Uptake and early outcomes of a meal replacement intervention in an ethnically diverse adult population living with obesity and significant comorbidity

Abstract

Aims: Structured meal replacement low energy diets (MR-LED) are effective in obesity management, but evidence for individuals of minority ethnic groups or those with BMI >35 kg/m2 and significant comorbidities is limited. Materials and methods: We evaluated the early effectiveness of a weight management program delivered by a multidisciplinary team within a specialist weight management service. We enrolled three groups: those who had been declined bariatric surgery, young adults with type 2 diabetes (T2D), and people awaiting corneal transplant who had their procedure deferred due to their weight. Individuals were primarily treated with a 12-week MR-LED. Adjunctive obesity medications were available under pre-specified criteria. The present study reports outcomes following the 12-week MR-LED, which was the first phase of a 12 month programme. Results: Of the 1172 people screened, 482 met inclusion criteria and 128 commenced MR-LED. Most participants (111/128, 87%) had previously been declined bariatric surgery; 11/128 (9%) were young adults with T2D and 6/128 (5%) were awaiting corneal transplant surgery. Ninety-three individuals (73%) were from Pacific or indigenous Māori ethnic groups. The cohort had mean (SD) baseline weight of 145.0 (38.6) kg (BMI 49.9 (11.3) kg/m2); 94 (73%) had T2D on treatment, with a mean HbA1c of 67.6 mmol/mol (11 young adults and 83 from the bariatric surgery declined list). Psychological distress was common with 41% and 30% having moderate depressive and anxiety symptoms, respectively. Ninety-two people (72%) completed the 12-week MR-LED, achieving a mean (SD) weight loss of 10.9 (7.8) kg. Young adults with T2D were less likely to complete the programme. Among people with diabetes, 63/94 (67%) completed the 12-week intervention, with 21/63 (33%) achieving an HbA1c <50 mmol/mol on no diabetes medication. Psychological and quality of life scores improved. Conclusions: A 12-week MR-LED intervention delivered in a specialist service achieved clinically meaningful weight loss and improved metabolic and psychological outcomes in a high-risk, multi-ethnic cohort living with higher body weight.