Low-calorie formula diets in type-2 diabetes - a useful strategy or dispensable?

Formula diets may lead to a rapid weight loss within a few weeks and are therefore highly effective in the short-term compared with a standard diet and moderate calorie restriction. However, the long-term effects of meal replacements do not yield better results in 4aEuro to 5aEuroyear follow-up studies. Strategies to maintain weight loss are essential after the implementation of very low calorie diets. Sustained success is only to be achieved by a comprehensive approach of lifestyle intervention consisting of dietary and food education, exercise, and behavioral treatment. Modern dietary concepts for diabetes suggest a choice of different options individually tailored for personal preferences and metabolic considerations. A Mediterranean diet with a high content of monounsaturated fatty acids may also be suitable as a low carbohydrate and high protein diet. Due to their rare but relevant side effects, formula diets without medical supervision should be viewed critically. However, over-the-counter products and strong marketing campaigns may facilitate improper use of meal replacements. Not only the yo-yo effect seen after low-calorie formula diets, but also lack of adherence seem to be based on multiple pathophysiological processes, such that formulas might interfere with the body's complex, and as yet insufficiently understood, weight regulatory mechanisms. Overall, the benefits of formula products do not compensate for the reduced quality of life associated with these diets and the rationale for their use in weight management remains to be established.