Total Diet Replacement powerful ally in tackling obesity, misinformation on TDR must be addressed says Dr Kelly Johnston at TDMR Europe’s webinar

Posted On: 18th May 2021

Dr Kelly Johnston from King’s College London spoke at the Group’s on-line seminar “Proven Facts versus Popular Myth about weight loss with Total Diet Replacement (TDR)”. Dr Johnston focused on the misinformation and myths about TDR. Her presentation pointed out the urgency of tackling these myths as they slow the wide acceptance of TDR as an effective and safe obesity treatment. As Dr Johnston stressed, “false beliefs about TDR are widespread and ultimately affect the effort within public health systems to fight obesity as well as the allocation of research resources on this issue”.

Is there any scientific basis for Myths about TDR?

Weight maintenance and attrition

Kelly Johnston, King’s College London


Many presumptions about the use of total dietary replacement for weight control (TDR) as a treatment for obesity persist despite the absence of supporting scientific evidence, and indeed in the presence of evidence to the contrary.

Several research studies have shown that there is no substance in the claim that longer-term weight loss maintenance as a result of weight loss using a TDR is any harder to achieve when compared with that achieved after more gradual weight loss. One such study, which looked at data after an exceptionally long follow-up duration of 144 weeks was able to demonstrate that obese individuals who had lost at least 12.5% of their initial body weight via rapid weight loss, did not regain significantly more weight than those who had lost their initial weight more gradually.

In addition, there exists the belief that attrition from TDR programmes is significantly greater than those based on conventional food, which has also been refuted. Research findings from a study which explored the efficacy and acceptability of very low energy diets in overweight or obese adults with Type 2 diabetes demonstrated that attrition rates did not differ between the TDR diets and the comparator arms at any measurement point. Indeed, similar findings from other research studies further support good compliance in a TDR weight loss arm when compared with other, more gradual weight loss interventions. Finally, the assertion that a greater incidence of weight loss related adverse events are observed after a period of rapid weight loss has also been investigated with data showing that there are no significant differences in recorded adverse events between the TDR and the usual care group.

These widely promulgated yet unsubstantiated beliefs, which ultimately adversely affect both clinical and public health advice, and which negatively impact on the allocation of scarce research resources, must be addressed in order that effective obesity treatments are made available as required.

References with web-links to original papers

Purcell K et al The effect of rate of weight loss on long-term weight management: a randomised controlled trial Lancet Diabetes Endocrinol. 2014;2(12):954-62.

Vink RG et al The effect of rate of weight loss on long-term weight regain in adults with overweight and obesity Obesity (Silver Spring) 2016;24(2):321-7.

Christensen P et al Long-term weight-loss maintenance in obese patients with knee osteoarthritis: a randomized trial Am J Clin Nutr. 2017;106(3):755-763.

Astbury NM et al Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET): pragmatic randomised controlled trial BMJ, 2018;362:k3760.

Rehackova L et al Efficacy and acceptability of very low energy diets in overweight and obese people with Type 2 diabetes mellitus: a systematic review with meta-analyses Diabet Med, 2016;33(5):580-91

Lean M et al Feasibility and indicative results from a 12-month low-energy liquid diet treatment and maintenance programme for severe obesity. Br J Gen Pract 2013;63:115–24.