Sustained Visceral Fat Reduction with Muscle Preservation in Obesity Management Using Intensive Lifestyle Modification and Meal Replacement: A 4-Year Follow-up Case Report

Background: Obesitypresents a globalhealth challenge, yet sustained weightloss with favorable body composition remains difficult. This case demonstrates the efficacy of intensive lifestyle modification (ILM) combined with meal replacement (MR) in achieving significant, sustainable weight loss over 4 years. CasePresentation: A 52-year-old Thai female with severe obesity(BMI 44.1 kg/m², weight 102 kg, height 152 cm) enrolled in an ILM+MR program including: (1) soy- based meal replacement twice daily for 8 weeks, (2) nutritional counseling, (3) structured physical activity, and (4) behavioral modification through group therapy. Results: At 8 weeks: weight 86 kg (15.7% reduction), BMI 37.2 kg/m², waist 42 inches (6-inchreduction), fat mass decreased 8.2%,muscle mass increased 2.1%, visceral fat level reduced from 30 to 24. At 1 year: weight 70 kg (31.4% reduction), BMI 30.2 kg/m², demonstrating progression from Class III to Class I obesity. At 2 years: weight 59 kg (42.2% reduction), BMI 25.5 kg/m² (overweight category). At 3 years: weight 58 kg (43.1% reduction), BMI 25.1 kg/m². At 4 years: weight 53 kg (48.0% sustained reduction), BMI 22.9 kg/m² (normal weight), with exceptional body composition showing 29.5% body fat, 26.8% musclemass, and visceralfat level of 6. Conclusion: Intensive lifestyle modification with meal replacement achieved remarkable weight loss of 48.0% maintained over 4 years with exceptional body composition changes. This case demonstrates extraordinary long-term efficacyin a patient with severe obesity, achieving and maintaining normal BMI with sustained improvements in metabolic health markers.