Dr Nerys Astbury: the future of TDRs

Posted On: 8th July 2019


“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 Nerys Astbury, senior researcher at the department of primary care at the University of Oxford, is interested in how dietary manipulations affect weight management and the regulation of energy intake. She is currently working on developing a weight loss toolkit which will utilise total diet meal replacements (TDRs) to help people manage their weight, including for the attenuation of weight gain during pregnancy. Her previous research has shown that TDRs followed by food reintroduction and a solid maintenance programme can be used effectively in a community setting after being referred by a GP practitioner.

The DROPLET trial successfully demonstrates that TDRs are an acceptable form of treatment to be delivered in routine care after a referral

Dr Astbury discusses what makes the DROPLET trial different from its predecessors. Previously, trials involving TDRs for diabetics and overweight patients have been carried out in controlled situations, such as intense research settings or specialist obesity clinics. The DROPLET trial successfully demonstrates that TDRs are an acceptable form of treatment to be delivered in a community setting after referral in routine care.

So, what does the future hold for TDRs? Co-payment as a solution to offset some of the cost of the treatment

Dr Astbury says that, given the results of the DROPLET study and others that have come before it – particularly the DiRect study led by Professor Mike Lean – we know that TDRs can be an effective treatment for obesity and Type 2 diabetes. As a result of this, the NHS has committed to piloting a scheme for 5000 people to trial the use of TDRs. Dr Astbury admits that payment of the programmes may be an issue, suggesting co-payment as a possible solution. Co-payment is a fixed amount for a covered service, paid by a patient to the provider of service before receiving the service, to offset some of the cost of the treatment. In the UK, eye care and dental care have already set the precedent for co-payments.

More investment in research is needed to further explore effective treatments, but also focus on prevention

Dr Astbury advises that we should be investing more in research, in order to discover new and effective treatments to tackle obesity and its related problems. But as well as innovative treatments, it is important to investigate preventative measures that stop people become overweight and obese in the first place.

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