Mixed

An intensive weight loss intervention combining total diet replacement (800-850 kcal/day), behavioral support, and weight loss medication achieves and maintains >20% weight loss and improves cardiometabolic risk in adults with severe obesity (BMI ≥35 kg/m²) over 2 years.

For severe obesity, standard 'eat less, move more' advice often fails. This protocol uses a 2-year structured approach: start with a very low-calorie formula diet (800-850 kcal) for 12 weeks with weekly support. If you don't lose enough weight, add a GLP-1 medication. Then, gradually transition to a healthy, low-calorie diet while maintaining exercise. The key is the intensive support and the ability to 'rescue' the plan with formula meals or medication if you regain weight.