Meal replacements available from supermarkets, drug and health food stores, in the form of breakfast or protein bars and in cans or bottles that generally feature a kind of flavored milk or milkshake taste and consistency, have been around for over half a century. First marketed in 1959, Metrecal,™ a Mead-Johnson product, was originally formulated as a powder to add to milk, but very quickly sold in the hundreds of millions of units as a ready mixed beverage in cans. Ever since then there has been debate as to whether or not these shakes or bars really work as an aid in losing weight, or in maintaining weight loss.
Many lingering questions about them have been coming closer to a resolution, and largely in their favor.
Do the bulk of studies confirm that they work?
Overwhelmingly, when taken as a replacement for one or two meals a day -----not for all three meals customarily eaten---- they seem to work by encouraging weight loss through overall caloric reduction, at least as long as the remaining meal or meals is not substantially increased in caloric content as a self-defeating offset (e.g. Egger 2008).
Studies based on replacing three meals a day or the use of VLO (very low calorie) meal replacements are not as often conducted any more, and are not the focus of this report.
Doesn’t simply following a reduced-calorie diet work as well?
In theory, following a healthy reduced calorie diet composed of ordinary food taken in smaller portions should work as well. In practice, however, more dieters stick with their meal replacements in a bar or can longer than other dieters stick with their healthy reduced calories diets involving reduced portions of normal food. Some studies (Sarwer, von Sydow, Green et al 2009) show that meal replacement users lose about 10% of their body weight in about the same time as other conventional dieters lose about 5%. Moreover, while virtually all dieters tend to regain much of the weight initially lost, users of meal replacers typically regain less, and regain more slowly.
Don’t dieters using meal replacement obsess about real food all the time, and in essence, become somehow emotionally unsettled or ineffective in their work or family life?
Studies based on females -----women are by far the biggest purchasers of meal replacement products---- show that in terms of overall mental health and cognitive functioning, users of replacement meals tended to be more alike than not compared to dieters using other methods. But in a number of cases, they appear to have gained an advantage in that meal replacers actually were less likely to engage in “emotional” binge eating (Annunziato, Timko, Crerand et al 2009, Butryn, Thomas & Lowe 2009).
Aren’t these replacement meal bars or liquids loaded with sugars, including the hated refined carbohydrates and fructose? What about artificial sweeteners, flavorings, colors, salt, and preservatives? Aren’t these dangerous for Diabetics, People with High Blood Pressure & Metabolic Syndrome?
Much as organic food purists and anti-corn syrup activists would wish to the contrary, the inclusion of sugar or fructose, or of artificial sweeteners, colors flavorings, preservatives, or salt in a recipe for meal replacement bars or liquids does not, of itself, render a meal replacement bar or liquid ineffective or make it unsafe for most overweight people who are otherwise healthy and trying to lose weight.
People who are already diabetic or who have high blood pressure that appears particularly sensitive to salt may wish to try bars or drinks with less sugar and salt. However, the only things that would make these bars or drinks ineffective in weight loss is if their caloric level as a meal exceeds much more than 20% of the recommended caloric content daily intake for a person of a given weight and age.
In fact, the fine details of the composition of these bars may be less important than the fact that their lowered caloric content, and the fact that many dieters will stay with them longer, tends to promote weight loss that demonstrably improves the health of both diabetics and persons with high blood pressure.
Indeed, there are numerous positive, statistically significant studies of the successful use of meal replacements by diabetics and others with chronic diseases or predispositions to them, particularly metabolic syndrome (Cheskin, Mitchell, Jhaveri et al 2008, Gugliucci, Kotani, Taing et al 2009, Konig, Delbert, Frey et al 2006, Sun, Chen, Chen et al 2008, Wadden, West, Neiberg et al 2009). Ideally, of course, these bars should have an amount of the vitamins, minerals, and fiber roughly equal to a “normal “ meal.
Should you go with high protein vs. high fiber/high complex carb bars or drinks?
One of the biggest surprises is that, given equal caloric content, both kinds of bars and drinks work, and that, in fact, there is some suggestion that dieters stick with high-protein bars and drinks longer than do adherents of the high-fiber, high complex carb meal replacements, and/or may lose more weight (Treyzon, Chen, Hong et al 2008). Using high fiber bars or drinks may help foster a healthy reduced energy density eating pattern ------in other words, eating a greater volume of food, but having that food be lower in calories (Lowe, Tappe, Annunziato et al 2008). But in tests using actual meal replacement users, the addition of naturally derived bulking agents such as beta-glucan or fructooligosaccharide did not stave off hunger any longer than equally caloric replacement bars without these substances (Peters, Boers, Haddeman et al 2009). One study (Kim, Kim, Kim and Lee 2008) found that in meal replacements featuring rice, those that included a mix of whole grain and white rice encouraged somewhat more weight loss than those featuring white rice alone, and had the benefit of a higher proportion of antioxidants.
Should you go with soy-based or whey (milk solids)- based bars or drinks?
The answer is that both sources of protein in meal replacements seem to work quite well, to the degree that they are equal in calories, for as long as you stick with them. There is some evidence that consumers prefer, and stick with, the taste of whey-based replacement meals, over mixed whey-and-soy-based meals, and either of them fare better than those based on soy alone (Child, Yates and Drake 2007)
Which makes you feel fuller longer? Liquids or Bars?
It appears from a small number of studies that solid bars when eaten with some water or other beverage with a total caloric input equal to a liquid meal replacement, seem to stave off hunger longer (Tieken, Leidy, Stull et al 2007). Intriguingly enough, one test (Stull, Apolzan, Thalacker et al 2008) was conducted by measuring the amount of oatmeal eaten by dieters using one or the other method, at given intervals after having consumed their replacement meal, with bar users eating less oatmeal before they reported they felt full again.
Will replacement meals work even if all my relatives are fat owing to genetics?
While the genetic relationship involved in obesity are complex, in those few studies where persons known to have genes strongly predisposing them to obesity, used meal replacements as part of their weight management strategy, it appeared to help in more cases than not (Tsuzaki, Kotani, Naigai et al 2009).
Can I use meal replacements even if I am on prescription diet drugs?
While the number of studies dealing with this are few, (Early, Apovian, Aronne et al 2007, Haddock, Poston, Foreyt et al 2008) users of meal replacements (Medifast™ in one trial, Slim Fast™ in another )who were also taking prescription weight loss medicines did better at weight loss in both the short (12 & 24 weeks in one study ) and the long run (a year in another) than users of either meal replacements, or prescription weight loss drugs alone.
Do Meal Replacements Works as Well for Men as they Appear to Do for Women?
This was pretty much an open question for a long time, because current purchasers of meal replacement bars and especially drinks are women. But Smith, Sigrist, Bathalon et al ( 2010), in a very recent study involving a majority of men (overweight active duty US Army personnel) demonstrated that users of meal replacements lost more weight, reduced their body fat more, and stayed in weight loss mode longer than those who participated in a traditional educational and counseling program that encouraged changes in their regular diet largely through portion control.
Won’t you somehow feel weak using meal replacements?
While it is hard to measure how weak one feels on any diet, it is actually possible to measure the strength of muscles and joints. Given that overweight elderly patients with osteoarthritis of the knee represents the largest pool of knee replacement surgery candidates, it was not too surprising that tests of dieting with meal replacements and exercise demonstrated no loss of strength, indeed, the opposite occurred (Wang, Miller, Messier, Nicklas 2007).
What steps, other than avoiding overeating in the non-replacement meals, can help a meal replacement strategy work better?
One answer is consistently reported: regular exercise. There is also some evidence that patients who receive some counseling or who belong to voluntary or for-profit support groups (e.g. Weight Watchers) will do better at weight loss.
But a curious strategy for weight loss that seems to work well with meal replacement is eating more ready-to-eat cereal as meals as well (Wal, McBurney, Cho & Dhurandhar 2007).
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Do Meal Replacements Like Breakfast Bars and Liquid Meals in a Can or Bottle Really Help in Weight Loss?
I don't so much.
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