Total diet replacements and meal replacement products: a means to solve the NHS’s budgetary problems?

Posted On: 11th January 2019

Total diet replacements and meal replacement products: a means to solve the NHS’s budgetary problems?

According to a recent investigation by The Sunday Times, joint replacement surgery for obese and overweight patients has risen dramatically in 2018. In total, more than 41,000 overweight patients got new hips and knees last year. This represents a 575 per cent increase in joint replacement operations which are reported to ‘have soared six-fold in only eight years from 6,191 in 2009-10 to 41,761 in 2017-18’. This increase probably reflects the rising prevalence of obesity in an ageing population and increasing sophistication of the surgical procedures. Osteoarthritis, the major cause for hip and knee replacement, cannot yet be prevented or slowed down, but the pain, immobility, social isolation and poor quality of life it causes can be addressed by use of total diet replacement products (TDRs) as has been shown in full scale clinical trials in Denmark.

With joint replacement surgery costing about £5,000 per operation, this sudden rise in the total number of operations is now expected to increase costs to the National Health Service (NHS) to £200 million a year, placing an even greater burden on NHS resources as some £6.1 billion are spent each year on overweight and obesity-related ill-health.

The figures revealed by The Sunday Times investigation, which were described as ‘horrifying’ by health officials, underline the scale and complexity of Britain’s obesity issues. To address these and reduce obesity, Prime Minister Theresa May’s NHS Long Term Plan – launched in Liverpool on Monday 7th January – included a set of actions to be taken by public authorities.

First, the NHS Long Term Plan aims to double enrolment in the type 2 NHS Diabetes Prevention Programme, a joint commitment by NHS England, Public Health England (PHE) and Diabetes UK. Second, and as indicated in a previous blog post, it also provides for the launch – by the NHS – of a trial programme supporting total diet replacement programmes for obese people with type 2 diabetes.

The introduction of this nine-month programme – which will initially be piloted in up to 5,000 patients who will be prescribed a liquid diet of just over 800 calories a day – comes after medical research emerged suggesting that TDRs can help patients who have type 2 diabetes to achieve remission. The preliminary results of Diabetes UK DiRECT study revealed for instance that a quarter of participants achieved a 15 kg or more weight loss using a low-calorie, diet-based, weight management programme, while almost half the participants (46%) receiving the programme were in remission after 12 months and were not taking medication for diabetes. The efficacy of TDRs was confirmed by the DROPLET trial set in a primary care environment, with similar weight loss being reported in obese individuals.

The UK-wide NHS costs attributable to overweight and obesity are projected to reach £9.7 billion by 2050 (according to figures from Public Health England). In this context, wider use of TDRs and meal replacement products (MRPs) could reduce the costs of obesity by reducing the prevalence of type 2 diabetes across the UK population. TDRs and MRPs could also – in some cases – reduce the need for anti-diabetes and anti-hypertension medications as well as reducing overall prescribing costs, thereby eventually relieving the NHS budget. A recent paper[1] by Seamus Kent and Susan Jebb from the University of Oxford showed that women who were approximately 10kg heavier at BMI 35 compared to those with BMI 31 require an additional £60 per annum in prescribing costs. TDR can deliver a 10kg weight loss maintained at one year in a primary care setting.

If you’d like to be part of the conversation, please get in touch with us via

[1] Body mass index and use and costs of primary care services among women aged 55–79 years in England: a cohort and linked data study. Kent S, Jebb S, Gray A, et al on behalf of the Million Women Study collaborators  2018 International Journal of Obesity