A random sample of 1167 overweight participants (female = 979, male = 188; body mass index (BMI) ≥ 25 kg/m2) has been included in the weight loss program in 250 Austrian primary care settings.
Data of men and women who attended the program at least 12 months without interruption have been analyzed, and their results were compared with their baseline data. Exclusion criteria were BMI < 25 kg/m2, diabetes mellitus, being pregnant or lactating, cardiovascular disease, other medical conditions prohibiting weight loss, substance abuse, severe psychiatric illness, and eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder). The corresponding descriptive statistic is presented in Table 1.
The procedures used in this evaluation were in accordance with the Declaration of Helsinki (1964) and its later amendments. The study is approved and registered under No 2107/2013 of the ethics committee of the Medical University of Vienna. All participants gave their written informed consent prior to their inclusion into the program.
The myLINE®-program (www.myline.at, AENGUS, Austria) is a standardized, meal replacement-based weight loss program for at least 24 weeks. The diet is in accordance with the latest nutritional recommendations of the German Nutrition Society (DGE), the Austrian Nutrition Society (ÖGE), the Swiss Nutrition Society (SGE), and the Swiss Association for Nutrition (SVE), which are called DACH-recommendations.
The program consists of four phases:
During the first 2 days, the participants use exclusively a very low-calorie diet. Five meal replacements should be eaten on a regular basis every 3 h.
Total energy intake: 835 kcal/day, 60.0 g/day of protein, 15.5 g/day of fat, and 100.0 g/day of carbohydrates.
Beginning with the third day, two out of three meals should be replaced by an energy-reduced standard diet for weight control, and one meal should be eaten as regular fat-reduced food.
Participants are trained in creating their meal according to an exchange schema. The total fat content is ≤ 30 % of the daily energy intake. The reduction phase should be undertaken until the participant achieves two-thirds of the intended weight reduction, but at least for 10 weeks.
Total energy intake: 1000–1300 kcal/day, 50–65 g/day of protein (~ 20 energy percent (E%)), 34–44 g/day of fat (~ 30 E%), and 125–160 g/d of carbohydrates (~ 50 E%). For persons with a high body cell mass (BCM), the content of proteins would be individually adjusted.
The beginning of the transitional phase is determined individually, but the participant should have performed the phase 3 for at least 10 weeks. In this phase, at least one meal should be replaced and the other two should be eaten as a fat-reduced mixed meal.
Total energy intake: 1300–1600 kcal/day, 50–65 g/day of protein (~ 20 E%), 34–44 g/day of fat (~ 30 E%), and 160–200 g/day of carbohydrates (~ 50 E%). For persons with a high BCM, the content of proteins would be individually adjusted.
Due to the acquired knowledge on how to arrange their meals correctly and how to adjust their energy intake to their daily requirements, the participants should maintain their weight without meal replacements. In this phase, they should eat three meals per day regularly.
During the whole program, at regular intervals (start, reduction, and transition phase: every 14 days; stabilization phase: once a month; afterward four times a year), the participants were measured by bioelectrical impedance analysis (BIA) and conventional anthropometry and received individual nutritional advice from a registered dietician. In the context of individual face-to-face consultations, aims and treatment plans, also including improvement of the activity level in accordance with the actual recommendations, are defined. A nutrition and activity diary for self-reflection and a participant handbook for support and exercises at home are used as instruments of behavior therapy.
After the weight reduction, there is the possibility to participate in a follow-up program. Regular controls should improve long-term weight loss and weight maintenance.
The declaration of all products took place at the Austrian Federal Ministry of Health as foods intended for use in energy-restricted diets for weight reduction. All products are in accordance with the directive 96/8/EG of the European dietetic food regulation. Furthermore, products undergo regular laboratory controls and are only available in primary care units in combination with regular follow-up examinations .
Measure of body composition
The measurement of body composition was performed by conventional anthropometry (weight, height, waist circumference) and BIA (AKERN BIA 101®, BIACORPUS RX 4000®, Software Bodycomp version 8.4 professional).
Statistical analysis was performed by SPSS for Windows Version 17.0 (SPSS Inc., Chicago). All results are presented as mean ± standard deviation (SD). Differences in the distributions of variables between men and women were tested by Student’s t-test for two independent samples (in case of normally distributed variables) and by Mann–Whitney U-test for two independent samples (if variables were not normally distributed). Comparison between baseline and 12 months was done using analysis of variance. p-Values < 0.05 were considered as significant.