HMR program

Definition

The Health Management Resources (HMR) program combines a commercial diet with exercise as well as behavioral and lifestyle changes developed by the company, HMR. It is focused on rapid weight loss followed by ongoing weight management. The HMR program diet consists of purchased meal replacement foods, including low-calorie shakes, meals, and nutrition bars, eaten in place of meals and snacks. Fruits and vegetables are eaten to supplement the meal replacements and replace higher calorie foods. The HMR program may be supervised by clinical staff and/or health coaches at medical centers and other health facilities, or it may be followed by individuals at home.

Origins

Merck states that this subsidiary “provides comprehensive, evidence-based weight management interventions for employers, hospitals, medical groups, health plans, and patients. These scalable weight management interventions combine a structured diet, behavior coaching and monitoring, and physical activity to achieve clinically meaningful weight loss that can help reduce the risks of chronic illnesses, such as diabetes and cardiovascular disease.” HMR programs are delivered in U.S. hospitals and health systems, and medical centers and by physician groups, where they have been recommended for patients requiring rapid weight loss, such as morbidly obese individuals being considered for bariatric surgery and very overweight or obese individuals with diabetes or high blood pressure. These programs are very structured and medically supervised. HMR then introduced a less structured program for at-home weight loss called Healthy Solutions at Home. Participants in this program have the option to receive diet and coaching support online and by phone. The at-home program is available via the HMR website ( https://www.hmrprogram.com/healthy-solutions-at-home-dietplan ). All of the HMR programs are trademarked.

Description

In 2016, 2017, and 2018, U.S. News & World Report ranked the HMR program as the top diet for fast weight loss. Components of the in-clinic program include medical screening prior to starting the diet, lifestyle education, group support, and ongoing medical supervision for certain participants. The need for medical supervision is determined by an evaluation of body mass index, medical history, and desired weight loss; usually, those with forty or more pounds to lose are supervised. The at-home Healthy Solutions program is available for individuals who wish to lose weight and do not have a medical condition (e.g., diabetes) that requires supervision while dieting.

Individuals participating in the in-clinic HMR program usually start with the medically supervised HMR Decision-Free diet, which restricts caloric consumption to only 500 to 800 calories daily. Only HMR meal replacements are allowed, with no added fruits or vegetables. Depending on their progress, individuals may then progress to the Healthy Solutions diet. According to HMR, dieters do not require medical supervision if their daily caloric consumption is 1,200 calories on the HMR program. Some individuals may still require medical supervision as they progress due to a medical condition.

The Healthy Solutions plan consists of two phases—a “quick start” phase and a maintenance phase. The goal of the first phase is rapid weight loss as quickly as possible. HMR provides a kit with all the foods needed for the first three weeks of phase one; the individual only needs to shop for fruits and vegetables to supplement the HMR foods. According to the HMR website, the meal replacements included in the kit are 48 servings of HMR shakes, 42 HMR entrees that can be selected/customized, and 18 servings of HMR multigrain hot cereal. The dieter adds five one-cup servings of fruits and vegetables. HMR also provides support guides, a recipe book, an HMR tracking app for smart phones, and online tools. HMR offers free shipping with automatic delivery every two weeks after the initial three weeks. With an automatic delivery subscription, HMR provides free weekly health coaching to help with improving healthy lifestyle choices.

The Healthy Solutions at Home program uses a 3+2+5 structure—daily food consumption includes three HMR shakes, two HMR entrees, and five servings of fruits and vegetables. Weekly 50-minute group health coaching sessions provide the dieter with motivation, accountability, advice on dealing with challenges, and assistance with personalized meal and physical activity planning. In this phase, HMR advises that dieters avoid restaurants, coffee shops, and social or work activities that focus on food. Alcohol is also prohibited. Health coaches encourage establishing regular exercise with the goal of burning approximately 2,000 calories per week. Online resources such as discussion groups, progress charts, success stories, and informational articles are also available.

According to U.S. News & World Report, as of 2018, the HMR Quick Start kit cost approximately $300, with discounts and special offers available for new customers. The standard two-week automatic delivery kit cost $185. HMR foods can also be purchased individually; entrees cost $3.70 per serving, and shakes, cereal, and soup range in cost from $2.00 to $2.50 per serving.

Function

The HMR program is designed specifically for rapid weight loss over a shorter time period than other types of diets. Medically supervised programs allow the program to be adapted for severely obese and overweight individuals with medical conditions that would benefit from weight loss. At-home programs are appropriate for overweight individuals who do not require medical supervision while dieting.

Benefits

According to HMR, weight loss on the Decision-Free plan ranges from 48 to 66 pounds over 12 to 26 weeks; total average weight loss exceeds 100 pounds for overweight and obese adults. Average weight loss for the Healthy Solutions at Home program with phone coaching was 23 pounds (10.4 kg) after 12 weeks. In comparison, average weight loss without coaching was 13 pounds (5.9 kg) after 12 weeks.

The HMR program is ideal for those who do not enjoy meal planning and preparation and find resisting high-calorie foods challenging. Having readily available prepared meals and snacks also makes it easy to maintain one's diet while working. Delivered and prepared HMR foods also reduce time spent grocery shopping and cooking.

A recent study found that some HMR dieters were able to stop medications for hypertension, high cholesterol, and diabetes as they lost weight and their symptoms improved after the weight loss.

Precautions

Individuals on the HMR diet with daily calorie consumption of less than 1,200 calories per day require medical supervision. Those with diabetes, cardiovascular disease, and other medical conditions also require supervision, possibly even on the higher calorie plan.

Dieters with gluten or lactose intolerance or religious restrictions may have limited choices from the HMR foods. Ingredients should be diligently checked before eating if the dieter has allergies or other food restrictions.

KEY TERMS
Atherosclerosis—
A thickening of the artery walls that impedes the flow of blood supplying the heart, brain, and other organs.
Bariatric surgery—
A surgical procedure that involves restructuring parts of the gastrointestinal tract or inserting specially designed devices (e.g., a balloon or sleeve) to promote weight loss in morbidly obese and very overweight individuals.
Cardiovascular disease (CVD)—
Disease affecting the heart and blood vessels.
Hypertension—
Abnormally high arterial blood pressure, which if left untreated can lead to heart disease and stroke.
Obesity—
Excessive weight due to accumulation of fat, usually defined as a body mass index of 30 or above or body weight greater than 30% above normal on standard height-weight tables.
Overweight—
A body mass index between 25 and 30.
Type 2 diabetes—
A condition in which the body does not properly utilize glucose due to insulin resistance or decreased insulin production.

Risks

Because HMR foods are prepackaged, they may contain some additives that are best avoided. For example, corn syrup, fructose, sucrose, saccharin, and sugar can have harmful effects on metabolism and weight gain. The soy protein isolate may be unsafe, and some people experience rashes, bloating, constipation, and headaches, in addition to other concerns about soy's effects on hormones. The artificial flavors, thickeners, and binders have been known to cause problems for some people, and some of them have been suggested to possibly have cancer-promoting effects. Partially hydrogenated soybean oil is a form of trans fat, which can cause obesity and cardiovascular disease.

Research and general acceptance

QUESTIONS TO ASK YOUR DOCTOR

Research indicates that both the in-clinic and at-home HMR programs can be effective for fast weight loss. Three published studies reported that a weight loss of 48 to 66 pounds (21.8 to 29.9 kg) over 12 to 26 weeks was possible for overweight and obese adults on the Decision-Free diet. In two of those studies, average total weight loss was greater than 130 pounds (59 kg). Four published studies reported weight losses of 28 to 37 pounds (12.7 to 16.8 kg) over 12 to 26 weeks for individuals using the at-home Healthy Solutions diet. In comparison to weight loss counseling only, study participants on the HMR program lost almost 30 pounds (13.6 kg) more over six months. Health systems licensing the HMR in-clinic programs have reported that patients lost almost 20% of their body weight after a year on the diet.

The most recent study of the in-clinic HMR program was published in April 2018 and retrospectively evaluated outcomes for 500 patients participating in HMR weight loss clinic programs across the United States. Researchers found that patients achieved clinically significant weight losses of 15% to 17% of their body weight over six months. Those who participated for up to two years lost even more weight. Patients with the highest BMIs achieved the greatest weight loss, regardless of comorbidities. In addition, approximately 22% of HMR patients were able to discontinue use of medications for high cholesterol, 39% were able to discontinue use of medications for hypertension, and 40% were able to discontinue use of medications for diabetes. This resulted in reduction of medication side effects and improvements in quality of life.

Resources

BOOKS

Kazaks, Alexandra, and Judith S. Stern. Nutrition and Obesity: Assessment, Management, and Prevention. Burlington, MA: Jones & Bartlett, 2013.

Nix, Staci, and Lillian Mowry. Williams' Basic Nutrition and Diet Therapy. 15th ed. St. Louis, MO: Elsevier, 2017.

PERIODICALS

Anderson, J. W., L. Grant, L. Gotthelf, et al. “Weight Loss and Long-Term Follow-up of Severely Obese Individuals Treated with an Intense Behavioral Program.” International Journal of Obesity 31, no. 3 (2007):488–93.

Anderson, J. W., L. R. Reynolds, H. M. Bush, et al. “Effect of a Behavioral/Nutritional Intervention Program on Weight Loss in Obese Adults: A Randomized Controlled Trial.” Postgraduate Medicine 123, no. 5 (September 2011): 205–13.

Donnelly, Joseph E., Jeannine Goetz, Cheryl Gibson, et al. “Equivalent Weight Loss for Weight Management Programs Delivered by Phone and Clinic.” Obesity 21, no. 10 (October 2013): 1951–59.

Gotthelf, Linda, Ya-Ting Chen, Srinivasan Rajagopalan, et al. “High Intensity Lifestyle Intervention and Long-Term Impact on Weight and Clinical Outcomes.” PLoS 13, no. 4 (April 2018): e0195794.

Torres-McGehee, Toni M., Kelly L. Pritchett, Deborah Zippel, et al. “Sports Nutrition Knowledge among Collegiate Athletes, Coaches, Athletic Trainers, and Strength and Conditioning Specialists.” Journal of Athletic Training 47, no. 2 (2012): 205–11.

WEBSITES

Best Diet Rankings. “HMR Program.” U.S. News & World Report. https://health.usnews.com/best-diet/hmrprogram (accessed May 29, 2018).

HMR Weight Management Services. “HMR.” Merck & Co. https://www.hmrprogram.com (accessed May 29, 2018).

ORGANIZATIONS

Academy of Nutrition and Dietetics, 120 S. Riverside Plaza, Ste. 2190, Chicago, IL, 60606-6995, (312) 899-0040, (800) 877-1600, amacmunn@eatright.org, http://www . eatright.org .

American Society for Nutrition, 9211 Corporate Blvd., Ste. 300, Rockville, MD, 20850, (240) 428-3650, Fax: (240) 404-6797, http://www.nutrition.org .

American Heart Association, 7272 Greenville Ave., Dallas, TX, 75231, (888) 242-8883, help@onlineaha.org, https://www.onlineaha.org .

British Nutrition Foundation, New Derwent House, 69-73 Theobalds Rd., London, United Kingdom, WC1X 8TA, +44 20 7557-7930, postbox@nutrition.org.uk, http://www.nutrition.org.uk .

Center for Food Safety and Applied Nutrition, Food and Drug Administration, 5001 Campus Dr., HFS-009, College Park, MD, 20740-3835, (888) 723-3366, https://www.fda.gov .

Jennifer E. Van Pelt, MA

  This information is not a tool for self-diagnosis or a substitute for professional care.