Weight Loss for Type 2 Diabetics: Meal Replacements or a Standard Food-Based Diet
Obesity continues to be an American epidemic that has shown no recent decline. In fact, more and more Americans are suffering from morbid obesity and the resulting physical damage and disease. Approximately 66% of American adults are currently diagnosed as obese, with a body mass index (BMI) of greater than 25 kg/m2. Over 32% have a BMI higher than 30. One of the most prevalent comorbidities of obesity in Americans is Type 2 diabetes. According to the National Diabetes data Group Diabetes in America, more than 70% of those with type 2 diabetes are overweight, with one third of type 2 diabetics being obese.
It has been proven that weight loss can be a very efficient means to counteract the effects of type 2 diabetes, and in some cases, eradicate the disease entirely. Even loosing a seemingly negligible amount of one's body weight can improve diabetes symptoms, which, in turn, decreases the early mortality rate of type 2 diabetics. What is complex about these facts is that while doctors and patients alike know the benefits of weight loss for diabetics, it is much harder for those who are overweight to successfully lose the weight and yield the benefits.
Lawrence J. Cheskin, MD designed and carried out a controlled study to determine whether or not meal replacements would be more effective in weight loss for type 2 diabetics than a standard food-based diet. The results of the study demonstrated that there is a significant health benefit to using meal replacements as opposed to a portion-controlled diet for type 2 diabetics.
The 112 study participants were both men and women between the ages of 18 and 70 who had met the criteria of type 2 diabetes at least three months prior to the commencement of the study. These participants were also either overweight or obese with an average BMI range of 25 to 40 kg/m2.
The participants were randomized into two groups for the study. They were given either a "25% energy-deficit diet in accordance with standard ADA recommendations (standard diet) or an equicaloric diet using Medifast Plus for Diabetics meal replacements (portion-controlled diet)."
After an initial 34-week weight loss period, the standard diet group continued at their maintenance levels for 52 weeks. The portion-controlled diet group, however, was randomized for the maintenance phase, the following 52 weeks. They either continued on a 26-week period of portion-controlled diet and a 26-week period of a standard diet or they did the reverse.
The 25% energy calorie deficit was changed to 10% during the maintenance phase. While the portion-controlled diet group continued to take 50-60% of their calories from meal replacements, the standard diet group received all of their calories from whole foods.
Of the initial 112 participants, 48 completed the 34-week weight loss phase. By week 60, only 33 participants remained. The results of the study were clear, however. While both the portion-controlled diet and the standard diet groups showed improvements in biochemical and metabolic measures, 40% of the portion-controlled diet group lost more than 5% of their initial weight compared to only 12% of the standard diet group. The following are the results based on distinct elements that the study examined, particularly as they impact type 2 diabetes patients.
Impact on Weight:
At 34 weeks, the BMI of both groups was significantly decreased. Yet the portion-controlled diet group demonstrated a higher degree of both weight loss and occurrence in participants. The portion-controlled diet group lost, on average, almost 7% while the standard diet group lost, on average, 3.7% of their body weight. Almost one third of the portion-controlled diet participants actually lost 10% or more during the 34 week period. The portion-controlled diet group also had more success maintaining the weight loss than the standard diet group.
Impact on Glucose:
At 34 weeks, the portion-controlled diet group had a lower fasting blood glucose by an average of 22 mg/dL, while the standard diet group showed no significant reduction.
Impact on Insulin:
At 34 weeks, again the portion-controlled diet group had a significant lowering of their fasting insulin while the standard diet group demonstrated no significant difference.
Impact on Hemoglobin A1C:
At 34 weeks, almost 75% of the portion-controlled diet group had achieved adequate glucose control, while only 35% of the standard diet group did (considering hemoglobin levels HbA1c of 7.0% as an indicator of adequate glucose control).
Impact on Cholesterol:
At 34 weeks, neither group demonstrated a significant lowering of cholesterol.
Impact on Triglycerides:
At 34 weeks, the portion-controlled diet group had reduced fasting triglycerides by almost 20%, whereas the standard diet group showed no change. This difference, however, was not statistically significant.
Impact on Blood Pressure:
At 34 weeks, both groups demonstrated significant reductions in both systolic and diastolic blood pressure.
Impact on Waist and Hip Measurements:
During the weight loss phase, the portion-controlled diet group showed a waist circumference decrease by 6.5 cm. The standard diet group showed a decrease of 4.9 cm. Hip circumference decreased 4.1 cm in the portion-controlled diet group and 1.6 in the standard diet group.
Impact on Psychology:
At the end of the study, neither group demonstrated a significant difference in respect to depression, diet satisfaction or deprivation, or appetite.
Impact on Retention:
Retention of study participants was significantly better in the portion-controlled diet group than the standard diet group. Thirty-one of the initial 54 in the portion-controlled diet group remained until the end of the 34-week phase. Only 17 of the 58 standard diet participants remained at the end of the 34-week phase. Twice as many portion-controlled diet participants saw the study through to the 86-week end.
Impact on Medications:
Of the 29 portion-controlled diet group participants using medication at the start of the study, 7 reduced their usage to control type 2 diabetes. None of the 13 standard diet participants reduced medication use.
Conclusions & Implications for Type 2 Diabetics and Weight Loss:
Cheskin draws some interesting conclusions from his study. A diet based on meal replacement foods can significantly and positively affect type 2 diabetic patients who are trying to control their weight. This is consistent with previous relevant studies. The portion-controlled diet was easier to adhere to than the food-based diet, which explains why there were fewer dropouts in the portion-controlled diet group. This was similar to diets where portions are regulated by guidelines, such as Weight Watchers.
While both groups clearly demonstrated benefits from weight loss on their type 2 diabetes symptoms, the portion-controlled diet group showed greater improvement over the standard diet group. Based on these findings, Cheskin suggests that meal replacements be considered as a standard complement in a type 2 diabetes weight loss program.
The above work, which was presented in the annual meeting of American Diabetes Association, was supported by Medifast, the company that produces the meal replacement products used in this study. However, none of the investigators had any financial interest in these products.
Matthew Denos, PhD, is a committed biologist and research scientist who works at Washington University. Stemming from his compassion for patients who struggle with weight loss and suffer from physical consequences as a result, he has a special interest in the field of obesity treatments. In his website (www.weightlosstriumph.com) he offers a Medifast promotion and a Nutrisystem diet discount, two clinically studied weight management programs.
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