Abstract

Case Series

Sustainable Weight Loss and Body Composition Improvement through Intensive Lifestyle Modification with Meal Replacement: A 12-Case Series with International Perspectives

Nawinda Vanichakulthada*, Sunaree Pitchaiprasert, Rasintra Jaroenying, Sumalee Hantragool and Chutima Samhugkanee

Published: 13 April, 2026 | Volume 10 - Issue 1 | Pages: 017-025

Background: Obesity is one of the most pressing global health challenges, with over one billion people now living with the condition worldwide. In Southeast Asia, nearly 40% of the population is projected to be overweight or obese by 2035, with Thailand reporting prevalence exceeding 42%. Intensive Lifestyle Modification (ILM) combined with Meal Replacement (MR) has emerged as a promising strategy for achieving sustainable weight loss, supported by landmark trials including the Diabetes Prevention Program, Look AHEAD, and DiRECT.
Objective: To illustrate the clinical effectiveness of ILM combined with MR through detailed case presentations documenting anthropometric outcomes at baseline, 8 weeks, and 52 weeks, contextualized within international obesity management guidelines and comparative research across diverse populations. We hypothesized that selected participants undergoing the ILM+MR intervention would demonstrate clinically significant weight loss (≥5% of initial body weight) sustained through 52 weeks, with concurrent improvements in waist circumference indicating reduced central adiposity.
Methods: Twelve participants (9 female, 3 male) from the ILM+MR arm of a previously published retrospective cohort study (n = 702) were selected based on complete longitudinal data and representativeness. The intervention comprised structured nutritional counseling, soy-based MR (220 kcal per serving, twice daily for 8 weeks), behavioral modification with group therapy, and physical activity guidance aligned with the 2013 AHA/ACC/TOS guidelines. Body weight and waist circumference were measured at baseline, 8 weeks, and 52 weeks.
Results: Mean total weight loss was 38.2 kg (35.3% of initial body weight), with mean waist circumference reduction of 13.0 inches (33.0 cm) over 52 weeks. All 12 participants achieved clinically significant weight loss (>5%), substantially exceeding the 5–10% threshold recommended by international guidelines. Weight loss occurred in two phases: a rapid intensive phase (mean 14.0 kg during weeks 0–8) followed by continued loss during maintenance (mean 24.2 kg during weeks 8–52). All participants completed the 52-week follow-up.
Conclusion: This case series demonstrates the potential for substantial, sustained weight loss through ILM+MR intervention, supporting findings from the larger Thai cohort study and international research including the DiRECT trial and systematic meta-analyses. These results reaffirm the foundational role of comprehensive lifestyle programs and highlight their relevance as scalable, culturally adaptable interventions for obesity management across diverse populations.

Read Full Article HTML DOI: 10.29328/journal.acem.1001034 Cite this Article Read Full Article PDF

Keywords:

Obesity; Intensive lifestyle modification; Meal replacement; Weight loss; Case series; Body composition; Global health; Asia-Pacific

References

  1. World Health Organization. Obesity and overweight fact sheet. 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
  2. McKinsey Global Institute. Overcoming obesity: an initial economic analysis. 2014. Available from: https://www.mckinsey.com/~/media/mckinsey/business%20functions/economic%20studies%20temp/our%20insights/how%20the%20world%20could%20better%20fight%20obesity/mgi_overcoming_obesity_full_report.pdf
  3. Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BWJH, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry. 2010;67:220-229. Available from: https://doi.org/10.1001/archgenpsychiatry.2010.2
  4. Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, et al. The metabolic syndrome and cardiovascular risk: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;56:1113-1132. Available from: https://doi.org/10.1016/j.jacc.2010.05.034
  5. Tee ES, Voon SH. Combating obesity in Southeast Asian countries: current status and the way forward. Global Health J. 2024;8(3):147-151. Available from: https://doi.org/10.1016/j.glohj.2024.08.006
  6. Weighing the crisis: the obesity imperative in Southeast Asia. White paper. 2024. Available from: https://www.iqvia.com/locations/asia-pacific/library/white-papers/weighing-the-crisis-the-obesity-imperative-in-southeast-asia
  7. Aekplakorn W, Porapakkham Y, Taneepanichskul S. Prevalence of overweight and obesity in Thai population: results of the health examination surveys. J Med Assoc Thai. 2020;103:215-225.
  8. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363:157-163. Available from: https://doi.org/10.1016/s0140-6736(03)15268-3
  9. Tham KW, Ghani RA, Cua SC, Deerochanawong C, Fojas M, Hocking S, et al. Obesity in South and Southeast Asia—a new consensus on care and management. Obes Rev. 2023;24:e13520. Available from: https://doi.org/10.1111/obr.13520
  10. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults. Circulation. 2014;129:S102-S138. Available from: https://doi.org/10.1161/01.cir.0000437739.71477.ee
  11. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403. Available from: https://doi.org/10.1056/nejmoa012512
  12. Diabetes Prevention Program Research Group. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374:1677-1686. Available from: https://doi.org/10.1016/S0140-6736(09)61457-4
  13. Look AHEAD Research Group. Eight-year weight losses with an intensive lifestyle intervention: the Look AHEAD study. Obesity. 2014;22:5-13. Available from: https://doi.org/10.1002/oby.20662
  14. Franz MJ, VanWormer JJ, Crain AL, Boucher JL, Histon T, Caplan W, et al. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc. 2007;107:1755-1767. Available from: https://doi.org/10.1016/j.jada.2007.07.017
  15. Dombrowski SU, Knittle K, Avenell A, Araujo-Soares V, Sniehotta FF. Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials. BMJ. 2014;348:g2646. Available from: https://doi.org/10.1136/bmj.g2646
  16. Heymsfield SB, van Mierlo CAJ, van der Knaap HCM, Heo M, Frier HI. Weight management using a meal replacement strategy: meta and pooling analysis from six studies. Int J Obes. 2003;27:537-549. Available from: https://doi.org/10.1038/sj.ijo.0802258
  17. Lean MEJ, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018;391:541-551. Available from: https://doi.org/10.1016/s0140-6736(17)33102-1
  18. Vanichakulthada N, Pitchaiprasert S, Jaroenying R, Hantragool S, Samhugkanee C. Efficacy of intensive lifestyle modification with meal replacement for sustainable weight loss and improved body composition in obese adults: a retrospective cohort study. Open Access J Clin Path Res. 2025;1(2):1-9. Available from: https://doi.org/10.61440/OAJCPR.2025.v1.26
  19. Wing RR, Tate DF, Gorin AA, Raynor HA, Fava JL. A self-regulation program for maintenance of weight loss. N Engl J Med. 2006;355:1563-1571. Available from: https://doi.org/10.1056/nejmoa061883
  20. Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82:222S-225S. Available from: https://doi.org/10.1093/ajcn/82.1.222s
  21. Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith B, et al. American College of Sports Medicine position stand: appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41:459-471. Available from: https://doi.org/10.1249/mss.0b013e3181949333
  22. Patel SR, Hu FB. Short sleep duration and weight gain: a systematic review. Obesity. 2008;16:643-653. Available from: https://doi.org/10.1038/oby.2007.118
  23. Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr. 2004;79:379-384. Available from: https://doi.org/10.1093/ajcn/79.3.379
  24. Pischon T, Boeing H, Hoffmann K, Bergmann M, Schulze MB, Overvad K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med. 2008;359:2105-2120. Available from: https://doi.org/10.1056/nejmoa0801891
  25. Nackers LM, Ross KM, Perri MG. The association between rate of initial weight loss and long-term success in obesity treatment: does slow and steady win the race? Int J Behav Med. 2010;17:161-167. Available from: https://doi.org/10.1007/s12529-010-9092-y
  26. Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248-256. Available from: https://doi.org/10.1016/j.amjmed.2008.09.041
  27. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Brethauer SA, Navaneethan SD, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376:641-651. Available from: https://doi.org/10.1056/nejmoa1401329
  28. Ard J, Fitch A, Fruh S, Herman L. Weight loss and maintenance related to the mechanism of action of glucagon-like peptide 1 receptor agonists. Adv Ther. 2021;38:2821-2839. Available from: https://doi.org/10.1007/s12325-021-01710-0
  29. Baumeister RF, Vohs KD, Tice DM. The strength model of self-control. Curr Dir Psychol Sci. 2007;16:351-355. Available from: https://doi.org/10.1111/j.1467-8721.2007.00534.x
  30. Bandura A. Social foundations of thought and action: a social cognitive theory. Prentice-Hall; 1986. Available from: https://doi.org/10.4135/9781446221129.n6
  31. Raynor HA, Champagne CM. Position of the Academy of Nutrition and Dietetics: interventions for the treatment of overweight and obesity in adults. J Acad Nutr Diet. 2016;116:129-147. Available from: https://doi.org/10.1016/j.jand.2015.10.031
  32. Lally P, van Jaarsveld CHM, Potts HWW, Wardle J. How are habits formed: modelling habit formation in the real world. Eur J Soc Psychol. 2010;40:998-1009. Available from: https://psycnet.apa.org/doi/10.1002/ejsp.674
  33. Rosenbaum M, Hirsch J, Gallagher DA, Leibel RL. Long-term persistence of adaptive thermogenesis in subjects who have maintained a reduced body weight. Am J Clin Nutr. 2008;88:906-912. Available from: https://doi.org/10.1093/ajcn/88.4.906
  34. Anderson JW, Konz EC, Frederich RC, Wood CL. Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr. 2001;74:579-584. Available from: https://doi.org/10.1093/ajcn/74.5.579
  35. Loveman E, Frampton GK, Shepherd J, Picot J, Cooper K, Bryant J, et al. The clinical effectiveness and cost-effectiveness of long-term weight management schemes for adults: a systematic review. Health Technol Assess. 2011;15:1-182. Available from: https://doi.org/10.3310/hta15020
  36. InsightAce Analytic. Digital health for obesity market: global and Asia-Pacific perspectives. 2024.
  37. National Institute for Health and Care Excellence. Obesity: identification, assessment and management. Clinical guideline. 2014. Available from: https://www.nice.org.uk/guidance/cg189
  38. Bays HE, McCarthy W, Christensen S. Obesity Algorithm eBook. Obesity Medicine Association; 2021. Available from: https://www.scribd.com/document/558035972/2021-Obesity-Algorithm-1
  39. Zeevi D, Korem T, Zmora N, Israeli D, Rothschild D, Weinberger A, et al. Personalized nutrition by prediction of glycemic responses. Cell. 2015;163:1079-1094. Available from: https://doi.org/10.1016/j.cell.2015.11.001

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