TDMR Europe webinar shows weight maintenance is possible using a balanced low glycaemic index diet following Total Diet Replacement diet

Posted On: 15th June 2022

On 12th 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.


Elena Philippou Glycaemic Index 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

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.


  • 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

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.