Updated: Nov 1
Most of my patients begin their weight loss treatment using medical food / meal replacements. These are shakes, soups, and puddings that are formulated to induce a fat burning state while providing all required micro and macronutrients as well as electrolytes. As a proponent of a diet based primarily on whole, unprocessed, plant based foods, I struggled with the idea of using these manufactured foods as initial treatment. This is why I decided they are the best first treatment and what I have observed from using them with hundred of patients to lose over 17,000 pounds over the last two years. It also explains why I think it is just wrong to tell someone who has come to me after having tried “every diet in the world” that they need to “eat more vegetables and walk more” and they will lose weight.
Most people who come to see me are between 40 and 50% fat. The state of being this high in body fat percentage is a toxic state. Fat is not an inert storage of energy. It is an active endocrine organ. It secretes many chemicals that are active in the body that cause inflammation and induce additional fat gain. So, fat begets fat. It frequently causes a state of high insulin, insulin resistance, leaky gut, and inflammation. The medical foods are a predictable, reproducible, immediate means of lowering insulin, removing potential inflammatory foods from the diet, and demonstrate changes in the body. This generally results in a 5 lb weight loss in females and 7-10 pounds weight loss in males, as well as improvement in aching and lethargy even before the weight is lost. This happens with a person simply consuming the prescribed meal replacements at the prescribed times. It leaves very little room for error. This is a very powerful demonstration that weight loss is possible to a person who typically has struggled for years to lose weight. I advise people that it is a “proof of concept” phase 2 trial. Follow a structured, proven protocol and see how you feel and how your body responds. To see the blood pressure and blood sugar and edema improve is a powerful motivator to continue change. With a typical “diet”, a weight loss of 1 pound a week is expected. That can be discouraging as it takes so long to result in clinically meaningful results that are demonstrable to an individual. Many people feel so much better after eliminating all of the poor quality food from their diet, that they do not want to add them back since they feel lethargic and achey. If they do add them back, they conclude that it “was not worth it.” But, when they add back whole, unprocessed, plant based food, the physical benefits persist, and that is how they know that is the “right food.” It is similar to Koch’s postulates of causality, where it is a powerful demonstration of the direct correlation between the quality of the nutrition and their symptoms.
In addition to the physical benefits of the meal replacements, many patients report they are a very powerful behavioral tool that changes their relationship with food. At first, they are an easy way to establish structured eating and learn the concept of nutrient timing. They provide very clear boundaries of what is on their meal plan and what is not. This is like “training wheels” where they are prepared, making a food plan, following it, and being in a food environment where they are not eating what everyone else does. This is a necessary skill for long term weight maintenance since celebrations and sweets are so ubiquitous in our food environment. Sugar and other foods are very addictive for some people. How do you break an addiction or habit? Have none of it for as long as possible. Food is especially challenge since humans have to eat to live. We can not give up food like an alcoholic can give up alcohol. But, meal replacements are the closest thing. Even without a food addiction, withdrawing from bad habits of mindless snacking and high sugar or salty and savory foods allows a new appreciation for a palate of other tastes. Predictably, patients report that vegetables and salads have a renewed pleasure and appreciation compared to before the program. Food that would have seemed like “diet food” now has the joy and pleasure of food.
So, in summary, meal replacements induce immediate fat loss and powerful changes in relationship with food that allow long term weight management. They demonstrate to a person that their body can lose fat, their metabolism is not broken, and breaks the cycle of being too tired, heavy, or in pain to lose weight and exercise. I encourage my patients to “put their blinders on, stay focused”, capitalize on the benefits of meal replacements, then follow them up with a structured transition and maintenance plan until established and confident in their new body composition and lifestyle, then transition again to more intuitive eating. Negative experiences and anecdote about meal replacements and liquid diets are usually due to the absence of some other crucial component of treatment. With obesity treatment, the devil is in the details, and “it’s complicated”, so evaluating any one component of treatment such as medication or meal replacements in isolation is useless.