Obesity and overweight are significant public health concerns due to their association with various comorbidities and increased mortality risk. Recent medical guidelines emphasize the active treatment of overweight and obesity through diet and lifestyle interventions, aiming for a weight loss of at least 5% within six months. Commercial weight loss programs like Medifast offer one approach to achieving this goal, provided there is evidence supporting their efficacy and safety.
Understanding the Scope of Overweight and Obesity
The prevalence of overweight and obesity has reached alarming levels in the United States. Overweight and obesity are linked to a multitude of comorbidities, including heart disease, stroke, diabetes, some forms of cancer, gallbladder disease, osteoarthritis, gout, breathing problems, high cholesterol, hypertension, complications of pregnancy, infertility, and depression. Understanding obesity as a complex, chronic disease is essential for providing effective interventions and “obligate[s] clinicians to go beyond mere recommendations to eat less and move more”.
The Role of Commercial Weight Loss Programs
Commercial programs that provide a comprehensive lifestyle intervention are also supported as an option for weight loss within these guidelines, provided they are backed by evidence of their safety and efficacy. The Medifast® Program is a commercial program that features a combination of Medifast Meal Replacements, conventional food choices, and customizable levels of support for weight loss and weight maintenance.
The Medifast Program: An Overview
The Medifast Program is a commercially available, nutritionally balanced, low-calorie weight loss plan. The Medifast® Program is a commercial program that features a combination of Medifast Meal Replacements, conventional food choices, and customizable levels of support for weight loss and weight maintenance. The Medifast (MD) MR plan features a combination of MD MRs and “conventional” food choices; it has been shown to be safe and effective for weight loss in obese individuals. It centers on meal replacements and aims to provide a structured approach to weight management. There are 65 options available: bars, shakes, soups, pastas, desserts and breakfast foods. A key component of the Medifast program is the Medifast 5 & 1 Plan, a low-calorie, nutritionally-balanced, commercially available weight loss plan that consists of 5 portion-controlled MD MRs plus one self-prepared “Lean and Green MealTM”. The structured MD MR plan is offered along with individualized 1-on-1 counseling and support.
Medifast Weight Control Centers (MWCC)
At Medifast Weight Control Centers® (MWCC), the Medifast meal plans are combined with individualized one-on-one weekly counseling to create a comprehensive lifestyle program. The weight management program offered at the MWCC consists of weekly one-on-one in-person sessions with MWCC counselors who utilize motivational interviewing and a series of personalized behavior change strategies designed to develop behaviors that promote long-term weight management through a healthy lifestyle. MWCC counselors are trained using a combination of on-the-job and corporate-based training to ensure thorough knowledge of the Medifast products and programs and an understanding of the behavior change strategies used at MWCC. At the MWCC a high level of support is provided to clients, including medical oversight and individual, weekly counseling sessions.
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The Medifast 4 & 2 & 1 Plan
The Medifast 4 & 2 & 1 Plan is often recommended for men and seniors (≥65 years), or based on specific individual behaviors or food preferences (e.g., individual engages in high levels of physical activity or wants to include fruit, dairy or whole grains daily). The 4 & 2 & 1 Plan is a calorie- and portion-controlled meal plan designed to stimulate gradual, steady weight loss and provides 1,100-1,300 calories daily. It consists of 4 Medifast Meal Replacements, 2 self-prepared “lean and green meals” (each including 5-7 oz of lean protein, 3 servings (~1½ cups) of non-starchy vegetables, and up to 2 healthy fat servings), and 1 healthy snack (fruit, dairy or whole grains). Medifast Meal Replacements, of which there are over 70 to choose from, each contain 90-110 calories, 11-15 g protein (primarily from soy and/or dairy), 8-15 g carbohydrates, and 0-3.5 g fat; they each share a similar nutritional profile and can be used interchangeably during the Weight Loss phase and with any of the Medifast weight loss meal plans. Both the 5 & 1 and the 4 & 2 & 1 Plans are designed to provide adequate protein to promote retention of lean mass during weight loss.
Program Phases
Programs generally include active Weight Loss, Transition, and Maintenance phases. Following the Weight Loss phase, some MWCCs may include a Transition phase, during which calorie intake and conventional food choices are gradually increased. After active weight loss, clients gradually decrease their use of the MD MRs and begin increasing calories from a variety of food groups to meet estimated energy needs for weight maintenance. Maintenance incorporates the ongoing use of MD MRs with conventional foods and is based on individual estimated energy needs to help maintain weight over time. All individuals who meet their weight loss goal or who have completed their prescribed weight loss weeks then have the option to enter the Maintenance phase.
Efficacy of the Medifast 4 & 2 & 1 Plan: A Retrospective Study
A systematic retrospective chart review was conducted to evaluate the effectiveness of the Medifast 4 & 2 & 1 Plan for weight loss across 24 weeks in overweight and obese adults at MWCCs. This study aimed to assess the effects of the plan on body composition and cardiometabolic risk factors.
Study Design and Participants
This study was a systematic retrospective chart review of MWCC clients who started the Medifast 4 & 2 & 1 Plan for weight loss on or after January 1, 2012 and completed the active Weight Loss phase of their program by March 31, 2014. Twenty-one MWCCs were chosen for this study based on (a) their close proximity to Medifast corporate headquarters (all MWCCs in Maryland), or (b) because they were among the centers with the largest base of clients following the 4 & 2 & 1 Plan - these MWCCs were located in Texas, Florida, and Pennsylvania. Charts from clients who met specific criteria were included: male or female overweight or obese adult (age ≥ 18 years, BMI ≥ 25 kg/m2), signed a PHI form, started the 4 & 2 & 1 Plan after January 1, 2012, followed the 4 & 2 & 1 Plan for at least 2 weeks, and not concurrently using any other weight loss program or pharmacotherapy for weight loss.
Data Collection and Analysis
Data were recorded in client charts at MWCCs by counselors. Weight was measured to the nearest 0.1 lb using a high-quality digital scale. Body composition was assessed without shoes and in light indoor clothing by direct, segmental, multi-frequency bioelectrical impedance analysis using either an InBody 230® or InBody 370® body composition analyzer (InBody Co., Cerritos, CA, USA). Weight, pulse, blood pressure, and adherence-related information were abstracted at baseline and weekly throughout the client’s Weight Loss phase through 24 weeks plus at the Final Visit. The primary outcome was change from baseline body weight at 12 weeks. Data were analyzed according to a pre-defined statistical analysis plan.
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Key Findings
Of the 478 charts received for screening, 310 met the study entry criteria and were included in the study. Sixty percent (n = 185) of individuals who started the 4 & 2 & 1 Plan remained on this plan and had weight data within the 12-week visit window and were, therefore, included in the completers analysis at the 12-week primary endpoint; 26 % (n = 81) remained on the 4 & 2 & 1 Plan and had weight data within the 24-week visit window and were, therefore, included in the completers analysis at this time point.
- Significant Weight Loss: At 12 weeks, completers (n = 185) experienced a mean weight reduction of 10.9 ± 5.6 kg (-10.1 %, p < 0.0001). At 24 weeks (n = 81), the mean weight reduction was 16.0 ± 7.9 kg (-14.3 %).
- High Percentage of Participants Achieving Clinically Meaningful Weight Loss: At 12 and 24 weeks, 85 % and 96 % of those remaining on the plan, respectively, had lost ≥5 % of their baseline body weight.
- Preservation of Lean Mass: Lean mass was preserved to within 5 % of baseline throughout the 24 weeks, and fat mass represented ≥80 % of the body weight lost from 12 weeks onward.
- Improvements in Cardiometabolic Risk Factors: Significant improvements in blood pressure, pulse and waist-to-hip ratio were observed.
- Weight Regain: Mean weight regain among the subset who entered a formal maintenance phase was <2 % during an average follow-up of 34 weeks.
- Broad Population Effectiveness: Men, women, seniors (≥65 years), and non-seniors (<65 years) all had significant weight reductions with preservation of lean mass.
Adherence
Program adherence was defined for meal replacements as: ≥75 % compliance of meal replacement consumption (i.e., on average 3 of the 4 assigned meal replacements were reported consumed) and for attendance as reporting to ≥75 % of their weekly visits while on the program.
Comparison to the Medifast 5 & 1 Plan
Previous studies have shown the 5 & 1 Plan to be safe and effective for weight loss in overweight and obese individuals. In results adjusted for race, body weight, BMI, waist circumference, fat mass, and fat-free mass were significantly reduced in the MD group at 26 weeks compared with baseline. Weight loss was greater in the MD group compared with the FB group (−7.5 vs. −3.8 kg; P = 0.0002), corresponding to a mean 6.7% loss of baseline weight in the MD group compared with a mean 3.4% loss in the FB group.
Considerations and Potential Risks
While Medifast can be effective, it's important to consider potential risks:
- Restrictive Caloric Intake: The caloric intake is highly restrictive, and the diet itself is hard to follow.
- Health Risks: Because the OPTAVIA diet is low in carbs and calories, it can result in potential health problems. Rapid weight loss increases the risk of arrhythmia, dehydration and electrolyte imbalance.
- Who Should Avoid: Pregnant women and those younger than 13 shouldn’t be on any OPTAVIA program. Teens, nursing mothers, people with gout and those with diabetes should stick to the OPTAVIA program options developed for their unique needs after clearing it with their doctors. Vegan. There’s no plan for eating vegan. Fuelings contain a vitamin D mix derived from lanolin (sheep’s wool). Vegetarian. Staying or going vegetarian is doable on OPTAVIA as most of its Fuelings are vegetarian-friendly. Still, it won’t be easy since you’re told to avoid good sources of plant-based proteins like peas, beans and lentils during your weight-loss phase since they’re too high in carbohydrates. Gluten free. It’s possible to go gluten free on OPTAVIA. Some Fuelings have been certified gluten free, including select shakes, soups, bars and pudding.
OPTAVIA: The Evolution of Medifast
Medifast closed their traditional program, and now sell product under the OPTAVIA brand. OPTAVIA is a low-carbohydrate, low-calorie lifestyle program designed for weight loss. Derived from the Medifast diet, OPTAVIA relies heavily on prepackaged foods, referred to as Fuelings, in combination with home-prepared recipes.
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How OPTAVIA Works
OPTAVIA offers seven different meal plans. You’ll also be matched with an independent coach. You'll eat a set number of prepackaged Fuelings each day and one or two low-carbohydrate meals, which you prepare using food from the grocery store. OPTAVIA Fuelings are nutrient-dense meal replacements that add vitamins, minerals and fiber to your diet without a lot of calories. Because they are already portioned for you, there is no room for error or unintended overeating.
The Promise of Weight Loss
Yes, you can lose weight on the OPTAVIA diet. As with all weight loss diets, factors such as weight, age, muscle mass, activity level, genetic makeup and metabolic rate influence how much weight you lose. Weight loss research specific to the OPTAVIA diet is limited to a handful of small studies, but short-term weight loss is possible with the diet:According to the company, the average weight loss on the 5 & 1 Plan is 12 pounds in 12 weeks.