In part 5 of this Exclusive Interview, Scott Isaacs talks with Diabetes in Control Medical Editor Joy Pape about how to move patients back to a regular diet after weight loss using meal replacements.
Scott Isaacs, MD, FACP, FACE is the medical director for the HMR Program for Weight Management at Atlanta Endocrine Associates and a faculty member at Emory University School of Medicine.
Transcript of this video segment:
Pape: And so, how do you transition patients from the meal replacements back to food without the weight regain? You said that, but how specifically do you do that?
Isaacs: So, transitioning patients is a really important thing because you’re not going to have meal replacements forever. When you’re using meal replacements, it’s for a defined period of time and it’s this goal of rapid weight loss. And then, it’s time to maybe have ongoing but slower weight loss and eventually weight maintenance. But we want you to maintain that weight loss because temporary weight loss is not really a success. If patients have been on just meal replacements, we generally want to gradually add back in regular foods, adding in fruits, vegetables, lean proteins, and whole grains and we usually do that over an eight-week period. The first four weeks are medically supervised and the second four weeks are not necessarily medically supervised.
Pape: You had mentioned earlier though the keeping off the weight, preventing weight regain, meal replacements will still be used. Now, not as they were doing the weight loss phase, but tell me how you use meal replacements.
Isaacs: That’s a great question as well because meal replacements have been shown in many studies to be healthful for weight loss and weight maintenance. And so, they’re tools. So, what is a meal replacement? Well, it’s simply a prepackaged, pre-measured food item that is used for weight loss, so it could be a shake, it could be an entree, a soup, a bar, a cereal. And the idea is that you’re replacing a higher calorie meal with a lower calorie meal replacement. And most of these they’re designed to be filling, so you’re going to fill up with less calories and that’s the idea. And the other thing is that dieting can be very difficult; trying to shop, trying to make decisions about what you’re doing, trying to cook and prepare. And so, meal replacements take a lot of that out of it. Take a lot the guesswork out of it. You know exactly how many calories you’re getting. And also, a lot of the decision anxiety that can come up sometimes trying to think of what’s the next healthy meal you should have.
Pape: And I find that a lot of my patients where they have problems are the celebrations and the holidays. You know, they’re getting out and going places with friends. And they get out and they’re confused, like you said, or they overdo. So, how do you recommend going out to eat with others? How do you recommend this? What should they do with the celebrations using meal replacements? Maybe before they get together with people. How do they do that?
Isaacs: That’s a big challenge. In fact, that’s probably one of the biggest challenges we see with our patients. Those exact situations, so celebrations, birthdays, travel, funerals are a big one as well. And so, if someone is on the rapid weight loss phase and they’re not supposed to really eat outside foods, we do have strategies to prevent that. So, you may want to take extra meal replacements before the event, not just to the point of feeling that you’re not feeling hungry but actually to the point that you’re feeling full. Because when someone is full, it’s really hard to eat something else. If you’re not hungry you might still eat, but if you’re full that makes it more difficult. Other situations or someone doesn’t have to be quite as structured with the meal plan, they may want to enjoy the celebration. And so, it’s okay to give yourself permission to sometimes have the piece of cake or to go to the restaurant and enjoy it with friends, but you want to try to get right back onto your program and really focus on the big picture. So, you don’t have to be 100% but you also don’t want that to be the slippery slope where then it’s something else and something else and it’s hard to really get back on the diet.