Evaluation of a 12-week lifestyle education intervention with or without partial meal replacement in Thai adults with obesity and metabolic syndrome: a randomised trial

Abstract

Background/ObjectivesThere have been no studies examining the efficacy of meal replacement (MR) on weight loss and metabolic syndrome (MS) improvement in Southeast Asians. Thus, we undertook a 12-week randomised trial to evaluate the effect of a lifestyle education intervention alone (LEI) or with partial MR (LEI + MR) in obese Thai adults with MS.Subjects/MethodsA total of 110 patients were randomised to receive either LEI or LEI + MR. Both groups received LEI to achieve weight loss. LEI + MR group additionally received two MR daily to replace either breakfast, lunch or dinner. Mean ± SE body mass index of all participants was 34.6 ± 0.6 kg/m2, mean ± SE age was 42.5 ± 1.1 years and 83% of patients were female. Both groups were compared for anthropometric and cardiometabolic indices at 12-week. Body weight was also compared at weeks 38 and 64.ResultsAt 12 weeks, both groups exhibited statistically significant percentage weight loss (%WL) compared to initial weight but greater %WL was observed in LEI + MR compared to LEI, 2.9% vs. 1.5%, respectively (p < 0.05). MS criteria such as waist circumference and blood pressure improved significantly in both groups compared to baseline. However, improvement in fasting plasma glucose (FPG) was only significant in LEI + MR, and more participants with impaired FPG at baseline in LEI + MR (42.9%) than LEI (19%) returned to normal FPG at 12 weeks (p < 0.05). HbA1c, fasting insulin and HOMA-IR in LEI + MR were significantly lower than with LEI. At the end of the 12-week intervention period, 16% of participants no longer fulfilled MS criteria. A statistically significant weight loss from baseline persisted until 38 weeks but no longer reached statistically significant difference between groupsConclusionsLEI and LEI + MR were acceptable and led to improvement in weight and MS. LEI + MR group exhibited additional weight reduction and glycemic benefits at 12 weeks.

A systematic review and meta‐analysis of the effectiveness of meal replacements for weight loss

“…Fourteen studies were conducted in people who were overweight but with no specific clinical condition, five in people with type 2 diabetes, two in participants with metabolic syndrome or impaired glucose regulation, one in men with type 2 diabetes and erectile dysfunction, and one in adults with developmental disabilities and obesity …”

“…In 15 studies (65%), the MR used consisted of specially formulated shakes, soups, or bars . In four studies (17%), the MR consisted of prepackaged portion‐controlled meals which participants reconstituted or cooked at home, and in four studies (17%), the MR was a combination of prepackaged portion‐controlled meals and specially formulated shakes, soups, or bars …”

“…During the weight loss phase, 13 studies advised participants to replace two eating occasions each day with a MR . One study advised participants to replace one eating occasion, and one, two, and four studies advised participants to replace three, four, or five eating occasions (meals or snacks) with one MR, respectively.…”

“…In 15 studies, in addition to the MR diet, participants also received support for weight loss during the active intervention. This support consisted of 12 sessions [IQR 7 to 19] over 24 weeks, ranging from 12 to 52 weeks [IQR 12 to 52 weeks] (MR diet + support) . In two studies (four intervention arms), an enhanced level of support was offered to the MR group (73 sessions [IQR 57.5 to 88.5 sessions] over 78 weeks [IQR 65 to 91 weeks]) compared with the support provided to the control group which consisted of two sessions [IQR 2 to 2] over 78 weeks [IQR 65 to 91 weeks]) (MR diet + enhanced support) …”

“…In eight studies, the control intervention was dietary advice or a diet plan providing guidance on what to eat to achieve weight loss (diet only) . In a further 12 studies, the control diet was combined with support for weight loss, consisting of 11.5 sessions [IQR 4.75 to 18.25] over 52 weeks ranging from 12 to 52 weeks [IQR 45 to 52 weeks] (diet + support) . In three studies, the control intervention consisted of an information leaflet, educational lecture, or usual care (minimal control) .…”