Safety of severely energy-restricted total meal replacement diets in the treatment of obesity in individuals with and without binge eating.

Abstract

Background:

Severely energy-restricted total meal replacement diets are the most effective dietary treatment for obesity. However, enduring safety concerns contribute to their underuse by healthcare professionals. Knowledge gaps in relation to the safety of severely energy-restricted total meal replacement diets in individuals with and without binge eating, may influence the way in which obesity is treated in clinical practice.

Aim:

To examine the safety of severely energy-restricted total meal replacement diets and provide additional safety-related evidence to inform clinical practice in the use of such diets in the treatment of obesity in individuals with and without binge eating.

Methods:

Two secondary analyses of a 52-week randomised controlled trial were conducted. One examined the changes in diet quality following a total meal replacement diet compared to a food-based diet in individuals with obesity (Chapter 2). The other examined changes in body weight and body composition following severe energy restriction for obesity treatment in individuals with and without binge eating (Chapter 3). A protocol was also developed to examine the real-world safety and effectiveness of an alternative treatment for individuals with obesity and binge eating (Chapter 4).

Results and Discussion:

Diet quality improved following the total meal replacement and food-based dietary interventions. However, at 52 weeks intake of fruit, vegetables and dairy foods were below the recommendations in both groups, with inadequate dairy possibly contributing to a loss of bone mass (Chapter 2). Less favourable weight and body composition outcomes were observed in individuals with binge eating compared to individuals without binge eating, following a severely energy-restricted diet (Chapter 3). A pragmatic protocol has been developed to evaluate a new treatment that addresses both excess adiposity and binge eating behaviour (HAPIFED) (Chapter 4).

Conclusion:

The safety of severely energy-restricted total meal replacement diets may be improved in clinical practice by ensuring nutritional adequacy both during and following their use, and by considering other treatment options for high-risk individuals, which may include individuals with binge eating.