The obesity epidemic is a worldwide problem. In fact, global obesity is worsening and has negative implications regarding both physical health and economic health. 
 
Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health. According to the World Health Organization (WHO), in 2016, more than 1.9 billion adults aged 18 years and older were overweight. Of these over 650 million adults were obese.¹
 
The nutritional status of obese individuals can be negatively affected if they consume food of poor diet quality, leading to inadequate intake of macronutrients and micronutrients.2 The WHO characterizes the coexistence of micronutrient deficiency along with overweight or obesity, or diet-related non-communicable diseases within individuals and populations as the “double-burden of malnutrition.”  
 
The Double-Burden of Malnutrition Has No Geographical Barriers
According to the WHO, the double-burden of malnutrition affects all regions worldwide.¹ The U.S. population as a whole has been shown to overconsume high-calorie, low-nutrient processed foods as the modern Western diet provides an excess of digestible carbohydrates, saturated fats, and salts, while being deficient in key macronutrients and micronutrients such as proteins, dietary fibers, vitamins, and minerals resulting in inadequacies and/or deficiencies in certain nutrients.1,2 
 
While an individual’s genetics, social or environmental factors, and even interactions between foods play a role in nutritional inadequacies and/or deficiencies, poorly-balanced nutrient intake can also elevate the risk of developing non-communicable diseases, such as type 2 diabetes and cardiovascular diseases, which are more prevalent in obese individuals.^2,3
 
While there are continued efforts in the nutrition research community to better understand the factors underlying nutritional inadequacies in the overweight or obese state, effective and economical strategies and practical solutions need to be researched.
 
A Clinical Study: Improvement of Macronutrition and Micronutrient Intake by a High-Protein Partial Meal Replacement Diet in Overweight and Obese Individuals
To investigate the effect of a High Protein Partial Meal Replacement (HPMR) diet on nutrient intake in overweight and obese people, an open-label, single cohort trial was conducted.
 
Fifty overweight or obese (healthy otherwise) subjects were enrolled to consume two HPMR shakes daily that replaced breakfast and lunch. The study consisted of a 1-week run-in followed by a 112-day study period. A 500 kcal + 20% deficit diet was adopted based on predicted Total Energy Expenditure (TEE), and those unable to adhere to the deficit were excluded during the 1-week run-in period. Each shake provided 16.5 g of protein, 3.5 g of fiber, and a mixture of 13 vitamins and 13 minerals, at 145 kcal. A validated on-line application (DietMaster Pro, Lifestyles Technologies, Inc) was employed to record food consumption (three days per month) and to calculate the intakes of macronutrients and 15 selected micronutrients during run-in period (Day -7 to 0) and at the end of the study (Day 112).
 
Validation of HPMR on Nutrient Intake in Overweight and Obese Individuals
Thirty-seven participants completed the study. The HPMR diet was well-tolerated, and similar results were obtained from both modified Intent-To-Treat (n=43) and Per-Protocol (PP) (n=25) analyses. The mean TEE of the PP subjects was 2381.27 ± 502.41 calories, and there was no significant difference in calorie intake at all timepoints compared to baseline (1758 kcal at Day 0, 1722 kcal at Day 112). 
 
The HPMR diet led to an overall improvement in diet quality over the course of the study. Significant decreases in fat and cholesterol intake and substantial increases in protein and fiber intake were observed at all time points (p<0.005 at each time point). Dietary intake of all micronutrients tested, including nutrients of U.S. public health concern (vitamin D, calcium, and potassium) increased significantly at all time points from baseline, and sodium intake significantly decreased (p<0.004 at each time point). 
 
Note: Data to be presented at the Food and Nutrition Conference and Expo, Philadelphia, PA—Oct. 26-29.
 
Is High Protein Partial Meal Replacement an Effective Strategy?
Considering that those who are overweight or obese are likely struggling to consume a nutrient-balanced diet, the HPMR diet may be an effective strategy to enhance overall nutrition quality of their diet. The HPMR diet could be incorporated into a healthy lifestyle program that includes healthy eating and exercise for those at risk for macronutrient and micronutrient deficiencies.
 
Further studies would help to verify the results physiologically by analyzing the levels of nutrient-related biomarkers in the blood, and also to investigate if improvement of nutrient intake leads to specific health benefits associated with meeting nutrient needs, such as enhanced weight loss and risk reduction of non-communicable diseases in overweight and obese individuals. 
 
References
1. World Health Organization, Double burden of malnutrition. Accessed October 2nd, 2019.
 
2. Astrup A & Bügel S. Overfed but undernourished: recognizing nutritional inadequacies /deficiencies in patients with overweight or obesity. Int. J. of Obesity. 2019; 43:219–232.
 
3. Casas R, Castro-Barquero S, Estruch R, Sacanella E. Nutrition and Cardiovascular Health. Int J Mol Sci. 2018;19(12): 3988.