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Tuesday, March 4, 2008

Replacing Meals Beats Skipping Them

One of the basic principles in weight management is not to let yourself get hungry.

This is based on the simple rationale that when you are hungry, your hypothalamus "kicks in", essentially overriding any "sensible" choices you may have intended to make.

For one, when you are hungry you are more likely to eat energy-dense foods.

But hunger also makes you eat faster, in turn making you more likely to overshoot your actual caloric requirements before satiety sets in. I have previously referred to this as ""homeostatic hyperphagia"".

Skipping meals is perhaps the most common reason for people to get hungry. The meals most likely to be skipped are breakfast and lunch, resulting in the evening "binge".

If the reason for skipping breakfast and lunch is lack of time and an irregular hectic schedule, commercial meal replacements can come in handy. The convenience of quickly drinking a shake or eating a bar is hard to beat.

Sure, a proper balanced meal prepared with fresh wholesome ingredients enjoyed in a relaxing setting would be best, but the reality is that that is rarely the reality.

Therefore, I would rather see my patients eating a meal replacement than skipping a meal. Meal replacements also promote portion control. Not least, meal replacements are cheap - costing as little as a couple of dollars per meal.

Because I have seen this strategy work over and over again, I was not at all surprised by the results of a recent randomised-controlled trial from John Hopkins (Baltimore), where a diet using portion-controlled meal replacements yielded significantly greater initial weight loss and less regain after 1 year of maintenance than a standard, self-selected, food-based diet in patients with type 2 diabetes (click here for abstract).

Obviously, this is not a strategy for people who "hate" meal replacements. And, like any weight-management strategy, it only works as long as you stick with it.

But for those who embrace it, using meal replacements to replace meals that they'd otherwise skip may prove a viable long-term strategy to regain control of their hypothalamus and their diet.


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