May 29, 2018

expert reaction to conference abstract (unpublished work) on the low energy total diet replacement treatment for obesity, presented at the European Congress on Obesity

Researchers presenting at the European Congress on Obesity in Vienna report unpublished work on the low energy total diet replacement treatment for obesity.

Comment from study author:

Prof Susan Jebb, Professor of Diet and Population Health, University of Oxford, said:

“This abstract reports headline data from our recent trial.  It is not the full paper, which is still under review.

“A Total Diet Replacement programme (TDR) is not just a diet, it’s a programme that includes a short period of intense dieting together with behavioural support.  This support programme continues beyond the end of the diet to help people return to usual food.

“In this study, we tested an intervention where normal food was entirely replaced with specially formulated, nutritionally complete, shakes, soups and bars for 8 weeks, followed by 4 weeks during which food was gradually reintroduced, and a further 12 weeks of continued support to help maintain weight loss.  Throughout the course of the 24-week programme, participants had weekly support sessions with a counsellor that included goal setting and feedback, encouragement, reassurance and support to adopt and maintain a healthy diet.

“People who wanted support to lose weight were offered the opportunity to enter a trial.  We measured weight change from the start to 1 year and found, on average, that people were about 10 kg lighter, which was 7 kg greater weight loss than the control group who were offered a weight management programme provided by the practice nurse.  We conclude that this total diet replacement programme is significantly more effective for weight loss than programmes usually offered in primary care to treat obesity.

“The results may be applicable to programmes with a diet of similar calorie intake and a comparable level of behavioural support.  But the results should not be extrapolated to the use of low calorie diet products alone, without support.

“This is an intensive intervention only suitable for people who are motivated to follow such a programme.  There are a small number of providers who offer this type of programme with appropriate diet products and the behavioural support which is a necessary component.  This trial provides reassurance that total diet replacement with behavioural support is a safe and effective way to lose weight.  Whether or not this type of treatment should be offered by the NHS depends on the cost-effectiveness of the programme and we will publish details on this in due course.”

Third-party comments:

Prof Tom Sanders, Professor emeritus of Nutrition and Dietetics, King’s College London, said:

“These participants were very fat with a BMI of 37 kg/m2.  While this approach may be OK for this group, the results cannot be generalised to the average man or woman who typically is overweight (BMI 25-29.9).  The weight loss is greater with very low calorie diets than the moderate calorie reductions used by groups such as Weight Watchers and Slimming world.

“In my opinion, the use of very low calorie meal replacement diets may be useful if a patient has a BMI greater than 35 which prevents them having surgery for other conditions such as renal transplantation.”

Dr Simon Cork, Research Fellow in the Division of Diabetes, Endocrinology and Metabolism, Imperial College London, said:

“Whilst low energy total diet replacement (TDR) shows superior weight loss in this clinical trial, previous studies have shown that low calorie diets do not provide long-term weight loss.  Owing to changes in how our body handles energy in the face of restricted calories, weight gain following such diets occurs in almost all people.  Studies have also shown that resting metabolic rate (the amount of energy used in order to stay alive) decreases with low calorie diets, which can ultimately lead to weight gain.  Also, given the significant change in lifestyle required for this diet (all meals swapped to a commercial low calorie diet), it would be interesting to see how many people stick to this diet long term if it were rolled out nationally.  Before such diets are recommended for national use, longer-term trials need to be conducted to better understand the implications on long term weight loss.”

* Abstract title: ‘Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET): results of a randomised controlled trial’ by N. M. Astbury et al.  This is a conference abstract from the European Congress on Obesity (ECO).  There is no paper as this is not published work.

Declared interests

Prof Susan Jebb: “Susan Jebb is one of the authors of this study.  This was an investigator-initiated study but it was mainly funded by Cambridge Weight Plan.  The funders of the study had no role in the design of the protocol, data collection, analysis or interpretation of the results.  The study was conducted and analysed in collaboration with an NIHR accredited Clinical Trials Unit.  The investigators have no personal financial relationships with the funder.”

Prof Tom Sanders: “Honorary Nutritional Director of HEART UK.  Scientific Governor of the British Nutrition Foundation.  He is now emeritus but when he was doing research at King’s College London, the following applied: Tom does not hold any grants or have any consultancies with companies involved in the production or marketing of sugar-sweetened drinks. In reference to previous funding to Tom’s institution: £4.5 million was donated to King’s College London by Tate & Lyle in 2006; this funding finished in 2011. This money was given to the College and was in recognition of the discovery of the artificial sweetener sucralose by Prof Hough at the Queen Elizabeth College (QEC), which merged with King’s College London. The Tate & Lyle grant paid for the Clinical Research Centre at St Thomas’ that is run by the Guy’s & St Thomas’ Trust, it was not used to fund research on sugar. Tate & Lyle sold their sugar interests to American Sugar so the brand Tate & Lyle still exists but it is no longer linked to the company Tate & Lyle PLC, which gave the money to King’s College London in 2006.  Tom also used to work for Ajinomoto on aspartame about 8 years ago.  Tom was a member of the FAO/WHO Joint Expert Committee that recommended that trans fatty acids be removed from the human food chain. Tom has previously acted as a member of the Global Dairy Platform Scientific Advisory Panel and Tom is a member of the Programme Advisory Committee of the Malaysian Palm Oil Board. In the past Tom has acted as a consultant to Archer Daniel Midland Company and received honoraria for meetings sponsored by Unilever PLC. Tom’s research on fats was funded by Public Health England/Food Standards Agency.”

Dr Simon Cork: “None that I can think of.”