Diabetes Forecast

Meal Replacements and Weight Loss

By Cassandra Verdi, RD, MPH , ,

What does it take for someone with diabetes to safely lose weight and keep it off? The answer for most people—which you’ve probably heard before—is more exercise plus fewer calories. For some, increased exercise is the straightforward part. Calorie reduction is the tougher part. But what if there was a way to simplify it all?

Enter Meal Replacements

Meal replacements may help you take the guesswork out of eating for weight loss. Slim Fast, Glucerna, and Boost shakes and bars are just a few examples of commercially made meal replacements. They are packaged in single servings and are intended to replace one or more meals or snacks throughout your day.

Meal replacements include a balance of protein, fat, and carbohydrate. Most are also fortified with vitamins and minerals to help prevent deficiencies. In addition to shakes and bars, you’ll find ready-to-mix powders, soups, and packaged entrées designed as calorie-controlled meal replacements.

Ideally, a meal replacement will have fewer calories than what you would normally eat for a meal or snack. By having one instead of your usual meal or snack, you create the calorie deficit that is needed to lose weight. Lawrence Cheskin, MD, FACP, director of the Weight Management Center at Johns Hopkins Bloomberg School of Public Health, regularly suggests meal replacements for his overweight patients, including people with type 1 or type 2 diabetes. “There’s no weighing, measuring, or calorie counting involved,” he says. “All you have to do is choose a flavor versus choosing from all of the foods at the supermarket.” By limiting choices—and temptation—meal replacements can be helpful for people who have trouble controlling portions or selecting lower-calorie healthful foods.

Research Says

Research over the past 15 years has shown that meal replacements can help with calorie reduction, weight loss, and weight maintenance. In the well-known Look AHEAD research study, people with type 2 diabetes participated in an intensive weight loss program with the option of using meal replacement shakes at breakfast and lunch, plus a bar for one snack. They were told to eat conventional foods for dinner or choose a packaged entrée. After six months, participants could continue using shakes and bars to replace one meal and one snack daily (and were encouraged to eat nutritious, lower-calorie foods for other meals). At the one year mark in the program, those who had most closely followed the meal replacement regimen were four times more likely to have reached the study’s 7 percent weight loss goal than those who used the fewest meal replacements.

In addition to Look AHEAD, smaller studies in people with diabetes saw similar effects on weight loss over one year of meal replacement use. They also consistently report medication reductions in people using meal replacements who lost weight.

It is pretty well established that meal replacements can help jump-start weight loss, which is usually most rapid during the first six months of a program. One study—though not specifically in people with diabetes—followed people for up to four years. People using meal replacements (for one meal and one snack per day), versus those choosing conventional foods for every meal, lost more weight and improved their triglyceride, blood glucose, and blood pressure levels by the end of year four.

For weight maintenance, you can continue to use meal replacements as tools for sticking to your routine after an initial weight loss, or start them back up if you see regain. “Usually when starting out, we have people using meal replacements for most meals and snacks per day. As we see weight loss and people get close to their goal, we work in a gradual manner to add back lower-calorie, healthy foods,” Cheskin says.

Consider This

Meal replacements can’t make weight loss happen on their own; they tend to be just one part of a weight loss program. For example, Look AHEAD participants who used meal replacements attended lifestyle counseling sessions. The program also encouraged reaching and sticking with at least 175 minutes of physical activity per week and used other strategies, such as keeping a food and activity diary. “Meal replacements will work very well as part of a program that also addresses the exercise and behavior components,” says Osama Hamdy, MD, PhD, medical director of Joslin Diabetes Center’s Obesity Clinical Program.

Play It Safe

If you don’t have access to a weight loss program, meal replacements can still be an option. It’s important to talk to your health care provider before using these products—medication adjustments may be necessary. “Meal replacements are lower in carbohydrate and calories than a typical meal, so they could lower blood glucose in a matter of days,” Hamdy says. “If prescribed, insulin or medications such as sulfonylureas will also need to be reduced to avoid hypoglycemia.” Hamdy usually recommends that his patients check their blood glucose two to three hours after using a meal replacement. If blood glucose is trending lower than desirable, he works with his patients to reduce their medications—a potential cost savings.

While there is not hard evidence for meal replacement use by people with type 1 diabetes who are overweight, Hamdy has such patients, and meal replacements have been a helpful strategy for them, too. “Again, it’s also important for this group to work closely with their provider regarding the effect on blood glucose and their insulin dose,” he says.

Don’t Add—Replace

Your health care provider can help you figure out a routine for using meal replacements instead of some of your usual meals or snacks. “I usually start patients out by replacing breakfast with a shake and an afternoon snack with a shake to help curb hunger later on,” says Zhaoping Li, MD, of the David Geffen School of Medicine at the University of California–Los Angeles. 

When used correctly, meal replacements have the potential to help people with diabetes lose weight. Just remember that they aren’t the only piece of the puzzle and are most effective when used with other weight loss strategies.

Ideal Meal Replacer

Look on the package and the Nutrition Facts panel for:

  • Lower-glycemic claims (see more details below)
  • Zero grams of trans fat 
  • Very little saturated fat (preferably less than 2 grams per serving)
  • Lower sodium levels (most have about 200 milligrams per serving)
  • Several grams of fiber (3 grams or more per serving)

Lower-Glycemic Claims

Experts tend to suggest lower-glycemic meal replacements for people with diabetes. These have fewer grams of total carbohydrate per serving. Many lower-glycemic varieties list resistant starch or modified maltodextrin in their ingredients. These forms of carbohydrate are digested more slowly than refined carbohydrate ingredients, which may help with blood glucose control.



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