Month: June 2022

As obesity rates in Europe continue to increase, decision makers are becoming aware of the need for a more harmonised nutrition policy and are looking at how to support Europeans to follow a healthy diet. In this context, the European Commission is planning to introduce a series of policy initiatives such as mandatory, harmonised front of pack nutrition labelling (FOPNL) and the setting of nutrient profiles that could affect the labelling of formula diet foods.

The Commission’s proposal on FOPNL and nutrient profiles aims to restrict the promotion of foods that are high in fat, salt and sugar (HFSS). Yet, a blanket application of the FOPNL and nutrient profiles across all food products would fail to recognise the specific use of specialist products, such as total diet replacements (TDRs) and meal replacements (MRPs) and would unfairly penalise businesses in the sector. Because nutrient profiles and interpretative FOPNL schemes, such as Nutri-score, often measure a substance in a product as a percentage rather than considering absolute levels, the sugar content in some MRPs and TDRs could be high in percentage terms and the products might score negatively under these schemes. However, the absolute amount of sugar in these products in comparison to their caloric content (between 200 and 250 kcal for MRPs per serving and 600 to 1200 kcal for TDRs per day) is in fact low. In this context, it is more important than ever for the slimming foods industry to secure appropriate and proportionate legislation. TDMR Europe is leading the sector’s efforts to tackle upcoming regulatory challenges, by working closely with political stakeholders on new policies and legislations that affect the industry.

TDMR Europe’s work to date includes the regulation of TDRs through the Regulation on Foods for Specific Groups (609/2013/EU). As a result of its targeted public affairs strategy, TDMR Europe avoided TDRs from being classified as medical foods, avoiding a stricter regulatory framework for these products. Moreover, TDMR Europe has engaged with the Commission and its agencies extensively on the specific compositional criteria for TDRs to achieve an appropriate regulatory environment for these products. With regards to MRPs, following TDMR Europe’s work, these products are regulated under general food law. TDMR Europe is also working to ensure that all additives currently authorised in MRPs are still in place, despite changes in their classification under the Additives Regulation.

To be able to provide the industry’s perspective in the development of regulations and policies affecting TDRs and MRPs, it is crucial to first increase understanding of these products among policymakers who are unfortunately often not aware of their potential in tackling skyrocketing obesity rates across Europe. TDMR Europe works to increase this awareness. For example, TDMR Europe organised a European parliamentary event “Helping the Consumer Help Themselves: Safely Tackling Obesity and Diabetes Today and Tomorrow”, which was attended by MEPs, the Commission and officials from the European Food Safety Authority (EFSA). TDMR Europe also organises impactful educational seminars on the latest scientific evidence on TDRs and MRPs, bringing together industry stakeholders, academics, policymakers and others. TDMR Europe’s events aim to review and raise awareness of the increasing evidence on the efficacy and potential of TDRs and MRPs to change the face of obesity and related diseases in Europe.

As decision makers are introducing new legislations on food labelling to address the increasing prevalence of obesity in Europe, the coming months and years will be decisive and possibly transformative for the slimming foods industry. In this context, it is crucial for businesses in the sector to make sure they have a say on regulatory changes that affect them and to increase awareness among policymakers of the potential of their products in tackling obesity.

To join TDMR Europe please get in touch via +44 (0)20 7463 0620 or secretariat@tdmr-europe.com. You can find more information about TDMR Europe in our membership leaflet here.

On 12 April 2022 TDMR Europe organised the online seminar “Diabetes Remission: Maintenance after weight loss with total diet replacement”. At this webinar health experts testified to the benefits of using total diet replacement (TDR) for weight loss as well as the impact of this weight loss on improving type 2 diabetes care. The event also reviewed evidence for the requirements for weight maintenance after weight loss with TDR.

Please follow the link to each individual presentation:

Glycaemic index: feasibility of using low GI/low GL diets in Mediterranean countries to facilitate weight maintenance

–Elena Philippou, University of Nicosia, Cyprus

Maintenance of weight loss and diabetes remission: barriers and solutions

– Gary Frost, Imperial College London, England

An update on development of guidelines for diabetes remission – remission possible!

– Mike Lean, University of Glasgow, Scotland

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.

On 12^th April, TDMR Europe, the leading organisation for the formula diet foods industry, organised an online seminar focusing on weight maintenance after weight loss with total diet replacement (TDR) and demonstrated TDR’s impact on type 2 diabetes (T2DM).

The event “Diabetes Remission: Maintenance after weight loss with total diet replacement” featured health experts Prof Mike Lean (Clinical Senior Research Fellow/Honorary Consultant – University of Glasgow), Prof Gary Frost (Chair in Nutrition and Dietetics – Imperial College London), Dr Elena Philippou (Associate Professor, Nutrition and Dietetics – University of Nicosia) and TDMR Europe Chair, Prof Anthony Leeds (Visiting Senior Fellow, Parker Institute, Frederiksberg Hospital, Copenhagen).

 

Professor Anthony Leeds, Chair of TDMR Europe said: 

“We were delighted to see such a successful outcome from our online seminar, with over 170 registrants, and attendees actively participating in the Q&A session that followed the insightful presentations.

This event took place as part of TDMR Europe’s effort to raise awareness among policy makers and healthcare professionals of the efficacy of total diet replacement’s (TDR) in healthy weight loss and the role of TDR in addressing obesity-related health conditions.

Following several studies that showed TDR’s effectiveness in tackling obesity and overweight, we hosted this seminar to demonstrate that weight maintenance is possible after rapid weight loss with TDR and provide stakeholders with a better understanding of how important this finding is for type 2 diabetes (T2DM) care.

Obesity and T2DM are among the most critical health problems that the EU is facing today, posing important challenges for the healthcare and economy sectors. Governments across Europe need to put this issue on the top of their agenda and consider all available options, including formula diet foods.”

Professor Mike Lean provided an update on the development of guidelines for diabetes remission, reviewing evidence from the DiRECT and DIADEM-1 trials, which included the use of TDR. Professor Lean showed that the “DiRECT study achieved diabetes remission for 46% of all participants randomized to the intervention, with mean 12m weight loss 10kg. Those who maintained >15kg loss had over 80% remissions at both 12 and 24 months, and >10kg loss brought remissions for over 70%”. “The new evidence reveals type 2 diabetes as a very serious life-shortening and disabling disease, part of the disease-process of ‘obesity’ in genetically predisposed people, but preventable and reversible at an early stage” said Professor Lean.

The event continued with Professor Gary Frost who highlighted that “there is a number of good practice points for weight loss maintenance”, including maintaining contact with professional support, use of corrective intervention, realistic but clinically important targets and physiological support.

Dr Elena Philippou took the floor to discuss the feasibility of using diets with low glycaemic index (GI) and low glycaemic load (GL) in Mediterranean countries to facilitate weight maintenance. Dr Philippou stressed that “while weight maintenance is a challenge, diets with reduced GI and GL are associated with better weight and fat mass outcomes through reduced hunger and desire to eat something sweet” but also emphasised that “physical activity is vital for both weight loss and maintenance”.

The full recording of the online seminar is available here, and the speakers’ biographical notes and abstracts are available here.

About TDMR Europe

TDMR Europe is the European organisation for manufacturers and distributors of formula diet products, including total diet replacement products (TDRs) and meal replacement products (MRPs) which provide weight loss and weight management programmes for people with obesity and overweight. TDMR Europe organises impactful educational seminars on TDRs and MRPs to review and raise awareness of the increasing evidence base within the scientific literature regarding the efficacy and potential of these products to change the face of obesity and related diseases in Europe.

If you would like to contact TDMR Europe to discuss the webinar or any other matter, email secretariat@tdmr-europe.com.

On 12^th April, Dr Elena Philippou, Associate Professor in Nutrition and Dietetics at the University of Nicosia, spoke at TDMR Europe’s webinar “Diabetes Remission: Maintenance after weight loss with total diet replacement”. The online seminar gathered health experts to show the role of TDRs in tackling obesity, discuss challenges and potential solutions regarding weight maintenance after rapid weight loss with TDR, and demonstrate its effectiveness in improving type 2 diabetes.

Dr Philippou provided an insightful presentation on the use of diets with low glycaemic index (GI) and low glycaemic load (GL) in Mediterranean countries to facilitate weight maintenance. She showed that, while weight maintenance is a challenge, diets with reduced GI and GL are associated with better weight and fat mass outcomes through reduced hunger and desire to eat something sweet. Dr Philippou argued that “policies should support people in choosing low GI Mediterranean foods aiming to reduce the obesity pandemic”. Her presentation also stressed the crucial role of physical activity for weight loss and weight maintenance.

 

Glycaemic index: feasibility of using low GI/low GL diets in Mediterranean countries to facilitate weight maintenance

Elena Philippou, University of Nicosia, Cyprus

Philippou.e@unic.ac.cy

Long-term weight loss maintenance is a challenge with most overweight individuals regaining weight in the long-term (Dombrowski et al, 2014).  A number of factors such as increased hunger, reduced satiety, preference for palatable foods, reduced total energy expenditure and poor adherence to behavioural changes are implicated (MacLean et al, 2015).

The glycemic index (GI) is a ranking of carbohydrate-containing foods based on the extent to which they raise blood glucose concentration after consumption, while glycaemic load (GL) is calculated by multiplying the food’s GI by the amount of carbohydrate contained, all divided by 100. Post-hoc analyses of the PREVIEW study, in which overweight individuals with prediabetes who lost ≥8% of body weight were randomized to a 146-weeks weight loss maintenance phase, showed that each 10-unit increment in GI was associated with a greater regain of weight (0.45 kg/year, 95% CI: 0.23, 0.68; p<0001), fat mass (0.39 kg/year, 0.15, 0.63; p=0.002) and HbA1c (0.02%, 0.01, 0.03; p<0.001) (Zhu et al, 2021).  In the same study, each 20 unit increment in GL was longitudinally associated with increases in hunger (0.92 mm/year; 0.33, 1.51, P=0.002), desire to eat (1.12 mm/year, 0.62, 1.62, P<0.001), desire to eat something sweet (1.13 mm/year, 0.44, 1.81, p<0.001) and greater weight regain  (0.35%/year, 0.18, 0.52, P<0.001) (Zhu et al, 2022). The above findings support the carbohydrate-insulin model of obesity proposing that increasing body fat deposition resulting from hormonal responses to a high GL diet drives positive energy balance (Ludwig et al, 2021).

The Mediterranean diet (MD), rich in unprocessed cereals, legumes, fruit, vegetables, nuts and extra-virgin olive oil and low in meat, could serve as a model of a low GI/GL diet. In the PREDIMED study, an inverse association was seen in multivariate adjusted models between GL and MD enriched with extra virgin olive oil (β= -8.52, -10.83, -6.20) and MD enriched with nuts (β= -10.34 (-12.69, -8.00) when compared with the control group (Rodríguez-Rejón et al, 2014). Nevertheless, evidence from several Southern European countries shows that adherence to the MD is only moderate-to-weak suggesting that MD recommendations are overlooked (Quatra et al, 2021). The feasibility of using low GI/GL diets in MD countries will be illustrated by providing practical examples on how high GI carbohydrates can be replaced with low GI alternatives within the MD.

References:

• Dombrowski SU, Knittle K, Avenell A, et al (2014) Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials. BMJ.348:g2646.
• Ludwig DS, Aronne LJ, Astrup A, et al (2021) The carbohydrate-insulin model: a physiological perspective on the obesity pandemic. Am J Clin Nutr. 114(6):1873–85.
• MacLean PS, Wing RR, Davidson T, et al (2015) NIH working group report: Innovative research to improve maintenance of weight loss. Obesity (Silver Spring). 23(1):7-15.
• Quarta S, Massaro M, Chervenkov M, et al (2021). Persistent Moderate-to-Weak Mediterranean Diet Adherence and Low Scoring for Plant-Based Foods across Several Southern European Countries: Are We Overlooking the Mediterranean Diet Recommendations? Nutrients 13(5):1432.
• Rodríguez-Rejón AI, Castro-Quezada I, Ruano-Rodríguez C, et al (2014) Effect of a Mediterranean Diet Intervention on Dietary Glycemic Load and Dietary Glycemic Index: The PREDIMED Study. J Nutr Metab 2014:985373.
• Zhu R, Larsen TM, Fogelholm M, et al (2021) Dose-dependent associations of dietary glycemic index, glycemic load, and fiber with 3-year weight loss maintenance and glycemic status in a high-risk population: A secondary analysis of the diabetes prevention study preview. Diabetes Care 44:1672.
• Zhu R, Larsen TM, Poppitt SD, et al (2022) Associations of quantity and quality of carbohydrate sources with subjective appetite sensations during 3-year weight-loss maintenance: Results from the PREVIEW intervention study. Clin Nutr 41(1):219-230.

If you would like to contact TDMR Europe to discuss the webinar or any other matter, please email secretariat@tdmr-europe.com.

TDMR Europe organises impactful educational seminars on TDRs and MRPs. Our events bring together industry stakeholders, academics, policymakers and others to review and raise awareness of the increasing evidence within the scientific literature regarding the efficacy and potential of TDRs and MRPs to change the face of obesity and related diseases in Europe. Find out more about TDMR Europe in our media pack and membership leaflet.