TDMR Europe Chair shows TDR’s impact on obesity and T2DM

Posted On: 4th May 2021

The Chairman of TDMR Europe, Professor Anthony Leeds, spoke at the Group’s successful online seminar entitled “Proven Facts versus Popular Myths about weight loss with Total Diet Replacement (TDR)”. This webinar addressed the myths and misinformation that surround the use of Total Diet Replacements and enabled stakeholders in both the public policy and healthcare sectors to gain a better understanding of TDR.  Prof Leeds shared updates on the latest research on TDR and presented the potential benefits of using TDR for weight loss, including type 2 diabetes (T2DM) prevention and remission.

Total Diet Replacements – update on latest clinical trial evidence 

Anthony R Leeds, TDMR Europe and Frederiksberg Hospital, Copenhagen, Denmark


Formula liquid 800kcal/d low calorie diets (LCD) are composed of nutritionally complete soups and shakes formulated to provide all needed vitamins, minerals, essential fats and protein, and are always offered with a behavioural component and physical activity guidance. When used exclusively LCD are defined as Total diet replacements (TDR) and facilitate 1–2kg weight loss weekly with metabolic improvement in glucose, insulin, blood lipids and blood pressure.

The Diabetes Remission trial (DiRECT) is a cluster-randomised trial of weight loss in a primary care setting of usual care versus TDR for 12 to 20 weeks followed by structured weight maintenance in people with early type 2 diabetes. At one year in the TDR treated group (n=149) 24% maintained 15kg weight loss and 46% were in remission while at two years 11% maintained 15kg loss and 36% were in remission. Usual care delivered 15kg weight losses in 0% and 2% of people and diabetes remission in 4% and 3% at 1 year and 2 years respectively (n=149). Remission was most likely in those who lost most weight and maintained most weight loss at all stages.

The Diadem-1 study is an intensive intervention using TDR for the initial weight loss in 147 people (73% were men) with early type 2 diabetes from the Middle East and North Africa studied in Qatar. In this first TDR study on non-Europeans 70 people lost and sustained an average 12kg weight loss at 12 months with 61% in remission, compared to 4kg in a best practice control group and 12% in remission.

The PREVIEW study was a 3-year weight maintenance study of low and high GI, low and high protein diets and two exercise levels preceded by an 8-week TDR initial weight loss in 2224 people with prediabetes and obesity. Average weight loss by 8 weeks was 10.7kg, weight loss maintained at 3 years was 4.6 to 4.9kg in the four groups. Overall, 6.3% developed diabetes by 3 years, less than expected.

Formula diet TDR programmes deliver, in a short period of time, the amounts of weight loss needed to achieve major health improvements and are a safe, cost-effective proven option for diabetes prevention and remission and other obesity comorbidities.

References with web-links to original papers

Very low-energy and low-energy formula diets: Effects on weight loss, obesity comorbidities and type 2 diabetes remission – an update on the evidence for their use in clinical practice Brown A, Leeds AR. Nutrition Bulletin 2019;44:(1) 7-24

Lean MEJ et al Primary care-led weight management for remission of type 2 diabetes
(DiRECT): an open-label, cluster-randomised Trial The Lancet 2018;391:541–551

Lean MEJ etal 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 and Endocrinology 2019;7(5):344-355

Taheri S et al Effect of intensive lifestyle intervention on bodyweight and glycaemia in
early type 2 diabetes (DIADEM-1): an open-label, parallel-group, randomised controlled trial Lancet Diabetes Endocrinol 2020;8:477–489

Christensen P et al Men and women respond differently to rapid weight loss: Metabolic outcomes of a multi-centre intervention study after low-energy diet in 2500 overweight, individuals with pre-diabetes. Diabetes Obes. Metab. 2018; 20(12):2840-2851

Raben A et al PREVIEW – Results from a 3-year randomised 2 x 2 factorial multinational trial investigating the role of protein, glycemic index and physical activity for prevention of type- 2 diabetes. Diabetes Obes Metab. 2021;23:324–337. doi:10.1111/dom.14219