The argument for Total Diet Replacements

Posted On: 13th February 2020

The argument for Total Diet Replacements

In the United Kingdom, the number of people with type 2 diabetes has doubled to 3.8 million in the last 20 years. In just 5 years’ time more than 5 million people will be affected. Diabetes care costs account for about 10% of the total NHS budget and this is estimated to rise to 17% in 15 years’ time. It is possible that NHS and even social care budgets could soon be overwhelmed by a tsunami of diabetes and other obesity-related costs. The UK desperately needs safe, effective low-cost solutions for diabetes prevention and remission.

Total diet replacements (TDRs) are designed to replace conventional foods to facilitate optimal weight loss for the overweight and obese, and the prevention and treatment of type 2 diabetes. The programmes are specifically formulated and replace the whole of the individual’s daily diet with nutritionally balanced soups, shakes and bars consisting of all essential vitamins, minerals, high quality protein, essential fats, and fibre. TDRs are strictly regulated and have been sold safely in the UK and the EU for over 30 years. There is increasing supportive evidence of their effectiveness in a wide range of obesity-related conditions.

The DiRECT type 2 diabetes remission trial conducted in Glasgow and Newcastle, funded by the patient-centered charity Diabetes UK, used the liquid low-calorie diet (a TDR) for 12 to 20 weeks to achieve initial weight loss. This was followed by a carefully managed re-introduction of conventional food with education and behavioural change. In those showing weight regain ‘rescue packages’ were used – these reinforced behavioural change with short-term use of meal replacements. Two thirds of those maintaining 10% weight-loss, and 83% of those maintaining over 15kg loss, remained free from diabetes, without need for medications, two years after starting the diet. NHS England is currently planning a roll-out of this type of intervention to achieve diabetes remission for 5000 people in primary care. All the NHS boards in Scotland are already starting to use this approach. In Copenhagen research teams have shown in published trials that 10% weight loss can be maintained for four years after this type of weight loss and others in Copenhagen have shown that the gut and body can adapt to reduce the drive to regain weight to the ‘set-point’. Ultimately, the success of TDRs will depend on greater recognition of their effectiveness, their wider availability and realization of the health-care cost savings that may be possible.


Watch Professor Mike Lean (University of Glasgow) discuss the DiRECT diabetes remission study.

Watch Dr Seamus Kent (University of Oxford) discuss the cost-effectiveness of TDR delivered in a primary care based setting (Droplet study)