Total Diet Replacements (the ‘Soups and Shakes diet’): a scientifically proven, cost-effective weight-loss solution for diabetes remission and osteoarthritis in Europe

Posted On: 18th April 2019


Total diet replacements (TDRs) – weight loss diets of soups, shakes, bars and porridges – can turn back the tsunami of osteoarthritis, diabetes and other obesity-related comorbidities that threaten to overwhelm healthcare services across Europe. This was made evident yesterday at a University College Dublin seminar, led by trade body Total Diet & Meal Replacements Europe (TDMR Europe) and World Obesity Federation.

Speakers including the University of Glasgow’s Mike Lean, Mikael Fogelhom from the University of Helsinki, Henning Bliddal from Denmark’s Parker Arthritis Institute in Copenhagen, and the University of Oxford’s Nerys Astbury and Seamus Kent gathered to discuss what TDRs and meal replacement products (MRPs) can do to alleviate the suffering and economic cost of obesity related comorbidities, especially diabetes and osteoarthritis. The Scope-accredited seminar also heard the personal testimony of Joe McSorley from Scotland who successfully used TDRs to lose and maintain weight and put his diabetes into remission.

TDMR Europe, which works to deliver a positive policy environment for the total diet and meal replacement products sector, organised the seminar to educate and raise awareness of the effect of TDRs and MRPs against a rising tide of obesity and related diseases. TDRs and MRPs provide thousands of overweight and obese people with an effective, safe and controlled weight loss plan that can deliver immense health benefits, including remission of type 2 diabetes and alleviation of osteoarthritis symptoms.

Professor Anthony Leeds, Chair of TDMR Europe said:

“TDMR Europe is delighted to have worked with the World Obesity Federation to host this seminar, and their support underlines the importance of these products to tackle obesity and related co-morbidities across Europe.

“Total diet replacement programmes offer rapid, safe weight loss which in itself is highly motivating. However, they also provide major health improvements through large weight loss (usually 10kg in 8 weeks). This large initial weight loss is associated with diabetes remission, reduced pain in osteoarthritis, improved obstructive sleep apnoea and improved cardiovascular risk factors, as well as better weight maintenance a year later.

“Total diet replacement programmes are mostly provided by trained commercial weight management consultants, offering behavioural and lifestyle guidance, often on a one-to-one basis or in groups, but can also be delivered effectively after referral by GPs (primary care physicians). They are unquestionably cost effective as assessed by standard UK NHS/NICE methods.”

Professor Carel le Roux, University College Dublin, said:

“We now treat obesity like all other chronic diseases and we understand the value of meal replacement strategies which helps change the symptoms of hunger and lack of satiety in a subpopulation of people with the disease of obesity. For these people losing weight is effortless as the meal replacements addresses the underlying biology of the disease.”

Professor Mike Lean, University of Glasgow, said:

“Formula diets, as currently designed, have proved extremely safe and effective in helping people to lose substantial amounts of weight, and gaining remission of type-2 diabetes. Almost nine out of 10 people with type-2 diabetes were still in remission, not diabetic and not needing medications, a year later if they lost 15kg. After two years they have developed fewer serious medical conditions such as heart disease and cancers. I am concerned that the new criteria for composition of total diet replacements are not based on good science or practical understanding of their medical use. The changes will make these products less effective, more expensive and less safe.”

Joe McSorley, TDR user, said:

“While the total diet replacement is not a cure, it can put type 2 diabetes in remission, what happens after that is down to will power and lots of hard work in the gym to maintain the weight loss. In truth, it is a lifestyle change but one that for me has been worth it as I am no longer classed as diabetic, I have managed to reverse it.”

Professor Mikael Fogelhom, University of Helsinki, said:

“PREVIEW-study is one of the largest and longest randomized intervention to study the effects of diet and physical activity prevention of type 2 diabetes in pre-diabetic individuals. Compared to earlier studies, the use of an 800 kcal/day meal-replacement strategy during the first two months (= weight-reduction phase) was a new element. The main interest was to study the effects of a diet higher than normal in protein (and lower in carbohydrate), with a lower glycaemic load, combined with higher intensity exercise. The control condition included a “usual care” diet (with moderate protein, and higher carbohydrate content), and moderate-intensity physical activity.

“We did not find a difference between the two diets or the two exercise regimens; hence it seems that neither the carbohydrate-protein –ratio nor intensity of physical activity are critical factors in prevention of T2D. A large initial weight loss that is partly sustained by an intensive behavioural intervention over 3 years may be one explanation for the generally very low incidence of T2D (<6%).”

Professor Henning Bliddal, Director, Parker Arthritis Institute said:

“Obesity is widely acknowledged as a risk factor for both the incidence and progression of osteoarthritis and has a negative influence on outcomes. Loss of at least 10% of body weight, coupled with exercise, is recognised as a cornerstone in the management of obese patients with osteoarthritis, and can lead to significant improvement in symptoms, pain relief, physical function and health related quality of life. However, questions remain surrounding optimal management. With the Copenhagen programme, the greater proportion of individuals obtain a significant weight loss and this can be sustained in various ways over years afterwards. These results have been reached in spite of co-existing knee osteoarthritis, leading to the phrase that ‘bad knees are no excuse for not losing weight’.

 “It is a general notion that replacement of a bad kneed with an alloplasty will pave the way for weight loss; this has been shown not to be the case, on the contrary, a weight gain has been observed after the operation. The ageing population in Western Europe will lead to increasing numbers of elderly citizens at risk for knee osteoarthritis. With a parallel increase in prevalence of obesity, we are facing an enormous burden for the individuals and society with increased health expenses. Fundamentally, the soundest move against this development is a tight weight control, which should be sponsored by the health authorities at all levels.”

Dr Nerys Astbury, University of Oxford, said:

“The DROPLET trial showed that after 12 months people on total diet replacements lost on average 10.7kg (1 stone, 9lb), which was 7.2kg (1 stone, 1 lb) more than those only receiving the standard nurse-led programme of weight loss advice. This new analysis adds to that finding by strongly suggesting it’s also a cost-effective treatment for the NHS to offer, particularly in middle-aged and older adults.”

Dr Seamus Kent, University of Oxford, said:

“Studies like ours, which provide reliable estimates of the long-term impacts of weight management programmes on patients’ health and healthcare costs, are of real importance to enable the NHS to select the most clinically and cost-effective services for their patients.”