Meal patterns and obesity. Does snacking play a role?

Abstract

Aims: To describe meal patterns, especially snacking, in obese subjects compared to areference population and to evaluate the importance of meal frequency in obesity treatment.Methods: Two cross sectional studies; 1. Women from the Swedish Obese Subjects (SOS)registry study (n=83) and SOS reference study (n=94); 2. Obese men (n=1891) and women(n=2368) from the XENDOS study (XENical in the prevention of Diabetes in ObeseSubjects) and SOS reference study, men (n=505) and women (n=587). 3. A retrospectiveanalysis on the relation between meal patterns and weight loss and adherence to life stylerecommendations including men (n=674) and women (n=705) who completed XENDOSfour-year clinical trial. 4. A one year clinical trial on weight loss in obese subjects (n=140)who were randomised to two regimes; 3 meals and no snacks (3M) and 3 meals and 3 snacks(3+3M). In all studies habitual meal and dietary intake were measured using a meal patternquestionnaire and SOS dietary questionnaire.Results: Obese women had a meal pattern deviating from the reference women with moresnacks especially during afternoon and evening. Obese subjects were more frequent snackersthan reference subjects and women were more frequent snackers than men. Snacks werepositively related to energy intake irrespective of physical activity, especially energy fromsweet, fatty food groups. After treatment energy intake did not increase with increasedsnacking frequency. In men adherence to the recommended 3 meals and 2-3 snacks/day waspositively related to weight loss but not in women. Weight loss was related to decreased fatintake, increased fibre intake and extra walking. Patients who completed the one year studychanged their snacking frequency in anticipated direction but there was no difference inweight loss between the two groups (3M vs. 3+3M = 4.1 kg ±6.1 vs. 5.9 ±9.4), notsignificantly different (p=0.31).Conclusions: Obese are more frequent snackers than reference subjects and women are morefrequent snackers than men. High snacking frequency increases energy intake, but intreatment subjects manage to cut down calories despite high snacking frequency.Recommending snacks or not does not influence weight loss. As life style changes aredifficult to adhere to it is of utmost importance that recommendations are evidence based.