Total diet replacement helps shed pounds among individuals with obesity

A total diet replacement (TDR) programme produces greater weight loss among people with obesity as compared with support from a practice nurse, with the benefit persisting to at least 3 years, a study has found.

The TDR programme was implemented for 8 weeks, followed by food reintroduction over 4 weeks. In addition, behavioural support was provided weekly for the first 8 weeks, bi-weekly for the next 4 weeks, then monthly for 3 months. On the other hand, the usual care (UC) group received dietary advice and behavioural support from a practice nurse for up to 3 months.

The analysis included 272 participants eligible for follow-up, among whom 179 (66 percent) had available follow-up outcome data (96 [72 percent] from the TDR group and 83 [62 percent] from the UC group).

The mean baseline body mass index at baseline was 36.8 kg/m², with 20 percent of participants had a type 2 diabetes and 25 percent had hypertension. Most participants were middle aged, 55 percent were female, and 90 percent were white British.

At 3 years, weight decreased by 6.2 kg with TDR and 2.7 kg with UC (adjusted mean difference, −3.3 kg, 95 percent confidence interval [CI], −5.2 to −1.5; p<0.0001). TDR also showed greater regain from programme end at 6 months to 3 years (8.9 kg vs 1.2 kg with UC; adjusted mean difference, 6.9 kg, 95 percent CI, 4.2–9.5; p<0.001).

At 3 years, TDR also led to greater reductions than UC in diastolic blood pressure (mean difference −3.3 mm Hg (95 percent CI, −6.2 to −0.4; p=0.024) and systolic blood pressure (mean differences −3.7 mm Hg (95 percent CI, −7.4 to 0.1; p=0.057).

There was no significant between-group difference in HbA1c (−1.9 mmol/mol, 95 percent CI, −0.7 to 4.5; p=0.15), low-density lipoprotein cholesterol concentrations (0.2 mmol/L, 95 percent CI, −0.3 to 0.7; p=0.39), and cardiovascular risk score (QRISK2; −0.37, 95 percent CI, −0.96 to 0.22; p=0.22).