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Multivitamins and Weight Maintenance

Introduction

No studies have examined the efficacy of multivitamin supplemention in preventing weight gain in non-overweight or obese patients.  Similarly, no clinical trials have evaluated their efficacy in promoting or maintaining weight loss.  However, there is compelling evidence supporting the use of multivitamins before, during, and after periods of caloric restriction to maintain adequate micronutrient status.   

Overweight and obesity

According to NHANES III, 27% of calories consumed by Americans come from energy dense, nutrient poor (EDNP) foods.  Rich in fats, oils, and sugars, EDNP foods are highly palatable, promote higher caloric intakes, and contribute to the development of overweight and obesity.  Eating patterns in which EDNP foods are consumed in place of nutrient-dense foods can result in the marginal intake of several micronutrients [1].

Weight loss diets

Micronutrient deficiencies, either overt or subclinical, can occur in people on weight loss diets or in others who restrict foods regularly.  However, data examining the micronutrient status of dieters is lacking.  Studies presenting nutrient intake data from subjects on weight control diets have shown a high prevalence of lower than recommended intakes of several micronutrients [2, 3, 4].  Intakes will vary with the type of diet consumed; the risk of deficiencies will also vary with the degree and duration of adherence.  Supplements containing vitamins and minerals at ≤ RDA or AI levels have a long history of use in low-calorie, weight reduction diets [5]. 

Weight loss maintenance after dieting

Maintaining a significant weight loss after dieting requires the intake of fewer calories than a previously non-obese person of the same weight due to a lowered BMR.  The risk of low micronutrient intake from food in people who have successfully maintained a weight loss might be increased.  However, a cross sectional study of successful dieters in the National Weight Control Registry database reported adequate intakes of vitamins A, C, E, and calcium [6].  Iron intake was low among women in this study.  No other micronutrients were assessed. 

Weight loss maintenance after bariatric surgery

Among patients whose weight loss is due to bariatric surgery, the need for regular supplementation with multiple micronutrients is well documented [7, 8], although no formal standards for supplementation are set [5, 9].  The most common nutritional problems, vitamin B12 and iron deficiencies, do not respond to supplementation with typical multivitamins due to inadequate dosage.  

Multivitamin supplements formulated for weight loss

Multivitamin preparations marketed to dieters often contain additional nutrient or non-nutrient (botanical) substances touted to promote/support weight loss.  B vitamins at levels > RDA are often added to compensate for their absence in high-protein, low carbohydrate (ketogenic) diets;  while chromium picolinate [10] and green tea extracts (EGCG) [11] are added to promote fat oxidation and increase metabolism.  The rationale for these and other additives is based on very limited evidence [12, 13], and there are no studies supporting their efficacy in combination with multiple micronutrients.

Critical thinking questions:

1. How does prolonged caloric restriction affect micronutrient status?

2. Are some dieters at risk of overdosing with multivitamins formulated at 100% DV?

3. What is the potential role of multivitamin supplementation in weight maintenance?

4. Are oral multivitamin supplements appropriate for all bariatric surgery patients?

5. Can specially formulated multivitamin supplements promote weight loss?

6. Could multivitamin supplementation affect eating behaviors in the overweight and obese?

Links:

From the Institute of Medicine:

• Dietary Reference Intakes (http://www.iom.edu/project.asp?id=4574)

• Weight Management: State of the Science and Opportunities for Military Programs (http://www.nap.edu/catalog/10783.html)

Professional Societies:

• American Dietetic Association – Position paper on Weight Management (http://www.eatright.org/cps/rde/xchg/ada/hs.xsl/advocacy_adar0802_ENU_HTML.htm)

• National Weight Control Registry (http://www.nwcr.ws/)