Therapeutic options for patients with severe obesity are limited. Low energy meal replacement regimes can induce significant short-term weight loss and improvements in metabolic variables. We sought to estimate the effect size on adiposity and cardiovascular risk factors of a relatively inexpensive 24-week regime based on meal replacement with semi-skimmed milk in severely obese adults. A retrospective cohort analysis showed that of 206 patients in our hospital-based bariatric medicine service who started, 112 (54%) completed the programme and underwent an initial milk-based weight loss phase, followed by weight stabilization and weight maintenance phases, each lasting 8 weeks. Patients were seen every two weeks by the bariatric physician, nurse and dietitian. We compared outcomes in completers (who had similar baseline characteristics to non-completers) at time 0, 8, 16 and 24 weeks, with repeated measures ANOVA. 50.9% of completers were female, 40.2% had diabetes, mean age was 50.9±10.3 years. BMI decreased from 52.7±9.3 to 46.9±8.7, 44.8±8.6 and 43.8±9.2 kg/m2 at 0, 8, 16 and 24 weeks, respectively (P<0.001 with repeated measures ANOVA), equivalent to 24.8 kg weight loss and a reduction in excess body weight from 110.6±37.2 to 75.2±36.9%, P<0.001 over 24 weeks. In patients with diabetes, HbA1c decreased from 63±18.3 to 48±14.5 mmol/mol, P=0.01. There were very significant reductions in all diabetes medications, except for metformin. These preliminary findings suggest that a 24-week milk-based meal replacement programme can have large effect sizes on important outcomes in severely obese. However, attrition was high. A more formal assessment of the efficacy of the intervention as well as its safety, feasibility and cost-effectiveness seems warranted.
20 - 23 May 2017
European Society of Endocrinology