Comparison of Very Low Energy Diet Products Available in Australia and How to Tailor Them to Optimise Protein Content for Younger and Older Adult Men and Women

Protein-enriched intermittent meal replacement combined with moderate-intensity training for weight loss and body composition in overweight women

The global rise in overweight and obesity has been exacerbated by sedentary lifestyles and suboptimal dietary habits. Traditional weight loss methods often struggle with adherence due to restrictive diets and metabolic adaptations. Intermittent meal replacement (IMR), incorporating formulated protein-enriched nutritional shakes, has emerged as a potential strategy for weight management. However, its combined effects with moderate-intensity continuous training (MICT) remain underexplored. This study aimed to evaluate the impact of a weight loss method incorporating formulated protein-enriched nutritional shake IMR in conjunction with MICT workout for overweight female adults. This 8-week parallel randomized controlled trial investigated the impact of protein-enriched IMR combined with MICT on weight loss and body composition in overweight female adults. Participants were randomly assigned to either the MICT group or MICT + IMR group. Body composition, hematological, and urinary biomarkers were assessed pre- and post-intervention. The MICT + IMR Group achieved a greater reduction in body weight (-3.70 kg vs. -1.17 kg, p < 0.001) and body fat mass (-2.25 kg vs. -1.19 kg, p < 0.001) compared to the MICT group. Additionally, fasting blood glucose and insulin levels significantly improved in the MICT + IMR Group, suggesting enhanced metabolic regulation. IMR, when combined with MICT, is a viable strategy for short-term weight loss in overweight women, offering improved fat reduction and metabolic benefits compared to exercise alone.Trial registration: Chinese Clinical Trail Registry, ChiCTR2300076750. Registered 17 October 2023, https://www.chictr.org.cn/bin/project/edit?pid=197611 .

Efficacy of Meal Replacement Products on Weight and Glycolipid Metabolism Management: A 90-Day Randomized Controlled Trial in Adults with Obesity

Background: The global obesity issue is growing increasingly serious, impacting personal health, economic development, and the sustainability of medical systems. There is an urgent need for effective weight loss strategies that can be widely implemented. This study conducted a 90-day randomized controlled trial to assess the impact of meal replacement products on weight management and glycolipid metabolism in adults with obesity. Methods: Adults with obesity meeting the inclusion and exclusion criteria were divided into three groups: the meal replacement group (n = 19), the diet control group (n = 19), and the normal diet group (n = 22). The meal replacement group used specially formulated meal replacement products for dinner, and the diet control group reduced the intake of staple food at lunch, both controlling daily energy intake between 1200 kcal and 1300 kcal, while the normal diet group maintained their regular dietary habits. Relevant indicators were measured at baseline and after 45 and 90 days of intervention. Results: The results showed that both the meal replacement group and the diet control group experienced significant decreases in weight, BMI, and body fat percentage, with the meal replacement group showing a more pronounced weight loss effect. The weight loss of the meal replacement group at 45 and 90 days was 4.44 ± 1.84 kg and 7.38 ± 3.24 kg, the diet control group was 2.62 ± 2.28 kg and 4.08 ± 2.94 kg, and the normal diet group was 0.66 ± 1.73 kg and 0.97 ± 2.02 kg. The decrease in BMI at 45 and 90 days for the meal replacement group was 1.08 ± 0.78 kg/m2 and 2.17 ± 1.57 kg/m2, for the diet control group was 0.82 ± 0.80 kg/m2 and 1.39 ± 1.16 kg/m2, and for the normal diet group was 0.19 ± 0.71 kg/m2 and 0.21 ± 0.96 kg/m2. The decrease in body fat percentage at 45 and 90 days for the meal replacement group was 1.76 ± 0.68% and 3.67 ± 2.62%, for the diet control group was 1.02 ± 1.11% and 1.52 ± 1.79%, and for the normal diet group was 0.81 ± 1.09% and 0.53 ± 0.93%. In addition, the decrease in BMI and body fat percentage in the meal replacement group was also significantly higher than in the other two groups. In terms of metabolic indicators, there were no significant differences in the changes of blood pressure, blood lipids, blood sugar, and ALT levels among the three groups during the intervention period. Conclusions: In summary, the results indicate that meal replacement products can significantly reduce weight and body fat percentage without affecting metabolic health.

Comparison of the Nutritional Adequacy of Current Food-Based Very Low Energy Diets: A Review and Nutritional Analysis

Very low energy diets (VLEDs) contain <800 kcal/day and typically comprise formulated meal replacement products with adequate protein and micronutrients. Food-based VLEDs are an alternative approach, but it is uncertain whether they can provide adequate nutrition within an 800 kcal/day restriction. This analysis aimed to assess the nutritional adequacy of food-based VLEDs compared with formula VLEDs. A systematized literature review was conducted to identify balanced food-based VLEDs by searching five scientific databases from inception to 23 March 2023 and online sources between 1 and 7 May 2023. Ultimately, nine diets were analyzed for nutritional content and compared with Codex Alimentarius standards for formula foods, and Australian estimated average requirement and adequate intake (AI) for adults 19-50 years. Optifast® was used as a comparator. None of the VLEDs met all nutritional benchmarks. Three food-based diets had nutrient profiles similar to formula VLEDs, with one being adequate for all nutrients except thiamine, magnesium and zinc in men and iron in women. All VLEDs, including Optifast®, did not meet AI for dietary fiber, except one. In general, food-based VLEDs offered more fiber than Optifast®. In conclusion, food-based VLEDs were inadequate in certain micronutrients but offered more dietary fiber than formula VLEDs. These nutritional deficits do not preclude food-based VLEDs from being recommended, provided they are addressed.

Real world evidence on the characteristics of regular and intermittent users of a very-low calorie diet program and associations with measures of program success, health, and quality of life

Background

Very low-calorie diet (VLCD) programs are readily available in Australia. However, there is a lack of real-world evidence describing the characteristics related to positive outcomes.

Aims

To examine the demographic, eating, self-efficacy and program engagement characteristics of VLCD users in Australia, and the associations between user characteristics and program success, weight loss, quality of life (QOL) and health.

Method

Cross-sectional data from Australian adults: regular users (n = 189: VLCD user ≥4 days/week for >4 weeks) and intermittent users (n = 111, VLCD user <4 weeks and/or <4 days/week). Self-reported data on demographics, VLCD program use, support, eating behavior, weight-related QOL, mental health, physical health, self-efficacy, and physical activity. Descriptive and inferential statistics were performed in R.

Results

Compared to regular users, intermittent users reported lower percentage weight loss (15.1% ± SD 9.8 vs. 9.9% ± SD 6.8, relative to starting weight), fewer reported their VLCD program as very successful (44% vs. 35%), higher depressive symptom scores (8.7 ± SD 2.8 vs. 6.7 ± SD 5.1), and lower general self-efficacy (23.9 ± SD 4.7 vs. 29.4 ± SD 5.7), nutrition self-efficacy (11.9 ± SD 2.0 vs. 14.5 ± SD 3.1) and weight-related QOL scores (60.9 ± SD 22.2 vs. 65.0 ± SD 11.8; p < 0.001 for all). In regular users, older age and longer program duration were associated with greater total weight loss, support, and program success (p < 0.001 for all). In intermittent users, program success was greater when dietitian support was used (odds ratio [OR] 6.50) and for those with higher BMIs (OR 1.08, p < 0.001 for all). In both groups, more frequent support was associated with better weight-related QOL (p < 0.001).

Conclusion

This study provides real-world evidence that regular VLCD users had greater success and weight loss than intermittent program users. These findings may be used to tailor and improve the delivery of VLCD programs in Australia and other countries with retail access to VLCDs.

Use of a Very Low Calorie Diet for Weight Loss in a Patient with Acute Kidney Injury and Class III Obesity: A Case Study

Very low calorie diets (VLCDs) induce rapid weight loss through severe energy restriction resulting in ketosis. VLCD manufacturer guidelines list acute kidney injury (AKI) as a contraindication for use with concerns around further damage to kidney function through increased protein catabolic load, diuresis, and risk of electrolyte derangements. We report on the successful concurrent management of AKI alongside provision of a VLCD for weight loss in the acute setting in a patient with class III obesity and comorbid complications during a prolonged hospital stay. AKI resolved at week 5 of a 15-week VLCD program, with no adverse side effects noted on electrolytes, fluid, or kidney function. A weight loss of 76 kg was attained. VLCD appears safe for use in patients with AKI during hospitalization under close medical supervision. Both health system sustainability and patients may benefit from seizing the opportunity to address obesity during protracted hospital admission.

Using a Very Low Energy Diet to Achieve Substantial Preconception Weight Loss in Women with Obesity: A Review of the Safety and Efficacy

Obesity in women of reproductive age is common. Emerging evidence suggests that maternal obesity not only increases the risk of adverse pregnancy outcomes but also has an enduring impact on the metabolic health of the offspring. Given this, management of obesity prior to pregnancy is critically important. Almost all international guidelines suggest that women with obesity should aim to achieve weight loss prior to pregnancy. However, current pre-conception weight loss therapies are sub-optimal. Lifestyle modification typically results in modest weight loss. This may assist fertility but does not alter pregnancy outcomes. Bariatric surgery results in substantial weight loss, which improves pregnancy outcomes for the mother but may be harmful to the offspring. Alternative approaches to the management of obesity in women planning pregnancy are needed. Very low energy diets (VLEDs) have been proposed as a possible tool to assist women with obesity achieve weight loss prior to conception. While VLEDs can induce substantial and rapid weight loss, there are concerns about the impact of rapid weight loss on maternal nutrition prior to pregnancy and about inadvertent exposure of the early fetus to ketosis. The purpose of this review is to examine the existing literature regarding the safety and efficacy of a preconception VLED program as a tool to achieve substantial weight loss in women with obesity.

Does a Higher Protein Diet Promote Satiety and Weight Loss Independent of Carbohydrate Content? An 8-Week Low-Energy Diet (LED) Intervention

Both higher protein (HP) and lower carbohydrate (LC) diets may promote satiety and enhance body weight (BW) loss. This study investigated whether HP can promote these outcomes independent of carbohydrate (CHO) content. 121 women with obesity (BW: 95.1 ± 13.0 kg, BMI: 35.4 ± 3.9 kg/m2) were randomised to either HP (1.2 g/kg BW) or normal protein (NP, 0.8 g/kg BW) diets, in combination with either LC (28 en%) or normal CHO (NC, 40 en%) diets. A low-energy diet partial diet replacement (LEDpdr) regime was used for 8 weeks, where participants consumed fixed-energy meal replacements plus one ad libitum meal daily. Four-day dietary records showed that daily energy intake (EI) was similar between groups (p = 0.744), but the difference in protein and CHO between groups was lower than expected. Following multiple imputation (completion rate 77%), decrease in mean BW, fat mass (FM) and fat-free mass (FFM) at Week 8 in all was 7.5 ± 0.7 kg (p < 0.001), 5.7 ± 0.5 kg (p < 0.001), and 1.4 ± 0.7 kg (p = 0.054) respectively, but with no significant difference between diet groups. LC (CHO×Week, p < 0.05), but not HP, significantly promoted postprandial satiety during a preload challenge. Improvements in blood biomarkers were unrelated to LEDpdr macronutrient composition. In conclusion, HP did not promote satiety and BW loss compared to NP LEDpdr, irrespective of CHO content.

Dietary adherence and program attrition during a severely energy-restricted diet among people with complex class III obesity: A qualitative exploration

Meal replacement Severely Energy-Restricted Diets (SERDs) produce ≥ 10% loss of body mass when followed for 6 weeks or longer in people with class III obesity (BMI ≥ 40 kg/m2). The efficacy of SERDs continues to be questioned by healthcare professionals, with concerns about poor dietary adherence. This study explored facilitators and barriers to dietary adherence and program attrition among people with class III obesity who had attempted or completed a SERD in a specialised weight loss clinic. Participants who commenced a SERD between January 2016 to May 2018 were invited to participate. Semi-structured in-depth interviews were conducted from September to October 2018 with 20 participants (12 women and 8 men). Weight change and recounted events were validated using the participants' medical records. Data were analysed by thematic analysis using line-by-line inductive coding. The mean age ± SD of participants was 51.2 ± 11.3 years, with mean ± SD BMI at baseline 63.7 ± 12.6 kg/m2. Five themes emerged from participants' recounts that were perceived to facilitate dietary adherence: (1.1) SERD program group counselling and psychoeducation sessions, (1.2) emotionally supportive clinical staff and social networks that accommodated and championed change in dietary behaviours, (1.3) awareness of eating behaviours and the relationship between these and progression of disease, (1.4) a resilient mindset, and (1.5) dietary simplicity, planning and self-monitoring. There were five themes on factors perceived to be barriers to adherence, namely: (2.1) product unpalatability, (2.2) unrealistic weight loss expectations, (2.3) poor program accessibility, (2.4) unforeseeable circumstances and (2.5) externalised weight-related stigma. This study highlights opportunities where SERD programs can be optimised to facilitate dietary adherence and reduce barriers, thus potentially improving weight loss outcomes with such programs. Prior to the commencement of a SERD program, healthcare professionals facilitating such programs could benefit from reviewing participants to identify common barriers. This includes identifying the presence of product palatability issues, unrealistic weight loss expectations, socio-economic disadvantage, and behaviour impacting experiences of externalised weight-related stigma.

Current Perspectives on the Role of Very-Low-Energy Diets in the Treatment of Obesity and Type 2 Diabetes in Youth

In both developed and developing countries, pediatric obesity and type 2 diabetes are an increasing public health concern: globally 5.6% of girls and 7.8% of boys aged ≥5 years have obesity. The incidence of type 2 diabetes has increased in youth in recent decades and disproportionately affects those from ethnic/racial minority groups and disadvantaged backgrounds. For the treatment of both conditions, conventional lifestyle intervention is frequently ineffective, access to bariatric surgery is very limited and many young people are unsuitable or unwilling to undergo surgery. A very-low-energy diet (VLED) provides a viable alternative and may be effective for weight reduction and improved glycemic control in youth, based on one systematic review. In particular, in the treatment of type 2 diabetes, a chart review and a pilot study both demonstrated that a VLED can reduce the requirement for medications, including insulin, and lead to the remission of diabetes. However, long-term follow-up and safety data remain limited and therefore a VLED is inconsistently recommended by clinical practice guidelines for the treatment of pediatric obesity and type 2 diabetes. In clinical practice, VLED use in children and adolescents is uniquely challenging due to intolerance of expected side effects, difficulty adhering to the highly restrictive diet and difficulty with behaviour change within the current social context and environment. Ultimately, more research, including larger, longer-term trials with comprehensive safety monitoring are required to strengthen the evidence base. This would inform clinical practice guidelines, which may facilitate more widespread utilization of VLED programs in the management of obesity and type 2 diabetes in youth.

Urine dipsticks are not accurate for detecting mild ketosis during a severely energy restricted diet

Background

Detection of the mild ketosis induced by severely energy‐restricted diets may be a clinically useful way to monitor and promote dietary adherence. Mild ketosis is often assessed using urine dipsticks, but accuracy for this purpose has not been tested.

Objective

To determine the accuracy of urine dipsticks to detect mild ketosis during adherence to a severely energy‐restricted diet.

Methods

Two hundred and sixty three (263) fasting urine and 263 fasting blood samples were taken from 50 women (mean [standard deviation, SD] age 58.0 [4.3] years and body mass index 34.3 [2.4] kg/m²) before and at six time points during or for up to 10 weeks after 16 weeks of severe energy restriction, achieved with a total meal replacement diet. The amount of ketones (acetoacetate) in the urine was classified as ‘0 (Negative)’, ‘+/− (Trace)’, ‘+ (Weak)’ or ‘++ (Medium)’ by urine dipsticks (Ketostix, Bayer). The concentration of ketones (β‐hydroxybutyrate) in the blood was measured with our reference method, a portable ketone monitor (FreeStyle Optium, Abbott). The diagnostic accuracy of the urine dipsticks was assessed from the percent of instances when a person was actually ‘in ketosis’ (as defined by a blood β‐hydroxybutyrate concentration at or above three different thresholds) that were also identified by the urine dipsticks as being from a person in ketosis (the percent ‘true positives’ or sensitivity), as well as the percent of instances when a person was not in ketosis (as defined by the blood monitor result) was correctly identified as such with the urine dipstick (the percent ‘true negatives’ or specificity). Thresholds of ≥0.3mM, ≥0.5mM or ≥1.0mM were selected, because mean blood concentrations of β‐hydroxybutyrate during ketogenic diets are approximately 0.5mM. Sensitivity and specificity were then used to generate receiver operating characteristic curves, with the area under these curves indicating the ability of the dipsticks to correctly identify people in ketosis (1 = perfect results, 0.5 = random results).

Results

At threshold blood β‐hydroxybutyrate concentrations of ≥0.3mM, ≥0.5mM and ≥1.0mM, the sensitivity of the urine dipsticks was 35%, 52% and 76%; the specificity was 100%, 97% and 78%; and the area under the receiver operating characteristic curves was 0.67, 0.74 and 0.77, respectively. These low levels of sensitivity mean that 65%, 48% or 24% of the instances when a person was in ketosis were not detected by the urine dipsticks.

Conclusion

Urine dipsticks are not an accurate or clinically useful means of detecting mild ketosis in people undergoing a severely energy‐restricted diet and should thus not be recommended in clinical treatment protocols. If monitoring of mild ketosis is indicated (eg, to monitor or help promote adherence to a severely energy‐restricted diet), then blood monitors should be used instead.

Attitudes and Approaches to Use of Meal Replacement Products among Healthcare Professionals in Management of Excess Weight

Meal replacement product-based diets are an effective weight loss intervention used in the management of obesity. Historically, these diets have been underutilised by HealthCare Professionals (HCPs). An online survey of mixed methods design was distributed to HCPs to capture current perceptions and prescribing patterns of meal replacement products (MRPs) in the management of overweight and obesity. A total of 303 HCPs working in weight management across Australia began the survey and 197 (65%) completed it. While over 70% of HCPs have prescribed MRP currently or in the past, MRPs are only prescribed to a median 7% of patients seeking weight management treatment. Qualitative analysis identified potential barriers to MRP prescription, which include experience with patient non-compliance, perceived poor long-term weight loss durability and safety concerns regarding the product and its use as a total meal replacement program. Safety concerns are centred on the perceived risk of weight cycling and its potential negative psychological impact. MRP prescription is 66% more likely to occur if HCPs had formal training in the use of MRPs relative to those who did not, with a relative risk (RR) of 1.7 (95% CI 1.4, 2.0). This study highlights the potential barriers to the prescription of MRPs, which are centred around safety concerns. This also indicates that formal training may enhance the likelihood of prescribing MRPs, suggesting that once HCPs have a comprehensive understanding of the products and the evidence behind their use, their prescription is likely to be increased.

3-Year effect of weight loss via severe versus moderate energy restriction on body composition among postmenopausal women with obesity - the TEMPO Diet Trial

We have previously shown that a severely energy-restricted diet leads to greater loss of weight, fat, lean mass and bone mineral density (BMD) at 12 months in postmenopausal women with obesity than a moderately energy-restricted diet. We now aim to evaluate whether these effects are sustained longer term (ie, at 36 months). 101 postmenopausal women were randomized to either 12 months of moderate (25 to 35%) energy restriction with a food-based diet (moderate intervention), or 4 months of severe (65 to 75%) energy restriction with a total meal replacement diet followed by moderate energy restriction for 8 months (severe intervention). Body weight and composition were measured at 0, 24 and 36 months. Participants in the severe intervention lost ~1.5 to 1.7 times as much weight, waist circumference, whole-body fat mass and visceral adipose tissue compared to those in the moderate intervention, and were 2.6 times more likely (42% versus 16%) to have lost 10% or more of their initial body weight at 36 months (P < 0.01 for all). However, those in the severe versus moderate intervention lost ~1.4 times as much whole-body lean mass (P < 0.01), albeit this was proportional to total weight lost and there was no greater loss of handgrip strength, and they also lost ~2 times as much total hip BMD between 0 and 36 months (P < 0.05), with this bone loss occurring in the first 12 months. Thus, severe energy restriction is more effective than moderate energy restriction for reducing weight and adiposity in postmenopausal women in the long term (3 years), but attention to BMD loss in the first year is required.

Trial registration

Australian New Zealand Clinical Trials Registry Reference Number: 12612000651886, anzctr.org.au.

Effect of Weight Loss via Severe vs Moderate Energy Restriction on Lean Mass and Body Composition Among Postmenopausal Women With Obesity: The TEMPO Diet Randomized Clinical Trial

IMPORTANCE

Severely energy-restricted diets are the most effective dietary obesity treatment. However, there are concerns regarding potential adverse effects on body composition.

OBJECTIVE

To compare the long-term effects of weight loss via severe vs moderate energy restriction on lean mass and other aspects of body composition.

DESIGN, SETTING, AND PARTICIPANTS

The Type of Energy Manipulation for Promoting Optimum Metabolic Health and Body Composition in Obesity (TEMPO) Diet Trial was a 12-month, single-center, randomized clinical trial. A total of 101 postmenopausal women, aged 45 to 65 years with body mass index (calculated as weight in kilograms divided by height in meters squared) from 30 to 40, who were at least 5 years after menopause, had fewer than 3 hours of structured physical activity per week, and lived in the Sydney metropolitan area of New South Wales, Australia, were recruited between March 2013 and July 2016. Data analysis was conducted between October 2018 and August 2019.

INTERVENTION

Participants were randomized to either 12 months of moderate (25%-35%) energy restriction with a food-based diet (moderate intervention) or 4 months of severe (65%-75%) energy restriction with a total meal replacement diet followed by moderate energy restriction for an additional 8 months (severe intervention). Both interventions had a prescribed protein intake of 1.0 g/kg of actual body weight per day, and physical activity was encouraged but not supervised.

MAIN OUTCOMES AND MEASURES

The primary outcome was whole-body lean mass at 12 months after commencement of intervention. Secondary outcomes were body weight, thigh muscle area and muscle function (strength), bone mineral density, and fat mass and distribution, measured at 0, 4, 6, and 12 months.

RESULTS

A total of 101 postmenopausal women were recruited (mean [SD] age, 58.0 [4.2] years; mean [SD] weight, 90.8 [9.1] kg; mean [SD] body mass index, 34.4 [2.5]). Compared with the moderate group at 12 months, the severe group lost more weight (effect size, -6.6 kg; 95% CI, -8.2 to -5.1 kg), lost more whole-body lean mass (effect size, -1.2 kg; 95% CI, -2.0 to -0.4 kg), and lost more thigh muscle area (effect size, -4.2 cm2; 95% CI, -6.5 to -1.9 cm2). However, decreases in whole-body lean mass and thigh muscle area were proportional to total weight loss, and there was no difference in muscle (handgrip) strength between groups. Total hip bone mineral density (effect size, -0.017 g/cm2; 95% CI, -0.029 to -0.005 g/cm2), whole-body fat mass (effect size, -5.5 kg; 95% CI, -7.1 to -3.9 kg), abdominal subcutaneous adipose tissue (effect size, -1890 cm3; 95% CI, -2560 to -1219 cm3), and visceral adipose tissue (effect size, -1389 cm3; 95% CI, -1748 to -1030 cm3) loss were also greater for the severe group than for the moderate group at 12 months.

CONCLUSIONS AND RELEVANCE

Severe energy restriction had no greater adverse effect on relative whole-body lean mass or handgrip strength compared with moderate energy restriction and was associated with 2-fold greater weight and fat loss over 12 months. However, there was significantly greater loss of total hip bone mineral density with severe vs moderate energy restriction. Therefore, caution is necessary when implementing severe energy restriction in postmenopausal women, particularly those with osteopenia or osteoporosis.

TRIAL REGISTRATION

anzctr.org.au Identifier: 12612000651886.

Experiences of using very low energy diets for weight loss by people with overweight or obesity: a review of qualitative research

Although very low energy diets (VLEDs) are the most successful non-surgical, non-pharmacological treatment for obesity, they are underutilized, and little is known about experiences of people using VLEDs for weight loss. This systematic review synthesizes qualitative studies investigating participants' experiences of undertaking a VLED composed of total meal replacement products to lose weight. Of the 4,911 articles screened, three studies met criteria for inclusion. Thematic synthesis was used to analyse the study findings. Health and appearance were the main motivators to use a VLED for weight loss. Adherence was facilitated by group support meetings, rapid weight loss and ease of use of the diet. Being part of a clinical trial gave a sense of accountability and further reason to adhere to a VLED, and the VLED itself was well accepted by users. Barriers to adherence, such as temptations and social occasions, were overcome by avoidance and distraction strategies. In conclusion, this qualitative synthesis of users' experiences of VLEDs shows that VLEDs are well accepted and positively viewed by users. More in-depth research could facilitate understanding of how this weight loss strategy influences the weight maintenance period, in order to facilitate better long-term results.

Rationale and Protocol for a Randomized Controlled Trial Comparing Fast versus Slow Weight Loss in Postmenopausal Women with Obesity-The TEMPO Diet Trial

Very low energy diets (VLEDs), commonly achieved by replacing all food with meal replacement products and which result in fast weight loss, are the most effective dietary obesity treatment available. VLEDs are also cheaper to administer than conventional, food-based diets, which result in slow weight loss. Despite being effective and affordable, these diets are underutilized by healthcare professionals, possibly due to concerns about potential adverse effects on body composition and eating disorder behaviors. This paper describes the rationale and detailed protocol for the TEMPO Diet Trial (Type of Energy Manipulation for Promoting optimal metabolic health and body composition in Obesity), in a randomized controlled trial comparing the long-term (3-year) effects of fast versus slow weight loss. One hundred and one post-menopausal women aged 45–65 years with a body mass index of 30–40 kg/m² were randomized to either: (1) 16 weeks of fast weight loss, achieved by a total meal replacement diet, followed by slow weight loss (as for the SLOW intervention) for the remaining time up until 52 weeks (“FAST” intervention), or (2) 52 weeks of slow weight loss, achieved by a conventional, food-based diet (“SLOW” intervention). Parameters of body composition, cardiometabolic health, eating disorder behaviors and psychology, and adaptive responses to energy restriction were measured throughout the 3-year trial.

Strategies to Improve Adherence to Dietary Weight Loss Interventions in Research and Real-World Settings

Dietary interventions are the cornerstone of obesity treatment. The optimal dietary approach to weight loss is a hotly debated topic among health professionals and the lay public alike. An emerging body of evidence suggests that a higher level of adherence to a diet, regardless of the type of diet, is an important factor in weight loss success over the short and long term. Key strategies to improve adherence include designing dietary weight loss interventions (such as ketogenic diets) that help to control the increased drive to eat that accompanies weight loss, tailoring dietary interventions to a person’s dietary preferences (and nutritional requirements), and promoting self-monitoring of food intake. The aim of this paper is to examine these strategies, which can be used to improve adherence and thereby increase the success of dietary weight loss interventions.