Prolonged refeeding improves weight maintenance after weight loss with very-low-energy diets

Abstract

The aim of the present study was to test the hypothesis that a prolonged refeeding duration after successful very-low-energy diet (VLED)-induced weight loss beneficially affects weight development and eating behaviour. Patients (n 269) were recruited to a 1-year obesity treatment programme with 12 weeks of an initial VLED. After the VLED, patients with $ 10 % weight loss were randomly allocated to 1 week (group 1) or 6 weeks (group 6) refeeding to an ordinary, energy-reduced diet, and thereafter followed and actively treated for an additional 40 weeks. Eating behaviour (revised twenty-one-item Three-Factor Eating Questionnaire) was measured at baseline, during and after refeeding, and at week 52. Weight change over time in the two treatment groups was tested by repeated-measures analysis in completers and by intention to treat (ITT). Of the patients, 169 (109 women) lost $ 10 % during the VLED and were randomised. At randomisation, weight loss was 216·5 (SD 3·7) % in group 1 and 216·7 (SD 4·3) % in group 6 (P¼ 0·73). Between weeks 12 and 52, completers in group 6 regained significantly less weight (3·9 (SD 9·1) %) as compared with group 1 (8·2 (SD 8·3) %; P¼ 0·006) (ITT, P¼0·05). Completers in group 6 also maintained a higher level of dietary restraint after refeeding was completed, but eating behaviour did not differ at week 52. Weight change after the refeeding periods were completed did not differ significantly between the groups (P¼ 0·06). Overall, longer refeeding duration after successful weight loss with a VLED improves weight maintenance in a 1-year perspective.Obesity: Randomised trials: Very-low-energy diets: Three-Factor Eating Questionnaire Very-low-energy diets (VLED) can be used to accomplish rapid and substantial weight reduction in obese patients (1) . VLED are liquid formulas containing all essential nutrients with an energy content of 1·9 -3·3 MJ/d (2) . The low energy level results in weight losses of 1·5 -2·5 kg/week (2) with concurrent risk factor improvements (3,4) .During a VLED food choice is easy since energy-free fluid is the only complement needed. Also, it has been suggested that food cravings are more reduced with VLED than with food-based low-energy diets (5) , which may contribute to better dietary adherence (6) . Studies have shown that greater early weight reduction (7 -10) and the use of VLED (8) predict greater weight loss long term. However, after a VLED period, gradual weight rebound is generally seen (11 -13) . Alternative strategies have been suggested to prevent or limit weight regain after a VLED. Different supplementations do not seem to have an effect on post-VLED weight development (14 -16) , but improved weight maintenance has been observed with pharmacological therapy (17,18) , exercise (19) , continued use of VLED as part of the dietary allowance (20) and protein supplementation (21) .An important phase in VLED programmes is when ordinary foods are reintroduced. Throughout refeeding, patients are required to adopt strategies to adjust eating behaviour and dietary...

Effects of anti-obesity drugs, diet, and exercise on weight-loss maintenance after a very-low-calorie diet or low-calorie diet: a systematic review and meta-analysis of randomized controlled trials

“…Eight of the studies used a strict VLCD, ie, no other food was allowed except for the VLCD powder mixed with water (6, 7, 10, 11, 20, 22, 23, 25). In 7 of the studies, the participants were allowed to consume vegetables (12–17, 19), and in 2 of the studies the powder formulas were mixed with milk (26) or a small ad libitum breakfast was allowed within the 800-kcal/d limit (31).…”

Successful maintenance of body weight reduction after individualized dietary counseling in obese subjects

“…For 18 months 55% of self-guided individuals were maintaining their weight loss within 2.3 kg, as compared to 13% of VLCD. Gripeteg et al 26 reported that after successful very low energy diets (VLED) inducing weight loss ≥ 10%, patients with six weeks of re-feeding maintained a significantly greater weight loss (regained: 3.9 ± 9.1%) over one year of treatment than patients with only one week of re-feeding (regained: 8.2 ± 8.3%, P = 0.006). Accordingly, it was suggested that ordinary foods should be re-introduced slowly to enhance weight control after a VLED period.…”

Very low‐energy and low‐energy formula diets: Effects on weight loss, obesity co‐morbidities and type 2 diabetes remission – an update on the evidence for their use in clinical practice

“…The gradual reintroduction of food following a LED or VLED is believed to assist with weight loss maintenance (Leeds 2014;Brown et al 2015). For example, research has shown that reintroducing food over a 6week period resulted in significantly less weight regain at 52 weeks compared with a reintroduction period of 1 week (3.9 kg vs. 8.2 kg, respectively) (Gripeteg et al 2010). In addition, reintroducing food over 6 weeks was associated with increased dietary restraint (the tendency to eat less than desired) and reduced external eating (the tendency to eat in response to external cues such as the sight of food) compared to reintroduction lasting only 1 week.…”