AWM: Portion Control and Meal Replacements/Structured Meal Plans 2014
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
AWM: Portion Control and Meal Replacements/Structured Meal Plans
For weight loss and weight maintenance, the registered dietitian nutritionist (RDN) should recommend portion control and meal replacements or structured meal plans as part of a comprehensive weight management program. Strong evidence documents a positive relationship between portion size and body weight and research reports that the use of various types of meal replacements or structured meal plans was helpful in achieving health and food behavior change.
Risks/Harms of Implementing This Recommendation
Conditions of Application
Potential Costs Associated with Application
Costs of medical nutrition therapy (MNT) sessions vary, however MNT sessions are essential for improved outcomes.
From the Nutrition Counseling ProjectFour RCT studies (three positive-quality and one neutral-quality) assessed the efficacy of various types of meal replacement or structured meal plan strategies, as compared to self-selected diets in middle aged-adults and found the use of various types of meal replacements or structured meal plans helpful in achieving health and food behavior change in middle-aged adults (Wing et al, 1996; Metz et al, 1997; Ditschuneit et al, 1999; Flechter-Mors et al, 2000; Ashley et al, 2001; Ditschuneit and Flechter-Mors, 2001). Additional research is needed to determine if benefits derived from temporary use of these behavioral strategies can be sustained over time.
From the 2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library (NEL) Evidence-Based Systematic Reviews
What is the relationship between portion size and body weight?
- Strong evidence documents a positive relationship between portion size and body weight.
Recommendation Strength Rationale
The Conclusion Statement from the Nutrition Counseling project in support of this recommendation received:
- What is the evidence that the behavioral strategy of meal replacements or structured meal plans, used as a component of a behavioral program, will result in health or food behavior change in adults counseled in an outpatient or clinic setting? Grade I.
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
What is the evidence that the behavioral strategy of meal replacements or structured meal plans, used as a component of a behavioral program, will result in health or food behavior change in adults counseled in an outpatient or clinic setting?
Ashley JM, St. Jeor ST, Schrage JP, Perumean-Chaney SE, Gilbertson MC, McCall NL, Bovee V. Weight control in the physician's office. Arch Intern Med 2001; 161: 1599-1604.
Ditschuneit HH, Flechter-Mors M. Value of structured meals for weight management: risk factors and long-term weight maintenance. Obes Res 2001; 9: 284-289S.
Ditschuneit HH, Flechter-Mors M, Johnson TD, Adler G. Metabolic and weight-loss effects of a long-term dietary intervention in obese patients. Am J Clin Nutr 1999; 69(2): 198-204.
Flechter-Mors M, Ditschuneit HH, Johnson TD, Suchard MA, Adler G. Metabolic and weight loss effects of long-term dietary intervention in obese patients: four-year results. Obes Res 2000; 8(5): 399-402.
Metz JA, Kris-Etherton PM, Morris CD. Dietary compliance and cardiovascular risk reduction with a prepared meal plan compared with a self-selected diet. Am J Clin Nutr. 1997; 66: 373-385.
Wing RR, Jeffery RW, Burton LR, Thorson C, Nissinoff KS, Baxter JE. Food provision vs. structured meal plans in the behavioral treatment of obesity. Int J Obes Relat Metab Disord. 1996 Jan; 20 (1): 56-62.
References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process
2010 Dietary Guidelines Advisory Committee (DGAC) Nutrition Evidence Library (NEL) Evidence-Based Systematic Reviews. Available at http://www.nutritionevidencelibrary.gov/category.cfm?cid=21