Efficacy of a Meal-Replacement Program for Promoting Blood Lipid Changes and Weight and Body Fat Loss in US Army Soldiers


      Excess weight is associated with negative health outcomes. Meal replacements are effective in promoting favorable body composition changes in civilian populations; however, their efficacy with military service members who have unique lifestyles is unknown. The objective of this randomized controlled trial was to determine the efficacy of the Army's education-based weight-management program, “Weigh to Stay,” with and without meal replacements for improving blood lipids, and to promote weight and body fat loss in overweight US Army soldiers. Soldiers (n=113; 76 males/37 females) attending Weigh to Stay at Fort Bragg, NC, in 2006/2007 were randomized to Weigh to Stay only or a commercially available meal-replacement program (two meal replacements per day) in conjunction with Weigh to Stay, and followed until Army body fat standards were met or for 6 months if standards were not met. Study completers (n=46) in both treatment groups lost weight (Weigh to Stay: −2.7±4.3 kg; meal replacers: −3.8±3.5 kg) and fat mass (Weigh to Stay, −2.7±3.2 kg; meal replacers: −2.9±2.5 kg), and improved high-density lipoprotein cholesterol concentrations (Weigh to Stay: 13±9 mg/dL [0.34±0.23 mmol/L]; meal replacers: 8±7 mg/dL [0.21±0.18 mmol/L]; P<0.05); however, no between-group differences were observed. Attrition was lower (P=0.009) and success in meeting body fat standards tended to be higher (P=0.06) for the meal replacers vs Weigh to Stay participants. Intent-to-treat analysis demonstrated that meal replacers lost more weight (1.2±0.5 kg), percent body fat (1.0%±0.4%), and fat mass (0.8±0.4 kg) compared to Weigh to Stay volunteers (P<0.05). Our findings suggest that meal replacement use can be recommended as a potential adjunct strategy to Weigh to Stay.
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        • Ogden C.L.
        • Carroll M.D.
        • Curtin L.R.
        • McDowell M.A.
        • Tabak C.J.
        • Flegal K.M.
        Prevalence of overweight and obesity in the United States, 1999-2004.
        JAMA. 2006; 295: 1549-1555
        • Mokdad A.H.
        Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001.
        JAMA. 2003; 289: 76-79
        • Finkelstein E.A.
        • Chen H.
        • Prabhu M.
        • Trogdon J.G.
        • Corso P.S.
        The relationship between obesity and injuries among US adults.
        Am J Health Promot. 2007; 21: 460-468
        • Mattila V.M.
        • Niva M.
        • Kiuru M.
        • Pihlajamaki H.
        Risk factors for bone stress injuries: A follow-up study of 102,515 person-years.
        Med Sci Sports Exerc. 2007; 39: 1061-1066
        • Knapik J.J.
        • Jones S.B.
        • Darakjy S.
        • et al.
        Injury rates and injury risk factors among US Army wheel vehicle mechanics.
        Mil Med. 2007; 172: 988-996
        • Dall T.M.
        • Zhang Y.
        • Chen Y.J.
        • et al.
        Cost associated with being overweight and with obesity, high alcohol consumption, and tobacco use within the military health system's TRICARE prime-enrolled population.
        Am J Health Promot. 2007; 22: 120-139
        • US Department of the Army
        AR 600-9, The Army Weight Control Program.
        (Accessed March 25, 2009)
        • Leu J.R.
        • Friedl K.E.
        Body fat standards and individual physical readiness in a randomized Army sample: Screening weights, methods of fat assessment, and linkage to physical fitness.
        Mil Med. 2002; 167: 994-1000
        • Rose M.S.
        • Moore R.
        • Mahnke E.
        • Christensen E.
        • Askew E.W.
        Weight Reduction Techniques Adopted When Weight Standards Are Enforced.
        US Army Research Institute of Environmental Medicine, Natick, MA1993 (T4931993)
        • Bathalon G.P.
        • McGraw S.M.
        • Sharp M.A.
        • Williamson D.A.
        • Young A.J.
        • Friedl K.E.
        The effect of proposed improvements to the Army Weight Control Program on female soldiers.
        Mil Med. 2006; 171: 800-805
        • McGraw S.M.
        • Bathalon G.P.
        • Ellison B.
        • Graff J.D.
        • Burrell L.M.
        • Carr R.E.
        • Ross C.M.
        • Williamson D.A.
        • Young A.J.
        Dieting practices of soldiers in the US Army weight control program [abstract].
        Med Sci Sports Exerc. 2005; 37: S142
        • Ditschuneit H.H.
        • Flechtner-Mors M.
        • Johnson T.D.
        • Adler G.
        Metabolic and weight-loss effects of a long-term dietary intervention in obese patients.
        Am J Clin Nutr. 1999; 69: 198-204
        • Ditschuneit H.H.
        • Flechtner-Mors M.
        Value of structured meals for weight management: Risk factors and long-term weight maintenance.
        Obes Res. 2001; 9: 284S-289S
        • Ashley J.M.
        • St Jeor S.T.
        • Schrage J.P.
        • Perumean-Chaney S.E.
        • Gilbertson M.C.
        • McCall N.L.
        • Bovee V.
        Weight control in the physician's office.
        Arch Intern Med. 2001; 161: 1599-1604
        • Ashley J.M.
        • St J.S.
        • Perumean-Chaney S.
        • Schrage J.
        • Bovee V.
        Meal replacements in weight intervention.
        Obes Res. 2001; 9: 312S-320S
        • Rothacker D.Q.
        • Staniszewski B.A.
        • Ellis P.K.
        Liquid meal replacement vs traditional food: A potential model for women who cannot maintain eating habit change.
        J Am Diet Assoc. 2001; 101: 345-347
        • Noakes M.
        • Foster P.R.
        • Keogh J.B.
        • Clifton P.M.
        Meal replacements are as effective as structured weight-loss diets for treating obesity in adults with features of metabolic syndrome.
        J Nutr. 2004; 134: 1894-1899
        • Ahrens R.A.
        • Hower M.
        • Best A.M.
        Effects of weight reduction interventions by community pharmacists.
        J Am Pharm Assoc. 2003; 43: 583-589
        • American Dietetic Association
        Adult Weight Management Evidence-Based Nutrition Practice Guideline.
        (Accessed March 25, 2009)
        • Institute of Medicine
        Weight Management State of the Science and Opportunities for Military Programs.
        National Academies Press, Washington, DC2003
        • Warnick G.R.
        • Knopp R.H.
        • Fitzpatrick V.
        • Branson L.
        Estimating low-density lipoprotein cholesterol by the Friedewald equation is adequate for classifying patients on the basis of nationally recommended cutpoints.
        Clin Chem. 1990; 36: 15-19
        • Ware J.H.
        Interpreting incomplete data in studies of diet and weight loss.
        N Engl J Med. 2003; 348: 2136-2137
        • Hensrud D.D.
        Dietary treatment and long-term weight loss and maintenance in type 2 diabetes.
        Obes Res. 2001; 9: 348S-353S
        • Donnelly J.E.
        • Hill J.O.
        • Jacobsen D.J.
        • Sullivan D.K.
        • Johnson S.L.
        • Heelan K.
        • Hise M.
        • Fennessey P.V.
        • Sonko B.
        • Sharp T.
        • Jakicic J.M.
        • Blair S.N.
        • Tran Z.V.
        • Mayo M.
        • Gibson C.
        • Washburn R.A.
        Effects of a 16-month randomized controlled exercise trial on body weight and composition in young, overweight men and women: The Midwest Exercise Trial.
        Arch Intern Med. 2003; 163: 1343-1350
        • Wilmore J.H.
        • Despres J.P.
        • Stanforth P.R.
        • Mandel S.
        • Rice T.
        • Gagnon J.
        • Leon A.S.
        • Rao D.
        • Skinner J.S.
        • Bouchard C.
        Alterations in body weight and composition consequent to 20 wk of endurance training: The HERITAGE Family Study.
        Am J Clin Nutr. 1999; 70: 346-352


      T. J. Smith is a research dietitian, US Army Research Institute of Environmental Medicine, Natick, MA.


      J. P. Karl is a research dietitian, US Army Research Institute of Environmental Medicine, Natick, MA.


      S. McGraw is a research nutritionist, US Army Research Institute of Environmental Medicine, Natick, MA.


      A. J. Young is division chief, Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA.


      COL G. P. Bathalon is Deputy Commander, US Army Research Institute of Environmental Medicine, Natick, MA.


      LTC L. D. Sigrist is Director of the Graduate Program in Nutrition, Fort Sam Houston, TX; at the time of the study, she was director of the Weight Management Program, Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA.