A meal replacement intervention delivered in a specialist service achieved clinically meaningful weight loss and improved metabolic and psychological outcomes in a predominantly Māori and Pacific population of adults with obesity and significant comorbidities. Participants (n = 128) had been declined bariatric surgery, were young adults with type 2 diabetes, or had been deferred from a corneal transplant because of their weight. Participants received a 12-week, meal replacement low energy diet, with adjunctive obesity medications available under pre-specified criteria. At baseline, mean body weight was 145.0 kg, body mass index was 49.9 kg/m2, and 73% of participants were receiving treatment for type 2 diabetes (mean glycosylated haemoglobin [HbA1c] 67.6 mmol/mol). Overall, 72% of participants completed the intervention, and achieved a mean weight loss of 10.9 kg. Among those with diabetes, 67% completed the intervention, with 33% achieving an HbA1c <50 mmol/mol on no diabetes medication. Mean psychological and quality of life scores improved.
