), and Google Scholar databases for randomized controlled trials of Herbalife HP products used as meal replacement (MR) published through July 2019 in peer-reviewed journals. We reviewed changes in efficacy and safety-related outcomes in treatment and control groups, and we estimated the pooled standardized mean difference (SMD) and corresponding 95% confidence intervals (CIs) with a DerSimonian and Laird random-effects method.

RESULTS

By pooling data from nine identified studies (934 participants: 463 in treatment groups and 471 in control groups), we found that participants who consumed HP products experienced significantly larger decreases in body weight (SMD = -0.24; 95% CI: -0.37 to -0.10), body mass index (SMD = -0.31; 95% CI: -0.50 to -0.11), and fat mass (SMD = -0.37; 95% CI: -0.65 to -0.09) than did individuals consuming control diets. Concerning safety outcomes, the participants in the treatment group had a significantly larger decrease in aspartate aminotransferase (SMD = -0.23; 95% CI: -0.42 to -0.03). There were no significant between-group differences in alanine aminotransferase or creatinine. However, blood urea nitrogen levels increased in both groups, with a significantly larger increase in the treatment group (SMD = 0.53; 95% CI: 0.15 to 0.92).

CONCLUSIONS

Herbalife HP MR products appear effective and do not evidence significant risk in reducing body weight.

Scientific evidence of diets for weight loss: Different macronutrient composition, intermittent fasting, and popular diets

New dietary strategies have been created to treat overweight and obesity and have become popular and widely adopted. Nonetheless, they are mainly based on personal impressions and reports published in books and magazines, rather than on scientific evidence. Animal models and human clinical trials have been employed to study changes in body composition and metabolic outcomes to determine the most effective diet. However, the studies present many limitations and should be carefully analyzed. The aim of this review was to discuss the scientific evidence of three categories of diets for weight loss. There is no one most effective diet to promote weight loss. In the short term, high-protein, low-carbohydrate diets and intermittent fasting are suggested to promote greater weight loss and could be adopted as a jumpstart. However, owing to adverse effects, caution is required. In the long term, current evidence indicates that different diets promoted similar weight loss and adherence to diets will predict their success. Finally, it is fundamental to adopt a diet that creates a negative energy balance and focuses on good food quality to promote health.

A review and critique of published real-world weight management program studies

BACKGROUND

Beyond the essential but somewhat artificial conditions that typify formal clinical studies, real-world evidence (RWE) of weight loss program effectiveness is paramount for an accurate assessment of such programs and refinement of best practices.

OBJECTIVES

To evaluate the current state of RWE studies and publications on weight loss, identify the range of weight loss components being used in RWE programs, and to provide a general overview of the consistency or lack of consistency with regard to measuring and reporting outcomes.

METHODS

A structured search of PubMed was performed to identify relevant English-language publications from 2006 to December 2017 that reported real-world studies of weight loss among adults. Duplicates, non-relevant publications, articles on weight loss surgery, pediatric studies, randomized controlled trials, studies with self-reported weight loss, no objective weight measures, or that failed to include weight loss results were excluded.

RESULTS

This review included 62 RWE publications. Forty-nine studies included dietary intervention, 37 included exercise, 29 included motivational counseling, and 5 contained some patients who had pharmacologic treatment as part of their weight loss regimen. The numbers of participants per study ranged from 10 to more than 3 million. The interventions reported in the publications included diet, exercise, counseling to promote diet and/or exercise, motivational counseling, and pharmacotherapy, and various combinations of these.

CONCLUSIONS

Despite general acceptance that weight loss programs are capable of facilitating successful outcomes, this review revealed substantial inconsistency in the design and reporting of such programs, making it very difficult to draw conclusions about the comparative merits of different real-world weight loss strategies/components. In addition, there was a marked lack of congruence with current weight loss management guidelines, and notably few studies incorporating anti-obesity medications. There clearly is a need for greater rigor and standardization among designing and reporting RWE weight-loss studies.