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

Abstract

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 energyrestricted 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.

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

“…Weight cycling, which is repeated bouts of intentional weight loss followed by weight regain, has not been shown to cause measurable psychological harm in individuals with obesity who seek weight loss treatment—rather weight cycling is thought to be a result of pre-existing psychological factors [ 51 , 52 , 53 , 54 ]. Contrary to the popular perception among HCPs, weight regain is not related to the severity of dietary energy restriction [ 26 ]. Formal education and training may be a way to improve this misconception among HCPs.…”

“…Another barrier to MRP prescription was the perception of poor long-term weight loss maintenance, with 49% of HCPs reporting that weight loss achieved during a meal replacement diet was not durable. In comparison to hypo-energetic food-based dietary interventions, severely energy-restricted meal replacement diets are more effective at weight loss and weight loss maintenance [ 26 , 43 ]. One long-term clinical trial demonstrated that at 3 years, after 4 months of severely energy-restricted meal replacement diet, 7.3 kg weight loss was maintained long-term.…”

“…One long-term clinical trial demonstrated that at 3 years, after 4 months of severely energy-restricted meal replacement diet, 7.3 kg weight loss was maintained long-term. In contrast, only 3.2 kg weight loss was maintained after a 12 month hypo-energetic food-based intervention at the 3 year time point [ 26 ].…”

“…The underutilisation of MRPs is surprising due to the success of meal replacements diets reported in several clinical trials published during the time these surveys were conducted (1991 to 2003) [ 13 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. On average VLEDs produce 2 kg weight loss per week acutely in approximately 80% of individuals [ 1 , 13 ] and are a more effective long-term mode of weight loss than a food-based energy-reduced intervention [ 26 ]. There is a 3.1-fold greater likelihood of losing 10% clinically significant weight loss at 24 months after a four month meal replacement diet of 65 to 75% energy restriction (followed by moderate energy restriction for 8 months), compared to a 12 month 25–35% moderate energy-reduced food-based diet [ 26 ].…”

“…On average VLEDs produce 2 kg weight loss per week acutely in approximately 80% of individuals [ 1 , 13 ] and are a more effective long-term mode of weight loss than a food-based energy-reduced intervention [ 26 ]. There is a 3.1-fold greater likelihood of losing 10% clinically significant weight loss at 24 months after a four month meal replacement diet of 65 to 75% energy restriction (followed by moderate energy restriction for 8 months), compared to a 12 month 25–35% moderate energy-reduced food-based diet [ 26 ]. The success of meal replacement diets in producing safe [ 27 ] and predictable weight loss [ 10 , 13 ] has led to their widespread commercialisation [ 28 ].…”