I'm very pleased to have the opportunity to speak with you today, because I believe that the information that will be presented can improve the care of your overweight patients. I will discuss the following three areas relating to weight control:

1. The definition of meal replacements
2. How to effectively use meal replacements
3. The research data showing that Slim·Fast is a safe and effective meal replacement for weight loss and long-term weight maintenance.

I have observed many patients who needed to lose weight for health reasons, but they did not have the knowledge of foods or meal planning to achieve their weight loss goals. Meal Replacements are an alternative for many such patients, because they provide a method for short-term success and the time to learn meal planning for long-term weight control. Because of time efficiency in prescribing Meal Replacements, it was proposed that Slim·Fast Meal Replacements could be an excellent tool for use by health professionals. To test this proposal, two steps were needed. First, scientific research was needed to validate that Slim·Fast is effective long-term and that it can be used safely in patients with the co-morbid conditions of obesity. Second, the information from these studies needed to be disseminated to health professionals so it could be easily incorporated in the office practice. Slim·Fast made the commitment to accomplish both these steps.

A series of research studies was initiated. The results of one such study was published this past month in the American Journal of Clinical Nutrition (vol. 69; 198-204, 1999), and a multi-center trial was published by Dr. Heber in the Journal of the American College of Nutrition (vol.13; 608-614, 1994). Both publications are included in your handout materials. In addition to these studies, Slim·Fast is sponsoring a number of other clinical studies.

Mayo Clinic and UCLA are investigating the use of meal replacements to reduce weight in patients with diabetes. Energy restricted diets are mandatory for effective management of most patients with type 2 diabetes, yet it remains one of the biggest challenges in health management. The studies at these two facilities will assist patients with type 2 diabetes, who do not require insulin, to lose weight and better control blood glucose.

There are also investigations being conducted at the University of Colorado on sleep apnea; the University of Nevada Dietetics Department on weight loss in obese women; Harvard, Tufts and Rutgers on bone health with weight loss; and a long-term study on weight loss in women at Luton Hospital in England.

Slim·Fast is also committed to the dissemination of information to physicians. This symposium, the material in your handout and the ability to order products for your office are all examples of how Slim·Fast is fulfilling this commitment. As new information becomes available, we will continue to inform you of these newer developments.

Before addressing the topic of Meal replacements, I would like to point out some myths about weight control that have been uncovered by Ann Fletcher, Dr. Jim Hill at the University of Colorado and Dr. Rena Wing at the University of Pittsburgh.

• Myth: "If you've been overweight since childhood, you'll always be overweight."


• Truth: Studies now show that large numbers of people who were overweight since childhood have been able to lose weight and keep it off.

• Myth: "If you've dieted and failed before, there's little hope of ever sustaining a weight loss."


• Truth: Significant numbers of people, most in fact, have tried and failed either to loss weight or to keep it off long-term. Much like in alcoholism, sustained weight loss may take a second, third, or even fourth try to be successful.

• Myth: "You can't lose weight on your own, let alone keep if off."


• Truth: More than half of the people in the National Weight Loss Registry reported by Drs. Wing and Hill lost weight on their own and kept it off for a minimum of five years.

• Myth: "If you start regaining weight, you're bound to gain it all back."


• Truth: Built into the program of Slim·Fast and many other programs are ways to stop the weight gain and then lose it again, a very important part of any weight control program.

• Myth: "You can't lose weight after 50."


• Truth: Significant numbers of patients who have lost weight and kept it off were over 50 years old when they started to lose weight and some already had co-morbid conditions associated with their obesity.

What Are The Key Attributes of a Successful Meal Replacement and Does Slim·Fast Have These Attributes? If you had the opportunity to develop a meal replacement strategy, what would be the most important attributes?

First, the meal replacement must taste good. If anyone is expected to incorporate a meal replacement into the diet for a lifetime, it must taste good. Slim·Fast Foods has promoted extensive research and development to optimize the taste of our products. State of the art technology is used to continually enhance the taste and consistency of Slim·Fast. I urge you to taste the various flavors to experience the advancements that have been made in these products. I think you will also be favorably impressed with our newest meal replacement product: "Meal On-The-Go" bars.

Second, the meal replacement must be filling. One must be satiated after consuming a meal replacement to remain on a weight loss program. Slim·Fast shakes are nutrient dense,11 fluid ounces and contain fiber, all of which can add to the sensation of fullness. The addition of a piece of fresh fruit to the meal replacement has also added to the success of some individuals.

Third, the meal replacement should be convenient to use. The ready to drink shakes are convenient, but are best served cold. The new Meal On-The Go bars offer the greatest convenience of a meal anytime, anywhere.

Fourth, the meal replacement should be economical and readily available. We are all concerned about the economics of health care. The average cost of a can of ready to drink Slim·Fast is $0.93 (Information Resource Inc. Food/Drug/Mass. 52 wks ending 3/21/99), much less than the meal it replaces. It is available in drug stores, grocery stores and mass merchandisers throughout the US. Meal On-The-Go bars are also less than $1.00 each.

Fifth, the meal replacement must be low in calories yet nutritious. Slim·Fast is only 200-220 calories, low in fat, contains protein, fiber, and is fortified with about 30-35% of the Recommended Daily Intake (RDI) of the essential vitamins and minerals (including 40% of the RDI for calcium). Combining the nutrients improves their utilization by the body.

Sixth, the plan should be easy to follow, include information about good eating habits, increased activity and methods for behavior change. The Slim·Fast Plan includes these important recommendations. Slim·Fast has partnered with Dr Kelly Brownell, an internationally renowned investigator in weight management, to publish a manual specific to Lifestyle modification with the use of Slim·Fast Meal Replacements.

Thus, all the important objectives for a successful long-term weight plan are included in the Slim·Fast Plan for weight loss and weight maintenance.

How to Use Meal Replacements with Your Patients

During the past 20 years, a number of research studies have documented the following methods for successful weight loss and maintenance using Slim·Fast Meal Replacements.

To lose weight, replace two meals with Slim·Fast and eat a sensible third meal. What is meant by that sensible third meal? This slide is representative of such a meal. The meal is only 540 calories, but because of the volume of low calorie vegetables and fruit, the meal is filling for most individuals.

To maintain weight, the most important part of any weight loss plan, replace one meal a day and eat sensibly the remainder of the day. If you start to regain weight, restart the Slim·Fast weight loss plan until that weight is lost and you stabilize again.

For sensible snacking, have a piece of fruit or a Slim·Fast snack bar, and drink plenty of water each day.

As you can see, the plan is easy to understand and follow, which is a major reason why it works for so many people.

Definitive Research Data Showing that Meal Replacements Work

I would like to present three research studies demonstrating the safety and efficacy of Slim·Fast. Two of the studies are published and included your folders. The studies lasted between one and four years and involve 509 patients. The first study is being carried out in a university obesity clinic and is now in its fourth year. The second study is a minimal intervention model to simulate a busy office practice. The third study compares maximal dietetic intervention, with and without Slim·Fast, in a university clinic.

A Two Year, Randomized, Controlled Trial

A randomized control trial of meal replacements for sustained weight loss was published this February in the American Journal of Clinical Nutrition. The study was divided into two periods. Period I was a three-month period in which a diet of 1200-1500 Calories was recommended to all patients. They also received instruction in behavior modification and physical activity. Patients were randomized to two groups. Group A patients were the control group and received a traditional, individualized diet of regular foods; Group B patients were instructed to use the same diet but were asked to replace two of the meals with a Slim Fast shake each day. As part of the daily plan, between meal snacks of a vegetable, fruit or Slim Fast snack bar (totaling 80 to 120 Calories each) were allowed. Results of Period I were as follows: Group A lost approximately three pounds. By contrast, the patients on the Slim·Fast plan, Group B, lost an average of 16 pounds, a significantly greater (p<0.005) weight loss than experienced by Group A.

As physicians, we are interested in weight loss, but we're also interested in the patient's health, as measured by glucose, insulin, triglycerides, and blood pressure. At the end of the three-month period, Group B patients showed about a 7% weight loss with an 8% reduction in blood pressure, a 10% reduction in fasting blood glucose concentration, over 35% reduction in fasting insulin concentration, and 22% reduction in triglyceride concentrations. However, there was virtually no change in these parameters in Group A patients, who did not lose substantial weight. It is also impressive that 100% of the patients remained in this study for the entire three-month period.

Period II was for evaluation of weight maintenance and lasted for 24 months. Both groups were prescribed the same 1500 calorie diet, low in fat and cholesterol, with one Slim·Fast meal replacement and snack replacement daily. So every patient, even those that had failed on the traditional diet, was prescribed one Slim·Fast meal replacement a day. What were the results of the weight maintenance period? Group A showed a gradual weight reduction during the subsequent 3 months, once they began one Slim·Fast meal replacement a day. At the end of the 24-month period, there was a significant weight loss of 14 pounds, or about 5% of the initial weight. Group B patients also lost additional weight to reach a total weight loss of 22 pounds.

What happened to the bio-markers of health in Group A, once they achieved this 5% weight loss? The bio-markers were significantly improved similar to that in Group B. Additionally, the bio-marker improvements were maintained in both groups for the entire study. The study indicates that if patients lose weight and keep it off, they can expect the improvement in bio markers to be sustained. The details of this study are available in your hand out materials.

A Multi-Center, Minimal Intervention Study to Mimic a Busy Office Practice

The second study used a minimal intervention model to evaluate the use of a meal replacement regimen to promote weight loss. This study tested the hypothesis that physicians could provide minimal instruction, yet promote significant weight loss in patients if meal replacements were prescribed. This was a five-center trial of 301 subjects, supervised by Dr. Heber. Subjects received five minutes of instruction by the health provider and a pamphlet about the use of Slim·Fast. They were weighed in on a regular basis by office personnel but received no further instruction. Ninety-one percent completed the weight loss period of twelve weeks. Those who had lost nine pounds were eligible to enter the two-year period of weight maintenance. The subjects were weighed every two weeks by office personnel. Men lost on average 18 pounds and women 14 pounds, both of which were about 8% of initial body weight. This is depicted graphically in the slide.

A University-Based Randomized, Prospective, Controlled Trial With Dietitians Using Slim·Fast

The third study I'd like to present is currently ongoing but I believe it is important to share the preliminary findings. This is a comparison between a physician office setting in which subjects receive minimal instruction (five minutes each month) and a group therapy environment in a dietitian practice, providing maximal intervention (75 minutes). One hundred and thirteen female subjects were randomized to one of three groups: Group 1 received maximal intervention to reduce calorie intake using dietitians and a psychologist to encourage behavior modification; Group 2 received maximal intervention similar to (1), but instead of just receiving instructions on reduced calorie diet, subjects are given Slim·Fast meal replacements and the Slim·Fast Plan; Group 3 received minimal instruction from a physician who prescribed Slim·Fast meal replacements. All groups received the LEARN manual for group and individual instruction.

Subjects receiving the maximal dietitian intervention program without Slim·Fast lost 6 pounds. By contrast, the Slim·Fast group showed significantly greater weight loss of 14 pounds. It is particularly noteworthy that the physician directed group lost almost 9 pounds.

Dr. Heber indicated that physicians can have a great influence on patients when they advise them to quit smoking. This study suggests that physician advice is extremely powerful in attaining significant weight loss.

Let me return now to my first slide which stated what many physicians say about weight loss.

"I don't have time in my practice." This is true for virtually all of us. The time to introduce the Slim·Fast plan takes less than five minutes of the physician time as demonstrated in the two studies I have presented.

"Weight is regained so why bother?" I've just shown you three studies that the Slim·Fast plan can be effective long-term.

"There is no effective program that I can use." Again, I've presented data showing that the Slim·Fast plan can be used in a busy office setting and it can be as effective as a more intensive program.

"I see patients for disease treatment, not weight management." As Dr. Heber has pointed out, 50% of patients in a series of primary practices already have one or more co-morbidities.