Total Diet Replacement in a primary care/community setting – sustainability and health economics

Posted On: 23rd November 2021

Dr Nerys Astbury, Senior Research Fellow at the Nuffield Department of Primary Care Sciences, University of Oxford reviewed the results of the DROPLET trial and three-year follow up in TDMR Europe’s webinar Total Diet Replacement: exploring sustainable weight loss and health benefits, including diabetes remission and prevention” held on 27th October 2021.  Dr Astbury showed that delivery of Total Diet Replacement (TDR) and subsequent weight maintenance was feasible and cost-effective in a primary care setting, and that some weight loss was maintained in some participants for up to three years.

Professor Anthony Leeds, chairman of TDMR Europe said: ‘The DROPLET study showed clearly that a total diet replacement weight loss and maintenance programme could be delivered within a primary care setting in collaboration with a commercial TDR provider working in a community setting. Medical management was maintained by the GPs. The cost-effectiveness analysis showed that delivered in this setting the programme was most cost-effective among heavier people and among middle-aged and older people.’

On 27th October, TDMR Europe’s online seminar brought together industry stakeholders, academics and others and showed the potential role of TDR in bringing down the incidence of obesity and severity of weight related comorbidities, such as type 2 diabetes, cardiovascular disease risk factors, osteoarthritis, and obstructive sleep apnoea. The recording of the webinar will be available soon on the TDMR Europe website.

More information on TDR is available here.

Dr Nerys Astbury is Senior Research Fellow in Diet & Obesity at the Nuffield Department of Primary Care Health Sciences, University of Oxford and one of the DROPLET trial investigators.  The DROPLET trial was designed to explore if the provision of a low-energy total diet replacement programme offered by GP’s was a clinically feasible and cost-effective method to help people with obesity manage their weight in the community.

The DROPLET clinical trial was funded by an investigator-initiated research grant from Cambridge Weight Plan UK Ltd to the University of Oxford. The three-year follow up was funded by National Institute of Health Research Applied Research Collaboration at Oxford Health NHS Foundation Trust.  Some research team members were also supported by the Oxford NIHR Biomedical Research Centre.


Total Diet Replacement in a primary care/community setting – sustainability and health economics

Nerys Astbury, DROPLET research team, University of Oxford, England


DROPLET was a randomised controlled trial testing the clinical effectiveness of primary care referral to total diet replacement (TDR) weight loss programme for the treatment of obesity. 272 participants from ten primary care practices were individually randomised to usual care (UC) weight management (n = 138) or a TDR weight loss programme (n = 134), delivered by lay counsellors in the community over 6 months. At one year weight loss in the TDR group was -10.7 kg and UC was -3.1 kg, a difference of 7.2kg (95%CI: -9.4 to -4.9) (1).

Participants were re-contacted and weighed approximately 3 years after randomisation. We used a linear mixed-effect model, adjusting for baseline weight, to assess the change in weight from baseline.

Of the 272 participants who took part in the DROPLET study, weight was recorded in 66% people (83 UC, 96 TDR). Mean (SD) age was 51 years (11.7) and 99 (55%) were female. Mean (SD) weight change from baseline was -2.7 kg (7.7) in UC and -6.3kg (9.1) in TDR group, an adjusted difference of -3.3kg (95% CI: -5.2 to -1.5; P=0.0005).

Primary care referral to a TDR programme in the community for the treatment of obesity leads to greater weight loss than usual care which is sustained for at least 3 years. Even without additional support after the initial weight loss intervention, two thirds of the weight loss achieved at one year was still apparent two years later.

TDR In Primary Care Community Setting; Sustainability And Health Economics


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

Kent S, Aveyard P, Astbury N, et al Is Doctor referral to a low-energy total diet replacement program cost-effective for the routine treatment of obesity?
Obesity 2019 27, 391-398

Astbury NM, Edwards RM, Ghebretinsea F, et al Extended follow-up of a short total diet replacement programme: results of the Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET) randomised controlled trial at 3 years. Int J Obes (Lond) 2021 45(11): 2432-2438. doi: 10.1038/s41366-021-00915-1