In 2018, Total Diet & Meal Replacements Europe (TDMR Europe), formerly known as the European Very Low Calorie Diet Industry Group, was established. Our members first got together in 2002 to create a voice for manufacturers and distributors of formula diet products in Europe. We anticipated the likely future growth of the total diet and meal replacements industry and decided to build an even stronger and more impactful industry group whose aims are to defend the interests of both the industry and its customers across Europe.
Over the past year, TDMR Europe has continued to work extensively to secure appropriate and proportionate European legislation for MRPs and TDRs, and to promote its products among policymakers, scientists, public health practitioners and consumers alike.
Click here to download the Annual report highlights for 2018 and have a look at our key activities during the past year.
Professor Anthony Leeds, chairman of TDMR Europe, discusses the benefits of meal replacements in the global fight against obesity.
TDMR Europe is this year partnering with Food Matters Live 2019, an event which aims to bring together a curated exhibition with hundreds of exhibitors and speakers and thousands of visitors from across the global food, drink and nutraceutical industry. It is a unique day dedicated to creating cross-sector connections focused on the future of food, drink and sustainable nutrition.
“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.”
Henning Bliddal is professor of rheumatology and director of the Parker Institute at Frederiksberg hospital, Copenhagen. His clinical research aims to increase the knowledge of treatments for the major groups of arthritis, including degenerative musculoskeletal diseases such as osteoarthritis. The most common type of arthritis in the UK, osteoarthritis is a condition that causes joints to become painful and stiff. Prof Bliddal’s research showed that weight loss with total diet replacement programmes (TDRs) and weight maintenance for four years improved symptoms in obese people with osteoarthritis and also reduced their heart age by 5 years.
Loss of at least 10% of body weight, coupled with exercise, is recognised as a cornerstone in the management of obese patients with osteoarthritis
Professor Bliddal explains that, as well as the weight loss achieved by TDRs, his research showed that patients became generally healthier. The majority of these patients, prior to the study, were lacking in vitamins and had poor nutritional status. And with healthiness comes happiness: his research demonstrates that a 10% weight loss results in an increase of 30% regarding general quality of life.
A sense of belonging and improved quality of life are important factors in successful weight loss maintenance
Too often for people on diet programmes, the issue is not losing the weight, but the challenging period that comes afterwards. Professor Bliddal has demonstrated the solution for this: support groups that meet on a regular basis, led by a dietitian. These groups give patients a sense of belonging by offering advice for the future, helping them to maintain the weight loss and maintain their improved knee joints in the long term.
The future for weight loss linked to arthritis is bright. Professor Bliddal’s team is also running a study evaluating the effect of weight loss in a group of obese patients with the arthritis of gout. The study is a trial where half the patients receive intensive weight loss in the form of TDRs as well as supervision from a clinical dietitian and the other half get the usual care that would be received by a patient with gout. Publication of the results is eagerly awaited.
Communities and groups advocating TDRs are needed for the future of weight loss
In terms of the future for weight loss, Henning Bliddal believes that more communities and groups advocating TDRs are needed. Furthermore, prevention is key to long term success. Evidence shows that certain population sub-groups experience sudden weight gain, such as post-natal women or recently retired sportspeople, increasing their risk of developing arthritis. Developing programmes for these specific subgroups could prove an extremely effective way of preventing weight gain and its related conditions.
Commenting on the research done at the Parker Institute in Copenhagen, Professor Anthony Leeds, Chairman of TDMR Europe, said ‘The Danish experience with weight loss using TDR delivered in a secondary care setting provides the solid evidence-base for effective weight loss as a primary intervention in people with knee osteoarthritis (KOA) and obesity. The DROPLET study run from GP practices around Oxford showed that larger amounts of weight loss (7 to 10kg) can also be delivered by commercial providers in a community-based setting after referral by GPs. Taken together these trials provide the evidence base for planning an ‘upscaling’ of weight loss with TDR in people with osteoarthritis delivered both in secondary care and on a larger scale in the community after referral from primary care by GPs.’
“The PREVIEW-study is one of the largest and longest randomized interventions 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 a total diet replacement strategy during the first two months 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.”
Mikael Fogelholm is a professor in public health nutrition at the University of Helsinki. His previous research includes a systematic review to study the relative health risks of poor cardio-respiratory fitness in normal-weight people compared with obesity in individuals with good cardio-respiratory fitness, and the long-term effects of weight loss on muscle strength and bone mineral density in adults who are overweight or obese.
In his interview, Fogelholm discusses the PREVIEW-Study. PREVIEW is an acronym of PREVention of diabetes through lifestyle intervention. The project is a large multi-national diabetes prevention project, with the primary goal of identifying the most efficient lifestyle pattern for the prevention of Type-2 diabetes in a sample of pre-diabetic overweight or obese individuals.
Fogelholm attributes the high success rates of total diet replacement programmes (TDR) in his studies to the frequent group meetings and support for the participants. Furthermore, he suggests that TDRs yield good results because participants are drawn to programmes which bring tangible results relatively quickly. Interestingly, his research has shown that during the three year maintenance phase, those who followed a high protein diet and pursued more physical activity did not maintain better weight loss than those in the other groups.
However, the study did show a low diabetes rate at three years compared with other major trials on the same subject. For the future, Fogelholm would like to pool his data together with other studies, such as the Diabetes Prevention Study in Finland, to take a closer look at individuals who have similar metabolism and then track their progress after their weight management programmes. This would allow for greater accuracy concerning the development of our knowledge of diabetes prevention and remission.
Professor Anthony Leeds, chairman of TDMR Europe notes that the PREVIEW results were also discussed at the American Diabetes Association meeting in June. Results of the TDR weight loss phase on 2,224 people with pre-diabetes in 8 countries showed that 8 weeks of TDR was completed by 91% of participants (an unusually high compliance rate) and average weight loss in that time was 10.7kg. (see Christensen P,et al Diabetes Obes. Metab. https://doi.org/10.1111/dom.13466). Reporting the ADA presentation Professor Ian Macdonald, University of Nottingham, said that 2020 participants achieved the 8% weight loss goal that justified entry into the three-year weight maintenance programme and 962 of those completed the three year programme at which point only 62 of 962 had developed diabetes. Macdonald added ‘….combining an initial low-calorie diet to establish significant weight loss followed by a maintenance diet and physical activity program with evidence-based advice on achieving behaviour change can achieve longer term maintenance of weight loss and reduce the risk of developing type 2 diabetes.’ (see: http://www.diabetes.org/newsroom/press-releases/2019/weight-loss-from-low-calories.html )
Commenting on the results Professor Anthony Leeds, chairman of TDMR Europe added ‘This large observational study of Total Diet Replacement diet (800kcal/d) shows for the first time, in a global context, that this is a safe, effective way to begin diabetes prevention programmes…Taken in conjunction with other published clinical trials showing weight maintenance after TDR for up to four years, these results are a substantial offering in the global fight against the tsunami of diabetes that will shortly overwhelm health care providers.”
