Attitudes and Approaches to Use of Meal Replacement Products among Healthcare Professionals in Management of Excess Weight.

Gabrielle Maston,Alice A Gibson,Tania P Markovic,Elisa Manson,Janet Franklin,Amanda Sainsbury,Samantha Hocking

doi:10.3390/bs10090136

Abstract

Meal replacement product-based diets are an effective weight loss intervention used in the management of obesity. Historically, these diets have been underutilised by HealthCare Professionals (HCPs). An online survey of mixed methods design was distributed to HCPs to capture current perceptions and prescribing patterns of meal replacement products (MRPs) in the management of overweight and obesity. A total of 303 HCPs working in weight management across Australia began the survey and 197 (65%) completed it. While over 70% of HCPs have prescribed MRP currently or in the past, MRPs are only prescribed to a median 7% of patients seeking weight management treatment. Qualitative analysis identified potential barriers to MRP prescription, which include experience with patient non-compliance, perceived poor long-term weight loss durability and safety concerns regarding the product and its use as a total meal replacement program. Safety concerns are centred on the perceived risk of weight cycling and its potential negative psychological impact. MRP prescription is 66% more likely to occur if HCPs had formal training in the use of MRPs relative to those who did not, with a relative risk (RR) of 1.7 (95% CI 1.4, 2.0). This study highlights the potential barriers to the prescription of MRPs, which are centred around safety concerns. This also indicates that formal training may enhance the likelihood of prescribing MRPs, suggesting that once HCPs have a comprehensive understanding of the products and the evidence behind their use, their prescription is likely to be increased.

Highlights

Formulated Meal Replacement Products (MRPs) have been used extensively in the management of overweight and obesity for more than 40 years [1]
An electronic invitation to participate in the survey was directed to HealthCare Professionals (HCPs) who work in weight management using Research Electronic Data Capture (REDCap® )
Our results found that clinical practice guidelines are the least used mode of training by HCPs to inform the use of meal replacement products (MRPs), it is unlikely that conflicting international clinical practice guidelines are the reason for MRP underutilisation

Summary

Introduction

Formulated Meal Replacement Products (MRPs) have been used extensively in the management of overweight and obesity (body mass index [BMI] ≥ 25 kg/m2 ) for more than 40 years [1]. Formula MRPs have been prescribed in the form of a very-low-energy diet (VLED). VLEDs are commonly implemented as a meal replacement diet, involving the exclusive use of MRPs and sometimes additional low-energy containing food items, such as low-starch vegetables, black tea and coffee [2]. Sci. 2020, 10, 136 are defined internationally by the World Health Organisation, international CODEX standardization by the United States of America (USA) Food and Drug Administration and the European Union as formula-based foods used in weight control diets that provide between 2090 to 3350 kJ (500 to 800 kcal) daily [3,4,5]. MRPs can be used during a low-energy diet (4200 to 5000 kJ, [1000 to 1200 kcal]), commonly prescribed as a combination of MRPs and energy-controlled food-based meals [6]

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