title: Meal replacements in the treatment of adolescent obesity: a randomized controlled trial.
abstract: Use of meal replacements (MRs) in lifestyle modification programs (LMPs) for obese adults significantly increases weight loss, compared with prescription of an isocaloric conventional diet (CD). This 12-month randomized trial examined 113 obese adolescents (mean ± s.d. age of 15.0 ± 1.3 years and BMI of 37.1 ± 5.1 kg/m2) who were assigned to a LMP, combined with meal plans of 1300-1500 kcal/day of CD (self-selected foods) or MR (three SlimFast shakes, one prepackaged meal, five vegetable/fruit servings). After month 4 (phase 1), participants originally treated with MR were unmasked to their phase 2 (months 5-12) random assignment: continued use of MR (i.e., MR+MR) or transitioned to CD (i.e., MR+CD). Participants initially treated with CD in phase 1, continued with CD (i.e., CD). All three groups were treated for an additional 8 months (phase 2). Regression models were used to evaluate percentage change in BMI from baseline to month 4 (phase 1), months 5-12 (phase 2), and baseline to month 12. At month 4, participants assigned to MR (N = 65) achieved a mean (±s.e.) 6.3 ± 0.6% reduction in BMI, compared to a significantly (P = 0.01) smaller 3.8 ± 0.8% for CD participants (N = 37). In phase 2, BMI increased significantly (P < 0.001) in all three conditions, resulting in no significant (P = 0.39) differences between groups in percentage change in BMI at month 12. Across groups, mean reduction in BMI from baseline to month 12 was 3.4 ± 0.7% (P < 0.01). Use of MR significantly improved short-term weight loss, compared with CD, but its continued use did not improve maintenance of lost weight.
authors.affiliation: Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. berkowitz@email.chop.edu
authors.forename: Robert I
authors.initials: RI
authors.lastname: Berkowitz
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Wadden
authors.forename: Christine A
authors.initials: CA
authors.lastname: Gehrman
authors.forename: Chanelle T
authors.initials: CT
authors.lastname: Bishop-Gilyard
authors.forename: Reneé H
authors.initials: RH
authors.lastname: Moore
authors.forename: Leslie G
authors.initials: LG
authors.lastname: Womble
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Cronquist
authors.forename: Natalie L
authors.initials: NL
authors.lastname: Trumpikas
authors.forename: Lorraine E
authors.initials: LE
authors.lastname: Levitt Katz
authors.forename: Melissa S
authors.initials: MS
authors.lastname: Xanthopoulos
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D001521:Behavior Therapy; D015992:Body Mass Index; D004038:Diet, Reducing / Q000379:methods / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D005526:Food, Formulated; D006801:Humans; D008019:Life Style; D008297:Male; D009765:Obesity / Q000178:diet therapy* / Q000517:prevention & control / Q000523:psychology / Q000628:therapy; D050177:Overweight / Q000178:diet therapy / Q000517:prevention & control / Q000523:psychology / Q000628:therapy; D010352:Patient Dropouts; D055502:Secondary Prevention; D016037:Single-Blind Method; D013997:Time Factors; D015430:Weight Gain; D015431:Weight Loss