Outpatient Weight Loss Through Meal-Replacement Therapy in Primary Care Practices: 2-Year Results of a Noncontrolled Observational Study

Background The continuously increasing morbidity of overweight and obesity and the accompanying concomitant and secondary diseases require nationwide measures. Guideline-based multimodal therapy centers prove to be effective but are not sufficient. A weight reduction program suitable for everyday use in medical practices could be a useful complementary method. Material and Methodology A supraregional, counselor-supported, unlimited-time course program for adults with overweight and obesity is presented. It is designed to improve body composition by reducing excess body fat with the best possi-ble preservation of muscle mass. The behavioral program focuses on dietary changes and integration of relaxation and exercise sessions into daily life. The consultations are offered in the practices by specifically trained physicians and their staff, either as individual or group consultations. Laboratory parameters and physical examinations are not part of the counseling sessions. They are carried out in parallel with the respective treating (general) practitioners. After the initial formula phase, a meal replacement therapy follows, adapted to the respective body composition, determined by means of bioelectrical impedance analysis. The drinking food used, with a specific protein composition and a high proportion of vegetable fiber, is intended to enable a largely insulin-independent metabolism. Each replacement meal contains 182 kcal, 18 g protein, 15 g carbohydrate, 4 g fat, 5 g fiber with vitamin and mineral fortification. For a representative sample of the per-protocol analysis, 104 adult participants were selected: Half women and half men with a BMI of > 30 kg/m(2) who voluntarily participated in the weight loss program regularly for at least 24 months and were measured. Evidence of eating disorders or psychological impairment led to exclusion. Measurements for this per-protocol analysis were extracted at baseline and after 3, 6, 12, and 24 months. Results Participants' weight reduced by an average of 12.6 kg (11 % from baseline weight) from 114.7 kg +/- 21.7 (BMI 38.9 +/- 6.0) to 102.1 kg +/- 20.8 (BMI 34.6 +/- 5.9). The average change in fat mass after 24 months is - 8.6 kg (18.3 %), which corresponds to 68.3 % of the average reduced body weight (BW). The percentage of Body Cell Mass (BCM) in BW increased from an average of 30.9 % (+/- 7.9 %) to 31.9 % (+/- 8.1 %). Conclusion The presented results show that with the help of the outpatient, medically supervised weight reduction program a significant weight reduction can be achieved in obese patients over two years, and thus beyond the required period. Weight loss was predominantly through fat reduction, and the relative proportion of BCM to KG was completely maintained.