Sleep significantly improved by 8 weeks Total Diet Replacement

Posted On: 25th May 2022

Sleep duration and sleep quality were significantly improved by 8 weeks Total Diet Replacement (TDR) 810kcal/d diet in 195 adults with obesity as reported at the European Congress on Obesity (ECO May 2022) by Prof Signe Torekov’s group from the University of Copenhagen.  The presentation (Bogh A et al 2022) reported preliminary data from accelerometry measurements and the Pittsburgh Sleep Quality Index (PSQI) scores on participants in the ‘S-LITE‘ study.  After the initial 8-week preparatory weight loss with TDR participants were randomised to a maintenance dietary regimen with a daily Liraglutide injection in one group, a daily placebo injection in the second, an exercise programme for the third group and exercise and Liraglutide for the fourth group. Weight outcomes have already been fully reported (Lundgren J R et al 2021) and showed an initial average loss of 13.1kg (12%) after 8 weeks TDR.  Accelerometry recordings of sleep duration and PSQI scores were made at baseline, after 8 weeks TDR and 26 and 52 weeks after weight loss.

Baseline sleep status influenced weight maintenance.  Poor sleepers, who at baseline slept for less than 6 hours regained more weight than those who slept for 6-7 hours/night.  Those who exercised maintained sleep quality improvements better than those who did not exercise.

These preliminary results suggest that improved sleep can be listed alongside diabetes remission, reduced blood pressure, reduced cardiovascular risk, reduced pain in osteoarthritis and reduced inflammatory markers as potential beneficial effects of weight loss with TDR.

In another recently published study (Tasali et al 2021) 80 young adults with overweight (BMI 25 to 29.9) aged 21 to 40 years and who habitually slept for less than 6.5 hours/night were randomised to either continuing their habitual sleep pattern or were entered into sleep hygiene counselling intended to extend sleep to 8.5 hours/night for two weeks. Dietary energy intake, energy expenditure (doubly labelled water method), body composition (DEXA scanning) and sleep duration (by actigraphy) were measured. Sleep duration increased by 1.2 hours/night in the sleep extension group in whom dietary energy intake decreased significantly by an average 270kcal/d compared to the control group. The sleep extension group lost an average 0.87kg in two weeks, significantly different from the habitual sleep group in whom an average 0.39kg body weight was gained.  The authors concluded ‘Improving and maintaining healthy sleep duration over longer periods could be part of obesity prevention and weight loss programs’.

The results from Copenhagen suggest that there would be merit in giving sleep hygiene guidance at the beginning of a TDR weight loss programme in order to facilitate better weight loss maintenance, however this would need to be tested in a specific study.  None the less since little or no harm can be done by following guidance to improve sleep duration and quality, there is no good reason why this should not be done anyway.  Key points of advice given would include:

  • Do get to bed at a regular time every night and get up at a regular time;
  • Do not read, eat or watch TV in bed;
  • Do limit or avoid all screen use for 1-2 hours before bedtime and especially avoid stimulating computer games;
  • Avoid caffeine containing drinks for up to 6 hours before sleep;
  • Avoid smoking and drinking alcohol for at least an hour before going to bed;
  • Avoid excessive exercise for a few hours before going to bed;
  • Do arrange a warm bed and a cool uncluttered room with low lighting (warm light rather than blue/white light);
  • Do write a list of worries and/or a ‘to-do’ list before going to bed.

Anthony Leeds, chairman of TDMR Europe said ‘I welcome these preliminary findings that provide some scientific support for what I and some colleagues had long suspected: that a good weight loss of 10kg or 10% improves sleep in people who are overweight or obese even in the absence of a specific sleep disorder.  People with obesity (or overweight) who are troubled by poor sleep should consider losing 10% body weight with TDR and follow simple sleep hygiene guidance now.  While more research will be helpful, we do not need to wait another 5 years before giving guidance, meanwhile I eagerly await publication of the full results from this study.’

Anthony R Leeds

The  S-LITE study was funded by the Novo Nordisk Foundation and TDR products and accelerometers were provided by Cambridge Weight Plan Ltd UK.


Bogh A H et al 2022 Short Sleep Duration is Associated with Weight Regain – PAGE 134 in Obes Facts 2022;15(suppl 1):1–240 DOI: 10.1159/000524469

Lundgren J R et al Healthy Weight Loss Maintenance with Exercise, Liraglutide, or Both Combined  N Engl J Med 2021;384:1719-30. DOI: 10.1056/NEJMoa2028198

Tasali E et al Effect of sleep extension on objectively assessed energy intake among adults with overweight in real-life settings: a randomized clinical trial. JAMA Intern Med doi: 10.1001/jamainternmed.2021.8098