We all know that being physically active, buying fresh ingredients andcooking healthy homemade foods is the best route to long-term weight loss and maintenance. However, despite our best efforts, we don’t always have the time or inclination to prepare our own meals, or sometimes we really do need to lose weight fast. Are there any real alternatives for people with diabetes?

The answer is a qualified yes. Very low-energy diets (VLEDs) are a special kind of meal replacement that can be used under certain circumstances for short periods to help you lose weight rapidly. Alternatively, meal replacement programs can provide you with healthy kilojoule-controlled readymade meals that will help you to lose weight safely and effectively, but at a slower rate than VLEDs.

Very low-energy diets
A VLED can help people lose more weight than regular healthy diets in the short-to-medium term (less than 12 months). This can be useful if you need to lose weight rapidly for surgery, or to help alleviate another acute health
problem e.g. severe joint pain. There is little evidence that they are healthy for long-term (1–5 years) weight management, however.

VLEDs are defined as diets providing fewer than 3300 kj/day. They are designed to produce rapid weight loss while preserving lean body mass (muscles and organs). This
is accomplished by providing high proportions of protein, typically 70–100 g a day. The protein is usually from milk, soy or egg-based powders that are mixed with water or skim milk and consumed as a ‘shake’.

Typical VLEDs provide 45–90 g of carbohydrate and 2–20 g of fat each day, and most provide 100% of the recommended daily allowance for most vitamins and minerals.

In addition, you need to drink two litres of non-caloric fluids (e.g. water,
black tea/coffee, diet soft drinks, etc.) and preferably two cups of non-starchy
vegetables (e.g. most vegetables except potatoes, sweet potatoes, yams, pumpkin, sweet corn, peas, carrots, beetroot and parsnip).

VLEDs are generally only recommended for people with diabetes who have a body mass index greater than 30 kg/m2. Because VLEDs can be relatively low in carbohydrate, your diabetes medications/insulin may need to be reduced to prevent hypos. Also, the high-protein content of VLEDs may put a strain on your kidneys, which can be a serious
problem if you have kidney disease. It is therefore very important that you discuss using a VLED with your doctor and dietitian before commencing it.

Once they were only found behind the counter of pharmacies but now some VLED formulas can be found in the ‘health food’ isle of supermarkets. Originally they were ‘shakes’ but now there are bars, soups and even desserts. Depending on the formula and where
you get them, good-quality VLEDs cost at least $45.00 per week for one person. Typically, a person will be on a VLED exclusively for a three-month period and then they progressively reduce their use and replace them with regular healthy meals over a few weeks or months.

Meal replacement programs
Designed for people who don’t like ‘shakes’ or similar meal replacement formulas, most meal replacement programs provide between 4200 and 6300 kJ/ day, are nutritionally complete (provide enough protein, fat, carbohydrate, vitamins and minerals for the typical adult), and consist of main meals, soups and desserts. Due to their higher kilojoule content, they do not promote as rapid weight loss in the short term as VLEDs (9.7% vs. 16.1% decrease in weight over an average of 12.7 weeks). However, the evidence suggests that they are as effective as VLEDs in the long term (5% vs. 6.3% decrease in weight over an average of 1.9 years).

As they may contain different amounts of carbohydrate and protein to your regular meals, it is also wise to consult your doctor and dietitian before commencing a
meal replacement program. Prices for one week’s supply of food from quality suppliers start from $105.00 per person.

The potential downside
Neither VLEDs nor meal replacement programs teach you how to buy and prepare healthy and appetising meals yourself. They are designed for individuals – not families and if you are the main grocery buyer/cook in your household, you will most likely have to continue to prepare regular meals for the rest of the family, while you only consume the “shakes†or meal replacements. This may not only be inconvenient, but it may also create tension within the family.

The bottom line
Many people with diabetes can use VLEDs or meal replacement programs to safely lose weight in the short term. If you need to lose weight rapidly for sound medical
reasons, discuss with your doctor and dietitian whether either option is suitable for you.

Dr Alan Barclay BSc, GradDip, PhD is Chief Scientific Officer at the Glycemic Index Foundation

This article was originally published in Conquest magazine published by Health Publishing Australia