Toronto Health

Can meal replacements help overweight diabetic patients lose weight effectively and keep it off? That was the question that Lawrence J. Cheskin and colleagues from the John Hopkins Bloomberg School of Public Health (Baltimore, Maryland) tried to answer in their recent study “Efficacy of Meal Replacements versus a Standard Food-Based Diet for Weight Loss in Type 2 Diabetes,” published in The Diabetes Educator.

Increased Rates of Type 2 Diabetes

High numbers of Americans are clinically obese with the number increasing each year. Approximately 66% of adults in the U.S. are overweight with about half of that number designated as obese. The higher obesity rate correlates with an increase in type 2 diabetes. The link between type 2 diabetics and obesity is clear with 70% of that population being overweight and 33% labeled obese. Over 18 million people in the U.S. currently experience type 2 diabetes with the number expected to go up dramatically. By 2050 the estimated number of people with type 2 diabetes will rise by 165% [1].

Weight loss is recognized as an effective method to manage or prevent type 2 diabetes. When patients lose even 2% of their body weight, they can see positive indicators in many health markers. Those who succeed in their efforts to lose weight most likely account for lower numbers in mortality rates for type 2 diabetics. However, achieving weight loss for this group is difficult. Most obese people find that losing weight is a challenge, but it is even more difficult for those with type 2 diabetes [2].

Are Food Replacements a Viable Alternative for Weight Loss?

The main objective in Cheskin’s study was to compare weight loss success and specific results in two groups. The groups were taken from 126 adult screened volunteers. One group followed a standard food-based diet while the other group used a food replacement supplement.

Groups included men and women from 18 to 70 years old with BMI numbers ranging from 25-40. Overweight and obesity rates were determined by body mass index. A BMI of 25 was considered overweight while a BMI of 32.2 represented obese. One purpose of the study was to see if either method could produce results of at least a 5% weight loss in obese patients with type 2 diabetes. The possibility of using a food replacement supplement as a viable tool to manage type 2 diabetes was also a focus.

The two groups involved in the study followed one of two diets. One group followed a standard diet using foods recommended by the American Diabetes Association (ADA). The other participants were prescribed Medifast Plus for Diabetics meal replacement for their portion-controlled diet. This food supplement contains soy-based products low in sugar with a low glycemic index [3]. Both diets had similar calorie content and both groups experienced a 25% calorie reduction in their diet. Each diet offered 45-50% carbohydrates, 25-30% fat and 15-25% protein.

What Were The Results Of The Study?

Following 34 weeks of weight loss, the standard diet group stayed on the same diet plan with the same guidelines for an additional 52 weeks. The food replacement group, however, broke into two groups. Each used the food replacement diet and the standard food diet alternating after 26 weeks. The nutritional value in the diet prescribed to both groups was similar. The standard diet group got all their allotted calories from whole foods using choices on the ADA list. The food supplements participants got about 50-60% of calories allowed through the Medifast meal replacement.

BMI

After 34 weeks, results showed better BMI numbers for both groups. However, the BMI numbers in the food replacement group were significantly lower than the standard diet group. Weight loss for the food replacement group was 6.84% compared to the standard diet number of 3.70%. In addition, food replacement participants dropped 5% of their starting weight. Fasting blood glucose and triglycerides also improved for the group using the supplement while the other group showed no significant change. Cholesterol numbers improved for both groups and ranged in lowering percentages from 2.5-4.4%.

HbA1c

The levels of hemoglobin HbA1c reveal how effectively glucose is controlled in the body. Glucose in diabetic patients is considered under adequate control if HbA1c is less than 7%. At the 34-week mark, almost 3 out of 4 food-replacement participants presented HbA1c below 7%. Specifically, the Medifast supplement group achieved an average of 74.2% of members gaining acceptable glucose control. The other group did not have a significant change in their HbA1c. In fact, the standard-diet group numbers were lower at 35.3%.

Blood Pressure

At 34 weeks systolic and diastolic blood pressure showed much lower numbers for both groups.

Waist and hip measurements also revealed improvement. The food replacement group reduced waist circumference by 6.5cm and hips by 4.1cm. The standard diet participants decreased waist size by only 4.1cm and hips by 1.6cm.

Psycometrics

The area of psychometrics measuring levels of depression, appetite, satisfaction with diet, or a sense of being deprived due to diet noted no significant difference between the groups.

Participants Reduced Dependence on Medications

After the 34-week weight loss phase, retention of people in the study was much better for the food replacement group. They retained 57% of participants compared to 29% in the standard food group. The food replacement members also noted several people who were able to reduce a need for medication to control the disease. In contrast, the standard-diet group’s medication needs remained the same.

Study Supports Potential of Supplement Use

As previously noted, successful weight loss is difficult for obese people with type 2 diabetes. It’s important to note that success rates are often poor. However, meal replacements show that the features of convenience, built-in portion control and easy use may prove beneficial to this group [4]. More members of the food supplement group remained in the study than the people eating a standard diet. That could indicate future potential in using food supplements in some of the so-called best rated weight loss plans for type 2 diabetes.

Several important achievements occurred in the study for participants using a food supplement diet. Li Z. has reported similar findings to support meal replacements as a weight loss tool for type 2 diabetes patients [5]. Members of the food replacement groups achieved an important goal of reducing the need for some medications. Taking less prescription medications is a positive indicator. Most importantly, those succeeding in losing weight with the food supplement diet reported an overall improvement in the quality of their lives.

The above results were presented in the annual meeting of American Diabetes Association. It is important to note that Medifast, the company that makes the meal replacement products that where used in this study, supported the project with its own grant. However, the authors reported no financial interest in the products mentioned.

Matt Denos

Having a medical science background Matt Denos, PhD, follows the current research in the field of diet and weight loss and enjoys writing relevant articles. In his website he offers Medifast diet coupon code discounts, a diet plan for diabetics.

References

1. Boyle, JP et al, Projection of diabetes burden through 2050; impact of changing demography and disease prevalence in U.S. diabetes care, 2001.

2. Hensrudd DD, Dietary treatment and long-term weight loss and maintenance in type 2 diabetes, 2001.

3. Noakes M, Foster PR, Keogh JB, Clifton PM, Meal replacements are as effective as structured weight-loss diets for treating obesity in adults with features of metabolic syndrome, 2004.

4. Pi-Sunyer FX, et al, Multicenter randomized trial of a comprehensive prepared meal program in type 2 diabetes, Diabetes Care, 1999.

5. Li Z, et al, Long-term efficacy of soy-based meal replacement vs. an individualized diet plan in obese type 2 participants; relative effects on weight loss, metabolic parameters, and C-reactive protein, 2005.

What on earth has being overweight got to do with being in debt?

They might not seem connected, but in fact, Dr. Eva Münster from the University of Mainz, Germany, and an international team of researchers have recently demonstrated that there is a significant association between being deeply in debt and the likelihood of being overweight.

Dr. Münster’s research was aimed at assessing the health status of individuals who are significantly in debt and their access to and use of health services. The number of people carrying serious levels of personal debt has risen dramatically in both Europe and the United States in recent years, and the current worldwide economic crisis increases that number every day. In Germany alone, more than 6 million people are estimated to owe more money they can afford to pay back and are facing serious cutbacks in their standard of living. The fear is that adequate health care may be one of the prime targets for cutbacks. As healthcare costs continue to rise and charity-based healthcare organizations also suffer from the economic downturn, access to healthcare may be limited for people who are financially strapped.

Dr. Münster’s report, “Over-indebtedness as a marker of socioeconomic status and its association with obesity,” was published in August 2009 in the journal BMC Public Health. She and her colleagues compared two separate study groups:

• 949 people who had consulted debt-counseling services were surveyed anonymously. This group was classified as “over-indebted.”
• 8318 adults who responded to a telephone survey that addressed a variety of health, economic and quality-of-life issues. This group was classified as “not over-indebted.”

Comparable information about age, sex, income, education, body mass index (BMI, an index of overweight that is based on a person’s height and weight), smoking history, and depression was gathered for both groups. The combined study sample totaled 9080 people, after those for whom no BMI data was available were excluded.

Participants were asked to report their height and weight, and that information was used to calculate their BMI. World Health Organization standards were used to classify individuals from both groups; people were rated as overweight if their BMI was higher than 25, and as obese if their BMI was over 30. The group of people who were in need of debt counseling were classified by definition as “over-indebted.” The researchers then performed a series of analyses to determine whether there seemed to be a significant correlation between weight and debt among these people.

The statistics

Among the study subjects, people deeply in debt were statistically more likely to be:

• younger;
• less educated;
• lower income;
• depressed;
• smokers;
• overweight or obese.

Men and women were equally likely to be in debt.

In the study group, it was also noted that the overweight people were more likely to be:

• male;
• over 40 years old;
• depressed.

People with more education, higher incomes, or who smoked were less likely to be overweight or obese.

The implications

The study results showed that people deeply in debt had a higher risk of obesity than most other people. And that increased risk did not seem to have anything to do with an individual’s overall socio-economic status as judged by traditional measures. Education, income, sex, age, depression and smoking levels–none of these factors seemed to explain this higher risk.

Why is it, then, that being in debt makes it more likely that a person will be obese?

One factor is that people in debt have less money to spend on daily needs and are less able to afford or even get access to healthy foods. People with limited funds can easily gravitate toward consuming more of cheaper and widely available “junk” foods. Because these foods tend to be high in fat and sugar, they can be more filling and immediately satisfying than a handful of carrots or a piece of fresh fruit.

People also often turn to these kinds of foods in times of stress and depression as a form of comfort food or surrogate gratification (like smoking). But while smoking is associated with lower weight, convenience foods and junk foods are big contributors to obesity. Owing money you can’t pay is most certainly stressful. Stress causes secretion of glucocorticoids (GC), a class of steroid hormones. GC stimulate drive for and ingestion of “comfort foods” and have been linked to increased food consumption, according to studies by Dr Dallman. So perhaps it is not so surprising to find that over-indebted people are more likely to be either overweight.

When debt causes people to cut back on spending, too often the things they cut are likely to be health-related. Membership at a health club or gym may be classed as a “frill” to be eliminated, but if it means that person is less likely to keep active and get exercise, it can have a negative impact on both health and weight. Lower quality foods are unfortunately often less expensive than healthy foods, and people who live in depressed areas or have limited transportation can find it hard to get to full-service or specialty markets where fresh foods are available.

It’s not a new observation that poverty and lower socioeconomic status often go hand-in-hand with poor nutrition and increased obesity. But debt has not been traditionally included as one of the markers of economic wellbeing. Dr. Munster’s study suggests that this factor needs to be taken into consideration in understanding people’s health risks–particularly in these days of rising debt and financial strain.

Matt Denos is a biologist at Washington University in St Louis, Missouri. As a research scientist he closely follows the relevant scientific literature and enjoys writing articles that contain newsworthy information in the field of nutrition, diet and obesity. His website contains information on weight loss programs and offers Nutrisystem promotion codes and discount coupons for BistroMD, two diet plans available in the US.

Even though this site is geared towards Canadians, we couldn’t help but take notice of all the changes in the health care system with our good friends and neighbours down south (notice the Canadian spelling!) in the United States. The most controversial and widely debated government change in the past few years (other than the Iraq war which we’re not going to even touch) has easily been health care.

President Obama’s biggest presidential initiative has been his drive to reform the current health care system in the States so that a higher percentage of average American citizens will actually have access to health care, as currently all health care is privatized in the States, and as a result it’s extremely expensive for both health procedures and any type of health insurance or coverage. Obama’s goal is that every American should have access to health care, just like we do here in Canada even though we may take it for granted.

The importance of this debate will have massive implications on the health care system in the States, and will allow for the average citizen to be able to afford decent health care coverage. If everything goes according to plan, health care will be provided along with access to cheap life insurance and health coverage. Currently, the cheapest health care coverage in the States is still way too expensive for the low income family, and way out or range for the poor or those struggling to make their monthly payments as it is.

That’s the whole point of the proposed health care system that Obama is campaigning for. We actually support the proposed system but there is a very heated debate currently going on in the States that looks like it will continue for some time, guess we’re lucky to be Canadian in this case as we have great health care and insurance coverage, hopefully soon our good neighbours to the South will as well!

When it comes to maintaining a healthy body it’s absolutely essential to make sure that you have the right amount of caloric intake as well as a healthy input of essential fats, vitamins and nutrients. This is especially important for athletes and weight trainers who depend on their fitness to make a living. But even if you’re just working out to get in shape or maybe lose a few pounds you still need to understand the importance of a proper diet.

Unfortunately, even though we all know we should be eating healthy foods and getting our daily requirements of vitamins and nutrients it’s often very tough to find the time to do it consistently. This can really affect your workout programs and your overall ability to recover from these workouts. If you don’t ensure you’re hitting your daily requirements, over time your bones and cartilage will start to slowly deteriorate and you will start to lose your muscle tone, and other health complications will start to arise.

To prevent this from happening and to ensure your bones and cartilage stay strong and healthy it’s now very well known fact that it’s essential to get the right amount of glucosamine in your diet. Glucosamine is actually produced naturally by the body and aids in repairing cartilage and muscles, but oftentimes the body doesn’t produce enough of it, and hence glucosamine supplements are now widely accepted by health professionals and athletes alike.

These glucosamine supplements are one of the best supplements to take to aid in joint and cartilage recovery and to promote healthy joints as well. It will help prevent deterioration of cartilage and joints, so if you are suffering from any of these symptoms - like sore joints, weak cartilage, or osteoarthritis, talk to your doctor about taking glucosamine supplements and how they can benefit you.