Total Diet & Meal Replacements Europe (TDMR Europe)’s webinar, ‘Reducing future risk: Obesity co-morbidities and nutritional status’, attracted over 100 academics, policymakers and medical specialists from all over the world.
The webinar, which had been awarded SCOPE World Obesity Federation accreditation, highlighted the use of total diet replacements to reduce future risk of diabetes and cardiovascular disease and diminish severe outcomes in COVID-19 among at-risk subgroups within populations. The speakers discussed a range of diverse and challenging topics, including obesity, nutritional status and COVID-19, TDR to achieve diabetes remission and diabetes risk reduction, TDR and vitamin D status in elderly obese people with knee osteoarthritis, and research needs and translation into practice in the context of diabetes remission.
Please follow the link to each individual presentation:
Reducing future risk: Obesity co-morbidities and nutritional status
Introduction by Anthony R Leeds, Chairman of TDMR Europe, University of Copenhagen and IMU, Malaysia
TDMR Europe represents the voice of European manufacturers and distributors of formula diet products, including Total Diet Replacements (TDRs) and Meal Replacement Products (MRPs), that provide weight loss and weight management programmes for overweight and obese individuals.
If you would like to contact TDMR Europe to discuss the webinar or any other matter, email secretariat@tdmr-europe.com.
The prevalence of obesity and its complications such as type 2 diabetes (T2D) is increasing worldwide. In particular, the Middle East and North Africa (MENA) region has one of the highest prevalence of obesity and T2D in the world with onset of both conditions at a younger age than observed in western populations.
The general view that T2D is an irreversible disease requiring lifelong medical treatment with an increasing array of medications has recently been challenged by the DiRECT study in the UK and by the DIADEM-I study conducted in Qatar. The DIADEM-I study recruited participants aged 18-50 years with shorter diabetes duration (≤ 3 years) and randomised them into usual best medical care or an intensive lifestyle intervention including diet, physical activity support, and behaviour change. The diet intervention included a total diet replacement phase using formula low-energy diet meal replacement products followed by gradual food introduction, and own diet thereafter.
Unlike previous studies, the participants were mainly male, originated from 13 different countries, and were younger. 147 participants (70 in the intervention group and 77 in the control group) were included in the final analysis. At 12 months, both groups achieved weight loss but the weight loss was about 4 times greater with the lifestyle intervention. The majority of those in the lifestyle intervention (61%) achieved diabetes remission and 33% achieved normoglycaemia. There were also significant cardiovascular benefits. Based on findings from DIADEM-I, the first diabetes reversal clinics in the MENA region have been established. The presentation will discuss findings from the DIADEM-I study, future research needs, and challenges in translating research findings into clinical services.
Dr. Shahrad Taheri joined Weill Cornell Medicine – Qatar (WCM-Q) in August 2013 as Professor of Medicine and Director of the Clinical Research Core. Dr. Taheri has extensive experience of leading the multi-professional care of patients with obesity and diabetes within the UK NHS. He has also led large multidisciplinary research teams aiming to develop, implement, and evaluate clinical services for patients with diabetes and obesity.
Dr. Taheri’s research experience extends from basic laboratory to human intervention, and population studies. His research interests are increasingly focused on the development, conduct, and implementation of a range of clinical trials into diabetes and obesity, and linking these trials to investigation of disease mechanisms through laboratory studies. Dr. Taheri has a vibrant portfolio of research studies into diabetes, obesity, and sleep. His goal at WCMC-Q is to develop and lead an internationally recognized, dedicated, collaborative research group performing clinically relevant investigation into diabetes and obesity, and their complications. This approach aims to have a major impact on public health, patient care, and advancement of medical science, making a significant contribution to Qatar’s healthcare system and Qatar’s vision to develop as a center of excellence in medical research.
Total Diet & Meal Replacements Europe (TDMR Europe)’s webinar, ‘Reducing future risk: Obesity co-morbidities and nutritional status’, attracted over 100 academics, policymakers and medical specialists from all over the world.
The webinar, which had been awarded SCOPE World Obesity Federation accreditation, highlighted the use of total diet replacements to reduce future risk of diabetes and cardiovascular disease and diminish severe outcomes in COVID-19 among at-risk subgroups within populations. The speakers discussed a range of diverse and challenging topics, including obesity, nutritional status and COVID-19, TDR to achieve diabetes remission and diabetes risk reduction, TDR and vitamin D status in elderly obese people with knee osteoarthritis, and research needs and translation into practice in the context of diabetes remission.
TDMR Europe represents the voice of European manufacturers and distributors of formula diet products, including Total Diet Replacements (TDRs) and Meal Replacement Products (MRPs), that provide weight loss and weight management programmes for overweight and obese individuals.
If you would like to contact TDMR Europe to discuss the webinar or any other matter, emailsecretariat@tdmr-europe.com.
Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet 2018;391(10120):541-51.
Taheri S, Chagoury O, Zaghloul H, et al. Diabetes Intervention Accentuating Diet and Enhancing Metabolism (DIADEM-I): a randomised controlled trial to examine the impact of an intensive lifestyle intervention consisting of a low-energy diet and physical activity on body weight and metabolism in early type 2 diabetes mellitus: study protocol for a randomized controlled trial. Trials 2018;19(1):284.
Taheri S, Zaghloul H, Chagoury O, et al. Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial. The lancet Diabetes & endocrinology 2020;8:477–89.
Henning Bliddal, Parker Institute, Frederiksburg Hospital, Copenhagen, Denmark
Introduction: Among several comorbidities to obesity, osteoarthritis (OA) of the knee is increasingly important. Obesity and kneeOA are linked in several ways and form a vicious circle, each intensifying the other. As the populations grow older and heavier, both individuals and society are facing increasing challenges with the combination of obesity and bad knees. These factors make it especially difficult to obtain and maintain a weight loss(1).
Methods: Over the past decade, the Copenhagen model for weight loss in the obese with kneeOA has been tested thoroughly. This model implies a weight reduction with 8 weeks of TDR, 4 meals a day, in total 415-810 kCal/day reinforced by group therapy lead by a dietician. Continuing in the groups, ordinary food is reintroduced over 4-8 weeks, though with a strict diet of 1200 kCal/day(2). In a later follow-up study, a lasting weight loss maintenance was shown over up to 4 years(3).
Results: In one pivotal study(4), A total of 175 patients (142 women), 91%, completed the 16-week program and had a body weight loss of 14.0 kg (95% confidence interval: 13.3 — 14.7; P<0.0001), consisting of 1.8 kg (1.3 — 2.3; P<0.0001) lean body mass (LBM) and 11.0 kg (10.4 — 11.6; P<0.0001) fat mass. Bone mineral content (BMC) did not change (-13.5 g; P=0.18), whereas bone mineral density (BMD) increased by 0.004 g/cm2 (0.001 –0.008 g/cm2; P=0.025). Plasma vitamin D and B12 increased by 15.3 nmol/l (13.2 — 17.3; P<0.0001) and 43.7 pmol/l (32.1 — 55.4; P<0.0001), respectively. There was no change in plasma ferritin.
Conclusion: With proper guidance, weight loss obtained with meal replacements may lead to a significant and clinically important effect on both symptoms and nutritional status
Henning Bliddal is a specialist in rheumatology. Since 1997 he has been Leader and Professor of Research at the Parker Institute, a clinical research unit of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark. HB’s research projects have over the last years concentrated on treatment of patients with knee osteoarthritis (OA) with very significant results in patients with this disease in combination with obesity. HB has supervised numerous medical students and physicians, including 32 PhD students. He has extensive teaching experience and is a regular contributor and guest speaker at national and international congresses. HB has contributed to textbooks, and has published more than peer 350 reviewed papers in international medical journals covering many different aspects of rheumatology.
Total Diet & Meal Replacements Europe (TDMR Europe)’s webinar, ‘Reducing future risk: Obesity co-morbidities and nutritional status’, attracted over 100 academics, policymakers and medical specialists from all over the world.
The webinar, which had been awarded SCOPE World Obesity Federation accreditation, highlighted the use of total diet replacements to reduce future risk of diabetes and cardiovascular disease and diminish severe outcomes in COVID-19 among at-risk subgroups within populations. The speakers discussed a range of diverse and challenging topics, including obesity, nutritional status and COVID-19, TDR to achieve diabetes remission and diabetes risk reduction, TDR and vitamin D status in elderly obese people with knee osteoarthritis, and research needs and translation into practice in the context of diabetes remission.
TDMR Europe represents the voice of European manufacturers and distributors of formula diet products, including Total Diet Replacements (TDRs) and Meal Replacement Products (MRPs), that provide weight loss and weight management programmes for overweight and obese individuals.
If you would like to contact TDMR Europe to discuss the webinar or any other matter, email secretariat@tdmr-europe.com.
Bliddal H, Leeds AR, Christensen R. Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons – a scoping review. Obes Rev 2014 Jul;15(7):578-86.
Riecke BF, Christensen R, Christensen P, Leeds AR, Boesen M, Lohmander LS, et al. Comparing two low-energy diets for the treatment of knee osteoarthritis symptoms in obese patients: a pragmatic randomized clinical trial. Osteoarthritis Cartilage 2010 Jun;18(6):746-54.
Christensen P, Henriksen M, Bartels EM, Leeds AR, Meinert LT, Gudbergsen H, et al. Long-term weight-loss maintenance in obese patients with knee osteoarthritis: a randomized trial. Am J Clin Nutr 2017 Sep;106(3):755-63.
Christensen P, Bartels EM, Riecke BF, Bliddal H, Leeds AR, Astrup A, et al. Improved nutritional status and bone health after diet-induced weight loss in sedentary osteoarthritis patients: a prospective cohort study. Eur J Clin Nutr 2012 Apr;66(4):504-9.
Type 2 diabetes (T2D) affects nearly 4 million UK people, previously considered permanent and inevitably progressive, with disabling, life-shortening complications. It accounts for ~10% of total healthcare expenditure across Europe. It is caused by adult weight gain in people with family/genetic predispositions. The Diabetes Remission Clinical Trial (DiRECT) has radically changed perceptions of T2D, and changed routine diabetes care.
DiRECT validated a structured primary-care weight management approach using 12-weeks 830kcal/day formula Total Diet Replacement (Counterweight-Plus), and then structured low-intensity support for long-term weight/remission maintenance. The programme, using current TDR formulation, proved well-accepted, entirely safe, and highly effective. Almost half of all patients were no longer diabetic at 12-months (off all medications, HbA1c<48mmol/mol), and with >10 kg loss 75% remained in remission at 2 years, plus lower blood pressures with fewer antihypertensive medications. Remissions were directly related to loss of damaging ‘ectopic’ fat in liver and pancreas. Serious Adverse Events were significantly more frequent in the Control (usual care) group: the intervention protected against vascular complications of T2D. Cost-effectiveness analysis projected longer survival, better quality-of-life, and lower lifetime medical costs.
Remission, using the DiRECT approach, is now a primary treatment target in European (EASD) and ADA guidelines. The most expensive component, potentially limiting use, is the TDR formula.
Any requirement to change the composition of the TDR used in DiRECT would need to be justified with evidence for better outcomes and acceptablility, without adding cost. There is no evidence that higher protein contents would improve outcomes: that would increase costs and reduce palatability. Magnesium content is not too high: diarrhoea was infrequent, and reducing magnesium would likely aggravate constipation on TDR. Choline is not an essential micronutrient in adults, not required in the diet
Professor Mike Lean has held the Rank Chair of Human Nutrition since 1992. He is also head of the department of Human Nutrition. He trained in medicine at the University of Cambridge and St Bartholomew’s Hospital subsequently specialising in general medicine, diabetes and endocrinology.
Total Diet & Meal Replacements Europe (TDMR Europe)’s webinar, ‘Reducing future risk: Obesity co-morbidities and nutritional status’, attracted over 100 academics, policymakers and medical specialists from all over the world.
The webinar, which had been awarded SCOPE World Obesity Federation accreditation, highlighted the use of total diet replacements to reduce future risk of diabetes and cardiovascular disease and diminish severe outcomes in COVID-19 among at-risk subgroups within populations. The speakers discussed a range of diverse and challenging topics, including obesity, nutritional status and COVID-19, TDR to achieve diabetes remission and diabetes risk reduction, TDR and vitamin D status in elderly obese people with knee osteoarthritis, and research needs and translation into practice in the context of diabetes remission.
TDMR Europe represents the voice of European manufacturers and distributors of formula diet products, including Total Diet Replacements (TDRs) and Meal Replacement Products (MRPs), that provide weight loss and weight management programmes for overweight and obese individuals.
If you would like to contact TDMR Europe to discuss the webinar or any other matter, email secretariat@tdmr-europe.com.
1.Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet 2018 Feb 10;391(10120):541-551. doi: 10.1016/S0140-6736(17)33102-1.
Lean ME, Leslie WS, Barnes AC, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol 2019 May;7(5):344-355. doi: 10.1016/S2213-8587(19)30068-3.
Lean ME, Low-calorie diets in the management of type 2 diabetes mellitus. Nat Rev Endocrinol 2019 May;15(5):251-252. doi: 10.1038/s41574-019-0186-6.
