12 January - 20 June 2016

Review investigates weight loss maintenance strategies after a low calorie diet

6 Nov 13

A systematic review published in the American Journal of Clinical Nutrition has evaluated the effect of anti-obesity drugs, diet or exercise on weight loss maintenance after an initial very low calorie/low calorie diet.  Very low calorie diets of less than 800 kcal/day and low calorie diets of less than 1200 calories a day are associated with substantial initial weight loss but also greater weight regain, compared with  weight loss achieved through a more moderate restriction in energy intake.  Johansson et al. note that different maintenance strategies after low calorie diets include meal replacements, high protein diets, low glycemic index diets, low-fat diets, and green tea extract amongst others.   The team searched for studies which were randomised controlled trials of adults aged over 18 years old and that consisted of an initial weight loss period with a VLCD or LCD followed by a maintenance strategy.  The review included 20 randomised controlled trials, which included 27 interventions arms, including 3 which evaluated anti-obesity drugs, 4 meal replacements, 6 high protein diets, 6 dietary supplements, 3 other diets and 5 exercise.  The studies in total involved 3017 participants with a greater proportion of women than men, with an age ranging from 28 to 48 years and mean BMI between 27.9 and 41.6. Eighteen studies used a very low calorie diet of less than 800 calories a day.  Eleven of the studies (8 diet studies and 3 drug studies) randomly assigned participants only if they had lost 5-10% of the initial weight during the diet.  The other studies randomly assigned participants despite weight loss.  The calorie diets lasted between 3-16 weeks with participants losing on average around 12.3 kg.  Even though the study shows that rebound weight gain is more the rule than the exception, the researchers found that several strategies obviously helped to reduce the unwanted effect. Compared with controls, anti-obesity drugs improved weight-loss maintenance by 3.5 kg (median duration: 18months), meal replacements by 3.9 kg (median duration: 12 months), and high-protein diets by 1.5 kg (median duration: 5 months). Exercise (median duration: 10 months) and dietary supplements such as green tea, high fibre, conjugated linoleic acid and oil supplementation (median duration: 3 months) did not significantly improve weight-loss maintenance compared with control.  The scientists note the anti-obesity drugs unfortunately carry a risk of adverse events, so the most effective drugs were completely withdrawn a few years ago.   Johansson et al state that they also found that a combination of a low-fat, low glycemic index and the Healthy Eating Pyramid was also associated with improved maintenance.  They conclude by stating that future studies should investigate the effect of combining several successful maintenance strategies.    

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