A low energy dense diet in the context of a weight management program improves appetite control in overweight and obese women

Background: Low energy density foods (LED) reduce energy intake (EI); whether this effect is sustained over time and during weight loss is unknown. Objective: This trial examined the effects of LED compared to high energy density (HED) meals on appetite, EI and control over eating in the laboratory and during a weight management program that encourages unrestricted intake of LED foods [Slimming World, UK (SW)] compared to a self-led Standard Care program [NHS weight loss plan (SC)]. Methods: Overweight and obese women (n=96;age:41.03±12.61 years; BMI:34.00±3.61 kg/m2) were recruited from SW- or SC-program. Primary outcomes included appetite, food preferences (liking and wanting for LED and HED foods), cravings and evening meal EI (LED, HED) in response to calorie-matched LED (≤0.8 kcal/g) and HED (≥2.5 kcal/g) breakfast and lunch meals. Probe day tests were conducted at weeks 3 and 4 and repeated at weeks 12 and 13 in a within-day cross-over design. Secondary outcomes including body weight and program experience were measured from week 1 to 14 in a parallel-group design. Dietary compliance was monitored using weighed food diaries at weeks 3 and 12. Results: Intention-to-treat (ITT) and completers-analyses showed SW lost more weight compared to SC [ITT:-5.9% (95%CI:-4.7, -7.2) versus -3.5% (-2.3,-4.8), p<0.05; completers:-6.2% (-4.8,-7.6) versus 3.9% (-2.5,-5.2), p<0.05]. SW reported greater control over eating and more motivation to continue the program compared to SC. LED meals increased sensations of fullness and reduced hunger on probe days (p<0.001). Total-day-EI was 1057±73 kcal less (95% CI:912, 1203;36%) under LED compared to HED (p<.001). Liking for LED and HED foods and wanting for HED foods were lower pre-lunch under LED compared to HED conditions and liking decreased to a greater extent after the LED-lunch. SW reported fewer cravings under LED compared to HED conditions (p<0.05). On probe days, appetite and EI outcomes did not differ between weeks 3 and 12 or SW- and SC-groups. Conclusion: LED meals improve appetite control in women attempting weight loss and the effect is sustainable. Consumption of LED meals likely contributed to weight loss in the SW-program.ClinicalTrials.gov #NCT02012426