Obesity Surgery

, Volume 26, Issue 6, pp 1343–1351 | Cite as

Commercial Very Low Energy Meal Replacements for Preoperative Weight Loss in Obese Patients: a Systematic Review

  • Lynda J. RossEmail author
  • Siobhan Wallin
  • Emma J. Osland
  • Muhammed Ashraf Memon



This systematic review assessed feasibility and effectiveness of preoperative meal replacements to improve surgical outcomes for obese patients.


PRISMA guidelines were followed and electronic databases searched for articles between January 1990 and March 2015.


Fifteen studies (942 participants including 351 controls) were included, 13 studies (n = 750) in bariatric patients. Adverse effects and dropout rates were minimal. Ten out of 14 studies achieved 5–10 % total weight loss. Six of six studies reporting liver volume achieved 10 % reduction. Endpoints for perioperative risks and outcomes were too varied to support definitive risk benefit.


Commercial meal replacements are feasible, have minimal side effects and facilitate weight loss and liver shrinkage in free-living obese patients awaiting elective surgery. A reduction in surgical risk is unclear.


Very low energy diet Meal replacements Preoperative weight loss Surgical outcomes 



Thank you to Paula MacDermott for providing a third opinion in the review process and assisting with time lines for the review.

Compliance with Ethical Standards

Conflict of Interest

Lynda Ross has no conflict of interest.

Siobhan Wallin has no conflict of interest.

Emma Osland has no conflict of interest.

Muhammed Ashraf Memon has no conflict of interest.


No funding was provided for the conduct of this review.

Human and Animal Rights and Informed Consent

This article does not contain studies with human participants or animals performed by any of the authors. Informed consent did not apply.


  1. 1.
    Australian Institute of Health and Welfare. Australia’s health 2014. Australia’s health series no. 14. Cat no AUS 178. Canberra: AIHW Welfare. 2014.Google Scholar
  2. 2.
    Cancer Council Australia. Body Weight. [updated 14 April 2014, cited 18 August 2014]. Available from:; 2014.
  3. 3.
    Meyerhardt J, Tepper J, Niedzwiecki D, et al. Impact of body mass index on outcomes and treatment-related toxicity in patients with stage II and III rectal cancer: findings from Intergroup Trial 0114. J Clin Oncol. 2004;22:648–57.CrossRefPubMedGoogle Scholar
  4. 4.
    Geiger T, Muldoon R. Complications following colon rectal surgery in obese patients. Clin Colon Rectal Surg. 2011;24:274–82.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Benoist S, Panis Y, Alves A, et al. Impact of obesity on surgical outcomes after colorectal resection. Am J Surg. 2000;179:275–81.CrossRefPubMedGoogle Scholar
  6. 6.
    Rullier E, Laurent C, Garrelon J, et al. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg. 1998;85:355–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Delbridge E, Proietto J. VLED (Very Low Energy Diet) for obesity. Asia Pac J Clin Nutr. 2006;15:49–54.PubMedGoogle Scholar
  8. 8.
    Saris WH. Very-low-calorie diets and sustained weight loss. Obes Res. 2001;9:295S–301S.CrossRefPubMedGoogle Scholar
  9. 9.
    Tsai AG, Wadden TA. Systematic review: an evaluation of major commercial weight loss programs in the United States. Ann Intern Med. 2005;142:56–66.CrossRefPubMedGoogle Scholar
  10. 10.
    Cassie S, Menezes C, Birch DW, et al. Effect of preoperative weight loss in bariatric surgical patients: a systematic review. Surg Obes Relat Dis. 2011;7:760–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Adrianzen Vargas M, Cassinello Fernandez N, Ortega SJ. Preoperative weight loss in patients with indication of bariatric surgery: which is the best method? Nutr Hosp. 2011;26:1227–12230.PubMedGoogle Scholar
  12. 12.
    Gerber P, Anderin C, Thorell A. Weight loss prior to bariatric surgery: an updated review of the literature. Scand J Surg. 2015;104:33–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Effective Public Health Practice Project Quality (EPHPP) Assessment Tool [Online] Available at: [Accessed 5 February 2016]; 2016.
  14. 14.
    Andersen T, Gluud C, Franzmann M-B, et al. Hepatic effects of dietary weight loss in morbidly obese subjects. J Hepatol. 1991;12:224–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Brody F, Vaziri K, Garey C, et al. Preoperative liver reduction utilizing a novel nutritional supplement. J Laparoendosc Adv Surg Tech A. 2011;21:491–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Carbajo MA, Castro MJ, Kleinfinger S, et al. Effects of a balanced energy and high protein formula diet (Vegestart complet (R)) vs. low-calorie regular diet in morbid obese patients prior to bariatric surgery (laparoscopic single anastomosis gastric bypass): a prospective, double-blind randomized study. Nutr Hosp. 2010;25:939–48.PubMedGoogle Scholar
  17. 17.
    Colles SL, Dixon JB, Marks P, et al. Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006;84:304–11.PubMedGoogle Scholar
  18. 18.
    Collins J, McCloskey C, Titchner R, et al. Preoperative weight loss in high-risk superobese bariatric patients: a computed tomography-based analysis. Surg Obes Relat Dis. 2011;7:480–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Edholm D, Kullberg J, Haenni A, et al. Preoperative 4-week low-calorie diet reduces liver volume and intrahepatic fat, and facilitates laparoscopic gastric bypass in morbidly obese. Obes Surg. 2011;21:345–50.CrossRefPubMedGoogle Scholar
  20. 20.
    Edholm D, Kullberg J, Karlsson A, et al. Changes in liver volume and body composition during 4 weeks of low calorie diet before laparoscopic gastric bypass. Surg Obes Relat Dis. 2014. doi: 10.1016/j.soard.2014.07.018 [epub ahead of print].Google Scholar
  21. 21.
    Foo J, Krebs J, Hayes MT, et al. Studies in insulin resistance following very low calorie diet and/or gastric bypass surgery. Obes Surg. 2011;21:1914–20.CrossRefPubMedGoogle Scholar
  22. 22.
    Fris RJ. Preoperative low energy diet diminishes liver size. Obes Surg. 2004;14:1165–70.CrossRefPubMedGoogle Scholar
  23. 23.
    Huerta S, Li Z, Anthony T, et al. Feasibility of a supervised inpatient low-calorie diet program for massive weight loss prior to RYGB in superobese patients. Obes Surg. 2010;20:173–80.CrossRefPubMedGoogle Scholar
  24. 24.
    Lewis MC, Phillips ML, Slavotinek JP, et al. Change in liver size and fat content after treatment with Optifast very low calorie diet. Obes Surg. 2006;16:697–701.CrossRefPubMedGoogle Scholar
  25. 25.
    Martin LF, Tan TL, Holmes PA, et al. Can morbidly obese patients safely lose weight preoperatively? Am J Surg. 1995;169:245–53.CrossRefPubMedGoogle Scholar
  26. 26.
    Pekkarinen T, Mustajoki P. Use of very low-calorie diet in preoperative weight loss: efficacy and safety. Obes Res. 1997;5:595–602.CrossRefPubMedGoogle Scholar
  27. 27.
    Reeves JG, Suriawinata AA, Ng DP, et al. Short-term preoperative diet modification reduces steatosis and blood loss in patients undergoing liver resection. Surgery. 2013;154:1031–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Van Nieuwenhove Y, Dambrauskas Z, Campillo-Soto A, et al. Preoperative very low-calorie diet and operative outcome after laparoscopic gastric bypass: a randomized multicenter study. Arch Surg. 2011;146:1300–5.CrossRefPubMedGoogle Scholar
  29. 29.
    Anderin C, Bustafsson UO, Heijbel N, et al. Weight loss before bariatric surgery and postoperative complications: data from the Scandinavian Obesity Registry (SOReg). Ann Surg. 2015;261:909–13.CrossRefPubMedGoogle Scholar
  30. 30.
    Nomikos IN, Sidiropoulos A, Vamvakopoulou DN, et al. Surgical complications of hyperglycaemia. Curr Diabetes Rev. 2009;5:145–50.CrossRefPubMedGoogle Scholar
  31. 31.
    Hanazaki K, Maeda H, Okabayashi T. Relationship between perioperative glycemic control and postoperative infections. World J Gastroenterol. 2009;15:4122–5.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Steven S, Taylor R. Restoring normoglycaemia by use of a very low calorie diet in long- and short-duration Type 2 diabetes. Diabet Med. 2015. doi: 10.1111/dme.12722 [Epub ahead of print].Google Scholar
  33. 33.
    Dhindsa P, Scott AR, Donnelly R. Metabolic and cardiovascular effects of very-low-calorie diet therapy in obese patients with Type 2 diabetes in secondary failure: outcomes after 1 year. Diabet Med. 2003;20:319–24.CrossRefPubMedGoogle Scholar
  34. 34.
    Adams TD, Davidson LE, Litwin SE, et al. Gastrointestinal surgery: cardiovascular risk reduction and improved long-term survival in patients with obesity and diabetes. Curr Atheroscler Rep. 2012;14:606–15.CrossRefPubMedGoogle Scholar
  35. 35.
    Despres JP. Intra-abdominal obesity: an untreated risk factor for Type 2 diabetes and cardiovascular disease. J Endocrinol Investig. 2006;29:77–82.Google Scholar
  36. 36.
    Bian H, Hakkarainen A, Lundbom N, et al. Effects of dietary interventions on liver volume in humans. Obesity (Silver Spring). 2014;22:989–95.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Lynda J. Ross
    • 1
    • 2
    Email author
  • Siobhan Wallin
    • 1
  • Emma J. Osland
    • 1
    • 3
  • Muhammed Ashraf Memon
    • 4
    • 5
    • 6
    • 7
    • 8
  1. 1.Department of Nutrition and DieteticsRoyal Brisbane & Women’s HospitalBrisbaneAustralia
  2. 2.Menzies Health Institute QueenslandGriffith University, Gold Coast campusSouthportAustralia
  3. 3.School of Human Movement and Nutrition Sciences, University of QueenslandBrisbaneAustralia
  4. 4.Sunnybank Obesity Centre and South East Queensland Surgery (SEQS)SunnybankAustralia
  5. 5.Mayne Medical School, School of MedicineUniversity of QueenslandBrisbaneAustralia
  6. 6.Faculty of Health Sciences and MedicineBond UniversityGold CoastAustralia
  7. 7.Faculty of Health Sciences, Mathematics and Computing, Australian Centre for Sustainable CatchmentsUniversity of Southern QueenslandToowoombaAustralia
  8. 8.Faculty of Health ScienceBolton UniversityBoltonUK

Personalised recommendations