TDMR Europe is delighted to announce that it is partnering with Food Matters Live 2019, an event which aims to bring together a curated exhibition with hundreds of exhibitors and speakers and thousands of visitors from across the global food, drink and nutraceutical industry. It is a unique event dedicated to creating cross-sector connections focused on the future of food, drink and sustainable nutrition.
TDMR Europe was previously featured in Food Matters Live Table Talk newsletter, with a video in which our member Rob Rona discusses the new regulations for total diet replacement products and the important role trade associations play in both guiding and enforcing legislation. To see the video please click here.
In this exclusive interview, Professor Anthony Leeds discusses the benefits of formula food diets (TDRs and MRPs) at our recent seminar ‘Healthcare cost reduction and improved quality of life with evidence-based weight loss in diabetes and osteoarthritis’ at University College Dublin.
The event, delivered in partnership with The World Obesity Federation, brought together policymakers, researchers, academics, nutrition and health organisations to discuss the most recent innovations of the industry and the potential for total diet replacement programmes to alleviate disease, prevent diabetes and significantly reduce public healthcare costs.
Professor Anthony Leeds is the chairman of TDMR Europe, a trade body that represents the voice of European manufacturers and distributors of formula diet products, that provide weight loss and weight management programmes for overweight and obese individuals.
Whilst life expectancy in Europe is on the increase, the World Health Organization (WHO) warns that progress risks backsliding amid growing rates of obesity. Recent reports indicate that almost 30% of the global population is either obese or overweight and the WHO confirms that worldwide obesity has nearly tripled since 1975. Contributing factors to this epidemic include inactive lifestyles with less exercise, increased calorie intake and larger portion sizes, the problem worsening in lower socio-economic groups amid growing rates of poverty. Obesity is a worldwide crisis, and Europe must face it head on.
European Obesity Day 2019 takes place on Saturday 18th May. The day is designed to raise awareness about obesity and the many other conditions linked to it. The campaign is recognised internationally amongst healthcare professionals, patients, political communities and the general public, aiming to encourage people who are overweight or obese to make lifestyle changes to manage their weight and improve their health, thereby enhancing their overall quality of life.
TDMR Europe works alongside other organisations at European Obesity Day in the fight against obesity, promoting increased exercise, improved lifestyle choices and better eating habits to help us live healthier lives. For those in need of a specific diet plan, total diet meal replacement programmes (TDRs) are an economical, credible and effective solution, scientifically proven to tackle weight loss and diabetes. Not only do TDRs provide fast and efficient weight-loss, they are clinically proven to reduce the health risks associated with being obese or overweight.
Held in conjunction with European Obesity Day 2019, the European Association of the Study of Obesity (EASO) delivered its EASO Policy Conference, which took place on 16th May in Brussels. Headlined ‘The Social and Economic Impact of Preventing and Treating Obesity’, the conference successfully provided a platform for healthcare providers and organisations, political communities and patients to raise awareness about obesity in Europe. TDMR Europe attended the event with other relevant policymakers, industry stakeholders and academics. The global community will only be able to succeed in preventing and tackling the global obesity epidemic if we join forces to raise awareness of the issue, advocate evidence-based solutions and confront vested interests that perpetuate no change.
Total diet replacements (TDRs) – weight loss diets of soups, shakes, bars and porridges – can turn back the tsunami of osteoarthritis, diabetes and other obesity-related comorbidities that threaten to overwhelm healthcare services across Europe. This was made evident yesterday at a University College Dublin seminar, led by trade body Total Diet & Meal Replacements Europe (TDMR Europe) and World Obesity Federation.
Speakers including the University of Glasgow’s Mike Lean, Mikael Fogelhom from the University of Helsinki, Henning Bliddal from Denmark’s Parker Arthritis Institute in Copenhagen, and the University of Oxford’s Nerys Astbury and Seamus Kent gathered to discuss what TDRs and meal replacement products (MRPs) can do to alleviate the suffering and economic cost of obesity related comorbidities, especially diabetes and osteoarthritis. The Scope-accredited seminar also heard the personal testimony of Joe McSorley from Scotland who successfully used TDRs to lose and maintain weight and put his diabetes into remission.
TDMR Europe, which works to deliver a positive policy environment for the total diet and meal replacement products sector, organised the seminar to educate and raise awareness of the effect of TDRs and MRPs against a rising tide of obesity and related diseases. TDRs and MRPs provide thousands of overweight and obese people with an effective, safe and controlled weight loss plan that can deliver immense health benefits, including remission of type 2 diabetes and alleviation of osteoarthritis symptoms.
Professor Anthony Leeds, Chairof TDMR Europe said:
“TDMR Europe is delighted to have worked with the World Obesity Federation to host this seminar, and their support underlines the importance of these products to tackle obesity and related co-morbidities across Europe.
“Total diet replacement programmes offer rapid, safe weight loss which in itself is highly motivating. However, they also provide major health improvements through large weight loss (usually 10kg in 8 weeks). This large initial weight loss is associated with diabetes remission, reduced pain in osteoarthritis, improved obstructive sleep apnoea and improved cardiovascular risk factors, as well as better weight maintenance a year later.
“Total diet replacement programmes are mostly provided by trained commercial weight management consultants, offering behavioural and lifestyle guidance, often on a one-to-one basis or in groups, but can also be delivered effectively after referral by GPs (primary care physicians). They are unquestionably cost effective as assessed by standard UK NHS/NICE methods.”
Professor Carel le Roux, University College Dublin, said:
“We now treat obesity like all other chronic diseases and we understand the value of meal replacement strategies which helps change the symptoms of hunger and lack of satiety in a subpopulation of people with the disease of obesity. For these people losing weight is effortless as the meal replacements addresses the underlying biology of the disease.”
Professor Mike Lean, University of Glasgow, said:
“Formula diets, as currently designed, have proved extremely safe and effective in helping people to lose substantial amounts of weight, and gaining remission of type-2 diabetes. Almost nine out of 10 people with type-2 diabetes were still in remission, not diabetic and not needing medications, a year later if they lost 15kg. After two years they have developed fewer serious medical conditions such as heart disease and cancers. I am concerned that the new criteria for composition of total diet replacements are not based on good science or practical understanding of their medical use. The changes will make these products less effective, more expensive and less safe.”
Joe McSorley, TDR user, said:
“While the total diet replacement is not a cure, it can put type 2 diabetes in remission, what happens after that is down to will power and lots of hard work in the gym to maintain the weight loss. In truth, it is a lifestyle change but one that for me has been worth it as I am no longer classed as diabetic, I have managed to reverse it.”
Professor Mikael Fogelhom, University of Helsinki, said:
“PREVIEW-study is one of the largest and longest randomized intervention to study the effects of diet and physical activity prevention of type 2 diabetes in pre-diabetic individuals. Compared to earlier studies, the use of an 800 kcal/day meal-replacement strategy during the first two months (= weight-reduction phase) was a new element. The main interest was to study the effects of a diet higher than normal in protein (and lower in carbohydrate), with a lower glycaemic load, combined with higher intensity exercise. The control condition included a “usual care” diet (with moderate protein, and higher carbohydrate content), and moderate-intensity physical activity.
“We did not find a difference between the two diets or the two exercise regimens; hence it seems that neither the carbohydrate-protein –ratio nor intensity of physical activity are critical factors in prevention of T2D. A large initial weight loss that is partly sustained by an intensive behavioural intervention over 3 years may be one explanation for the generally very low incidence of T2D (<6%).”
Professor Henning Bliddal, Director, Parker Arthritis Institute said:
“Obesity is widely acknowledged as a risk factor for both the incidence and progression of osteoarthritis and has a negative influence on outcomes. Loss of at least 10% of body weight, coupled with exercise, is recognised as a cornerstone in the management of obese patients with osteoarthritis, and can lead to significant improvement in symptoms, pain relief, physical function and health related quality of life. However, questions remain surrounding optimal management. With the Copenhagen programme, the greater proportion of individuals obtain a significant weight loss and this can be sustained in various ways over years afterwards. These results have been reached in spite of co-existing knee osteoarthritis, leading to the phrase that ‘bad knees are no excuse for not losing weight’.
“It is a general notion that replacement of a bad kneed with an alloplasty will pave the way for weight loss; this has been shown not to be the case, on the contrary, a weight gain has been observed after the operation. The ageing population in Western Europe will lead to increasing numbers of elderly citizens at risk for knee osteoarthritis. With a parallel increase in prevalence of obesity, we are facing an enormous burden for the individuals and society with increased health expenses. Fundamentally, the soundest move against this development is a tight weight control, which should be sponsored by the health authorities at all levels.”
Dr Nerys Astbury, University of Oxford, said:
“The DROPLET trial showed that after 12 months people on total diet replacements lost on average 10.7kg (1 stone, 9lb), which was 7.2kg (1 stone, 1 lb) more than those only receiving the standard nurse-led programme of weight loss advice. This new analysis adds to that finding by strongly suggesting it’s also a cost-effective treatment for the NHS to offer, particularly in middle-aged and older adults.”
Dr Seamus Kent, University of Oxford, said:
“Studies like ours, which provide reliable estimates of the long-term impacts of weight management programmes on patients’ health and healthcare costs, are of real importance to enable the NHS to select the most clinically and cost-effective services for their patients.”
Five things you may not know about Total Diet Replacements
With the prevalence of obesity rising across Europe, more and more people are seeking to quickly and effectively lose weight. A quick Google search provides hundreds of ways to achieve weight loss, including through the use of pills and other popular diets. These usually promise rapid weight loss as well as other health advantages, though often lack the scientific evidence to support these claims.
Total Diet Replacements (TDRs) are specifically formulated programmes that replace the whole of the daily diet. TDRs, which include Very Low Calorie Diets (VLCDs) and Low Calorie Diets (LCDs), provide controlled energy intake and have been proven to be far more effective than cutting calories through other conventional food combinations. Here are Five things you might not know about TDRs:
They are easy to follow
There are a lot of diets on the market, but many are difficult to follow with dieters often feeling unhealthier due to the lack of intake of nutrients. The use of TDRs is accompanied by trained Consultant or Counsellor support, so people feel more motivated to continue. Meanwhile, the nutritionally balanced programme ensures they feel better quickly, which makes compliance easier.
TDRs provide users with all the nutrients they need
While some popular diets often exclude entire food groups – resulting in a lack of intake of certain nutrients –, TDRs are based around formula foods, which are nutritionally balanced. They are composed to provide 100% of the Dietary Reference Values and include key vitamins, minerals, high quality protein, essential fats, fibre and other nutrients. Indeed, it is almost impossible to maintain nutritional requirements through the consumption of ‘normal foods’ alone once daily consumption falls below 1200 kcal.
They deliver other health benefits
Recent research has shown that the use of TDRs is not only effective in delivering weight loss, but also contributes to tackling a number of obesity-related diseases. The DIRECT trial showed that after 12 months, 46% of TDR users diagnosed with Type 2 Diabetes went into diabetes remission. Recognising the health benefits, NHS England recently announced that TDRs will now be made available to Type 2 Diabetes sufferers. Aside from benefits in diabetes, TDRs are also proven to reduce pain in osteoarthritis, improve the metabolic state and reduce blood pressure.
They are strictly regulated and safe to use
Popular diets are mostly based on fashion trends and are not regulated. TDRs, on the other hand, are specifically regulated under EU law. These rules set general compositional and labelling criteria to ensure that products are safe and that consumers are not misled on what results to expect from the use of TDRs.
They are more effective than most diets
Some popular diets are focused on short-term weight-loss and some dieters often experience extreme weight fluctuations, which may be bad for their health. Clinical trials have shown that TDRs result in better weight maintenance at six months to three years later, making these programmes particularly effective as well as healthier in the long-term.
Overall, TDR programmes provide consumers with a safe and effective weight loss method that is easy to follow and results in multiple health benefits in the long-term.
If you have any further questions about TDRs, please get in touch with us at secretariat@tdmr-europe.com.
TDMR Europe is delighted to announce that it will be delivering the free seminar ‘Healthcare cost reduction and improved quality of life with evidence-based weight loss in diabetes and osteoarthritis’, alongside The World Obesity Federation, taking place on 16th April, 11:00am -1:00pm, at the University College Dublin, Conway Institute of Bio-molecular and Biomedical Research, Dublin, Ireland.
The event will gather policymakers, researchers, academics, nutrition and health organisations to discuss the most recent innovations of the industry, including the latest findings of the DiRECT and DROPLET studies, marking a watershed moment in the recognition of the significance and potential for formula food diets (TDRSs and MRPs) to alleviate disease, prevent diabetes and significantly reduce healthcare costs.
Speakers will include:
Professor Carel le Roux, Chair of Experimental Pathology at University College Dublin
Anthony Leeds, Bariatric physician Central Middlesex Hospital, England, on behalf of TDMR Europe
Mike Lean, University of Glasgow, Scotland
Mikael Fogelhom, University of Helsinki, work package leader on EU 7th Framework funded PREVIEW project
Henning Bliddal, Director, Parker Arthritis Institute, Copenhagen, Denmark
Joe McSorley, TDRs user, Paisley, Scotland
Nerys Astbury and Seamus Kent, University of Oxford, England
*A networking lunch and drinks will follow the event.
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.
The World Obesity Federation represents a global community of professional members of the scientific, medical and research communities from over 50 regional and national obesity associations, dedicated to solving the problems of obesity.
World Obesity recognises the event of an outstanding educational standard through its SCOPE Accreditation programme by awarding 1 SCOPE point.
Newly published review supports effectiveness of meal replacement for weight loss
A new review[1] of trials has added more support to the science behind meal replacements products (MRPs) for weight control and their effectiveness in helping people lose weight.
Published in Obesity Reviews – the official journal of the World Obesity Federation – this paper describes the findings of a systematic review with meta‐analysis of randomised controlled trials which compares the effectiveness of weight loss programmes that included MRPs with those that did not, in adults with overweight or obesity.
The main findings show that programmes incorporating MRPs as part of their dietary intervention, resulted in greater weight loss at one year than those not incorporating MRPs. Specifically, those participants who had included MRPs in their diet had lost an additional 1.44 kg at one year compared with those participants whose diet did not.
The review also showed that this greater weight loss achieved was maintained over the longer term with data being reported after four years follow-up showing a more significant degree of weight loss maintenance in participants who had undertaken programmes incorporating MRPs. Additionally, the results showed that including MRPs into a behavioural weight loss programmes improved their results by an extra 2.22 kg at one year.
This review further supports the increasingly widely held views of a both medical professionals and nutrition experts as well as that of the industry who believe that MRPs should be provided and included as an option in national health guidance for those overweight and obese individuals looking to lose weight.
As the review states, MRPs are currently neither recommended nor even included in the national clinical guidelines for the management of overweight and obesity, despite mounting evidence of their effectiveness and cost-effectiveness. TDMR Europe continues to work towards the recognition of both MRPs and TDRs to be recognised as an economical, healthy and effective solution for weight loss. The recent UK National Health Service decision to launch a trial programme supporting TDRs for obese people with type 2 diabetes is a step in the right direction. This decision, and the growing number of research studies provide even more evidence for the effectiveness and safety of these products and, should be a sign to other European countries that TDRs and MRPs represent the future in the fight against obesity and related diseases.
If you’d like to be part of the conversation, please get in touch with us via secretariat@tdmr-europe.com.
[1] Astbury NM, Piernas C, Hartmann‐Boyce J, Lapworth S, Aveyard P, Jebb SA. A systematic review and meta‐analysis of the effectiveness of meal replacements for weight loss. Obesity Reviews. 2019;1–19. https://doi.org/10.1111/obr.12816
The University of Oxford has published a paper into the cost-effectiveness of low calorie meal replacements for the treatment of obesity in the NHS, which concludes that replacing all regular meals with a low calorie diet of soups, shakes and bars, together with behavioural support, is cost-effective as a routine treatment for obesity. Welcoming the publication of the study, Professor Anthony Leeds, Chairman of TDMR Europe said:
“We very much welcome the results of this study. Health care costs are higher among older and heavier people so it is not a surprise to find that GP referral to a Total Diet Replacement (TDR) programme delivered in the community is most cost effective among those over 50 years and those with a BMI over 35. This fits with the typical age and weight of people with Type 2 diabetes, osteoarthritis and other obesity-related co-morbidities.”
“Total Diet Replacement weight loss programmes should now be offered to people with recently diagnosed Type 2 diabetes based on the DiRECT diabetes remission trial, and to the elderly with osteoarthritis based on Danish studies which have shown pain reduction and 10% weight loss and maintenance for four years in TDR users. Quality of life is improved and there are reductions in use of medications – including those for high blood pressure because TDR lowers blood pressure.”
The paper, by Seamus Kent and colleagues at the Nuffield Departments of Population Health and Primary Care Sciences, University of Oxford, used the data from the recently published DROPLET randomised controlled trial set in primary care centres around Oxford in which GPs randomly allocated patients to either a TDR programme delivered commercially in the community by Cambridge Weight Plan Consultants, or to usual care, delivering the best possible weight loss with conventional guidance from the practice nurses.
Total diet replacements and meal replacement products: a means to solve the NHS’s budgetary problems?
According to a recent investigation by The Sunday Times, joint replacement surgery for obese and overweight patients has risen dramatically in 2018. In total, more than 41,000 overweight patients got new hips and knees last year. This represents a 575 per cent increase in joint replacement operations which are reported to ‘have soared six-fold in only eight years from 6,191 in 2009-10 to 41,761 in 2017-18’. This increase probably reflects the rising prevalence of obesity in an ageing population and increasing sophistication of the surgical procedures. Osteoarthritis, the major cause for hip and knee replacement, cannot yet be prevented or slowed down, but the pain, immobility, social isolation and poor quality of life it causes can be addressed by use of total diet replacement products (TDRs) as has been shown in full scale clinical trials in Denmark.
With joint replacement surgery costing about £5,000 per operation, this sudden rise in the total number of operations is now expected to increase costs to the National Health Service (NHS) to £200 million a year, placing an even greater burden on NHS resources as some £6.1 billion are spent each year on overweight and obesity-related ill-health.
The figures revealed by The Sunday Times investigation, which were described as ‘horrifying’ by health officials, underline the scale and complexity of Britain’s obesity issues. To address these and reduce obesity, Prime Minister Theresa May’s NHS Long Term Plan – launched in Liverpool on Monday 7th January – included a set of actions to be taken by public authorities.
First, the NHS Long Term Plan aims to double enrolment in the type 2 NHS Diabetes Prevention Programme, a joint commitment by NHS England, Public Health England (PHE) and Diabetes UK. Second, and as indicated in a previous blog post, it also provides for the launch – by the NHS – of a trial programme supporting total diet replacement programmes for obese people with type 2 diabetes.
The introduction of this nine-month programme – which will initially be piloted in up to 5,000 patients who will be prescribed a liquid diet of just over 800 calories a day – comes after medical research emerged suggesting that TDRs can help patients who have type 2 diabetes to achieve remission. The preliminary results of Diabetes UK DiRECT study revealed for instance that a quarter of participants achieved a 15 kg or more weight loss using a low-calorie, diet-based, weight management programme, while almost half the participants (46%) receiving the programme were in remission after 12 months and were not taking medication for diabetes. The efficacy of TDRs was confirmed by the DROPLET trial set in a primary care environment, with similar weight loss being reported in obese individuals.
The UK-wide NHS costs attributable to overweight and obesity are projected to reach £9.7 billion by 2050 (according to figures from Public Health England). In this context, wider use of TDRs and meal replacement products (MRPs) could reduce the costs of obesity by reducing the prevalence of type 2 diabetes across the UK population. TDRs and MRPs could also – in some cases – reduce the need for anti-diabetes and anti-hypertension medications as well as reducing overall prescribing costs, thereby eventually relieving the NHS budget. A recent paper[1] by Seamus Kent and Susan Jebb from the University of Oxford showed that women who were approximately 10kg heavier at BMI 35 compared to those with BMI 31 require an additional £60 per annum in prescribing costs. TDR can deliver a 10kg weight loss maintained at one year in a primary care setting.
If you’d like to be part of the conversation, please get in touch with us via secretariat@tdmr-europe.com
[1] Body mass index and use and costs of primary care services among women aged 55–79 years in England: a cohort and linked data study. Kent S, Jebb S, Gray A, et al on behalf of the Million Women Study collaborators 2018 International Journal of Obesity https://doi.org/10.1038/s41366-018-0288-6
21 December 2018 Following the release of the DiRECT trial health economics paper this morning by Diabetes UK, Professor Anthony Leeds, Chairman of Total Diet and Meal Replacements Europe (TDMR Europe), the trade association representing the European total diet and meal replacements industry, welcomed the news:
“This analysis of costs and savings confirms what we all suspected. Total Diet Replacements (TDR) are cost effective because they deliver larger amounts of weight loss than conventional diets and greater initial losses are associated in other clinical trials with better weight maintenance later at 6 months, one year and three years later. Larger weight losses give greater metabolic improvement with more people in diabetes remission. Compliance is high because people feel better quickly. They often sleep better and become more mobile as well as gaining the invisible benefits: improved metabolic state and often a lowering of blood pressure. Aside from benefits in diabetes, TDR are proven to reduce pain in osteoarthritis and improve sleep in obstructive sleep apnoea. TDR are nutritionally complete and there is some evidence for improved nutritional status after weight loss with TDR. TDR should now become part of the physicians’ portfolio for first intervention in newly diagnosed type 2 diabetes.”
NHS England’s recent news that total diet replacements will now be available via an NHS trial to thousands of people with type 2 diabetes was a very welcome announcement for our industry. It’s a testament to how effective our members’ products are and validates the very real impact these could have on the nation’s growing obesity epidemic and its associated diseases. They have proven immensely successful over the years, and with good reason. They provide a safe and effective way to lose weight; they come with support (both one to one and in groups), behavioural therapy and education, and they have been carefully designed to ensure they consist of compositionally sound food products that provide 100% of recommended dietary allowances. NHS England’s news is, we hope, the first step toward making these effective products much more widely available to people across the country who need and can benefit from them.
But what about the rest of the region?
Based on the latest estimates from the EU Commission, over 50% of the entire European population is overweight. The costs to health services of treating the resultant ill health are estimated to be in the region of 7% of total health care expenditure in Europe, with the indirect costs due to loss of productivity, adding as much again. Overall, obesity costs the EU Member States around €59 billion a year from indirect health care costs alone. However, the broader economic impact could be as high as €118 to €236 billion, with rising childhood obesity auguring badly for the future.
We hope that NHS England sets an example that will be replicated across Europe. We believe total diet replacements and meal replacement products can play a significant role in helping address the public health problem of obesity related conditions and it’s what TDMR Europe is constantly working towards: increased awareness of our products and a favourable regulatory and policy environment for the industry, by promoting TDRs and MRPs and establishing them as a safe evidence-based option to tackle the obesity crisis. We focus on an improved understanding of the products, their use and impact on obesity, overweight and diabetes, and we educate policy makers on the importance of investing sufficient resources into helping treat the two thirds of the population who are already obese or overweight, rather than directing all actions and available funding towards prevention.
3 December 2018. NHS England has today informed the public about the decision to include total diet replacements (TDR) as part of the NHS action to tackle obesity and related diseases such as type 2 diabetes.
According to Simon Stevens, NHS Chef Executive, the programme will be initially piloted in up to 5,000 people following the Diabetes UK funded DiRECT trial, where almost half of those who went on a very low calorie diet achieved remission of their Type 2 diabetes after one year. A quarter of participants achieved a staggering 15 kg or more weight loss, and of these, 86% put their type 2 diabetes into remission.
Professor Roy Taylor, lead researcher of the DiRECT trial said that this is ‘a hugely important step forward for the NHS, allowing people with type 2 diabetes to return to full health. This approach has gradually been taken up by doctors, nurses and dieticians, but now practical support will be provided.’
Professor Anthony Leeds, Chair of TDMR Europe said: “We are delighted that the very real benefits of total diet replacement products have been recognised and will be used in an effort to tackle our nation’s growing obesity rates and associated diseases. TDRs have drastically improved the lives of thousands across the country by helping them lose weight safely and effectively, and it is marvellous that they will be made available to more of the public who need them. Obesity is not easy to tackle; it takes a tremendous amount of mental, emotional and physical effort. Our products have proven immensely successful over the years, and with good reason. They provide a safe and effective way to lose weight. They come with support from trained consultants, behavioural therapy and education. They have been carefully designed to ensure that they provide 100% of recommended dietary allowances.”
TDMR Europe is extremely delighted with the announcement made today by NHS England, acknowledging once again the efficacy of Total Diets and Meal Replacement Products in tackling obesity and related diseases.
More information regarding the NHS announcement can be found here.
TDMR Europe’s representative, Rob Rona, discussed with Food Matters Live the activity of TDMR Europe, describing what is the main objective of total diet replacement products and meal replacement products, the association’s impact on addressing public health challenges and reducing the burden of public finances. Our spokesperson also briefed the audience on the new regulations for total diet replacement products and the important role trade associations play in both guiding and enforcing legislation.
The interview was taken for Food Maters Live Table Talk newsletter, which is a platform for thought-provoking, cross-sector debate where food, health and innovation meet.
TDMR Europe at the European Association for the Study of Diabetes (EASD) 2018 Annual Meeting
Last week (1-5th October), Berlin hosted one of the biggest international conferences related to the study of diabetes held by the European Association for the Study of Diabetes (EASD) which gathers annually 15,000 delegates from over 130 countries.
At the conference, the members of the PREVIEW research team presented results on weight maintenance over three years in over two thousand overweight people with pre-diabetes who begin their risk-reduction with an 800kcal/d total diet replacement (TDR) diet given with a behaviour change intervention.
A ‘soups and shakes’ total diet replacement TDR (800kcal/d) diet was used as the initial intervention to achieve weight loss in people with pre-diabetes based in eight centres around the globe*. The initial weight loss was intended to prepare subjects prior to a three-year weight maintenance and lifestyle intervention intended to prevent diabetes.
Of 2224 (of whom 1504 were women) participants who were overweight (BMI >25 kg/m2) with pre-diabetes (according to ADA** criteria) who commenced the dietary programme the overall mean weight loss after 8 weeks was 10.7 + 0.4kg (10.8% of body weight). After eight weeks women lost 10.2kg and men 11.8kg body weight on average, of which 3.2kg (31%) and 1.9kg (16%) were fat free mass respectively (FFM).
First author, Dr Pia Christensen, a postdoctoral fellow and dietitian at the University of Copenhagen, Faculty of Science, who has over ten years’ experience of using formula diets said ‘When I started work with formula diets I, like most of my dietetic colleagues, did not believe that this type of diet could be so effective nor that weight could be maintained afterwards’. She added ‘We showed that compliance with this type of programme is very good (only a small proportion of participants dropped out) probably because the fast weight loss makes the participant feel better very quickly and they want to stay in the programme.’
After 8 weeks 35% of participants were no longer ‘pre-diabetic’ but among those with slightly higher baseline blood glucose levels (using WHO criteria***) and who achieved a ‘successful’ weight loss of 8% or more, nearly two-thirds were no longer ‘pre-diabetic’.
Systolic blood pressure was ‘normalised’ in women, down 7 mmHg from 127mmHg and nearly normalised in men, down 8mmHg from 133mmHg. Blood lipid profiles were largely improved, fasting blood glucose and insulin were reduced, and insulin sensitivity was significantly improved. Metabolic syndrome was less severe in the group as a whole after 8 weeks LED diet.
Adverse events were reported in detail, 7.6% of participants complained of constipation despite the advice to avoid this from the beginning by using bulk laxatives, 2.0% complained of dizziness and no cases of gout occurred in any of the women, but six cases in men. Establishing meaningful rates for low-frequency adverse events requires that large subject numbers be studied, and this data-set enables meaningful rates to be quoted.
After the initial weight loss period those who achieved 8% weight loss were entered into a randomised trial of higher and lower dietary protein intake, higher and lower dietary glycaemic index levels and higher and lower physical exercise activity intensity levels for three years. The results of the three-year maintenance outcomes presented at the European Diabetes meeting (EASD) in Berlin on 5th October 2018 showed that both diets and both exercise strategies were equally effective for weight-loss maintenance and most participants were able to sustain ≥8% weight loss at 3 years. Indeed, the PREVIEW intervention was so effective that there were too few cases of type 2 diabetes to distinguish between the diets.
The PREVIEW team also showed that having a higher initial BMI, a higher income, being less discouraged to eat healthily by family members and being male were linked to greater weight loss.
Commenting on the results Professor Anthony Leeds, chairman of TDMR Europe said ‘This large observational study of Total Diet Replacement diet (800kcal/d) shows for the first time, in a global context, that this is a safe, effective way to begin diabetes prevention programmes. Compliance was high (90%) and the average weight losses of >10% were close to the American endocrinologists’ 10% weight loss targets for diabetes prevention. Metabolic and blood pressure changes were good as expected, and adverse event rates were low. Taken in conjunction with other published clinical trials showing weight maintenance after TDR for up to four years, these results are a substantial offering in the global fight against the tsunami of diabetes that will shortly overwhelm health care providers.’
* The centres were located in Denmark, Finland, The Netherlands, Spain, Bulgaria, the United Kingdom, Australia and New Zealand.
Criteria for impaired fasting glucose:
*American Diabetes Association (ADA): fasting plasma glucose from 5.6 to 6.9 mmol/l
**World Health Organisation criterion: fasting plasma glucose from 6.1 to 6.9 mmol/l
New research set to turn treatment of osteoarthritis on its head, lives could be “transformed”, say researchers.
A solution for England’s heart age problem: Danish study shows 10% weight loss can take 5 years off heart age and ease the pain of osteoarthritis.
Overweight elderly sufferers of osteoarthritis could have their lives “transformed” a leading scientist will today claim at a national conference on obesity.
Speaking at the UK conference on obesity in Newcastle, England on Thursday 6th September, Professor Henning Bliddal, director of the Parker arthritis Institute at Frederiksberg Hospital, Copenhagen will describe how his research team had shown weight loss with TDR (total diet replacement formula diet) and weight maintenance for four years improved symptoms in obese people with osteoarthritis and reduced their heart age by 5 years.
‘Elderly obese people with osteoarthritis have a very high risk of heart attack and stroke’ he said. ‘Our series of published clinical trials shows that an initial 12 to 13% weight loss over 16 weeks with total diet replacement reduces the pain of arthritis and that reduction of pain can be maintained over four years by careful weight maintenance’.
‘This amount of change in so short a time transformed their lives,’ said Professor Anthony Leeds, a bariatric physician at the Central Middlesex Hospital, London and a visiting senior research fellow at the Parker Institute. ‘Although weight loss is a core component in management of KOA, as recommended by the UK’s National Institute of Health and Care Excellence, in practice it is almost impossible to achieve by conventional diet in this type of patient. However, the team at the Parker has shown that a big weight loss with reduction of pain and blood pressure is possible’, he said.
Following the initial weight loss and one-year maintenance phase the Parker research team published the results of a three-year weight maintenance trial using the same participants, in effect showing that a 10% weight loss can be achieved and maintained for four years, with no significant deterioration of symptoms, and with maintained lower blood pressure. Professor Henning Bliddal said ‘These remarkable results should turn osteoarthritis treatment upside down. ‘We should now start with weight loss if the patient with knee osteoarthritis is heavy. ‘We know that most patients can do the programme with well over half getting good results after a total of four years. ‘Pain of osteoarthritis is due to a number of factors including inflammation and a sufficiently restricted diet will reduce the inflammation and hence reduce pain. ‘Pain causes misery for millions of OA patients across the globe, and this diet reduces pain, and the reduction of weight makes moving easier.’
Using the UK’s QRisk2 algorithm Professor Bliddal will present preliminary data showing that heart age before weight loss was on average 6 years greater than chronological age, while four years later heart age had been reduced by 5 years, in the two/thirds of participants who stayed in the programme. The maintenance of reduced blood pressure and reduced weight were probably the important factors contributing to this effect. Use of medications for blood pressure was also slightly reduced reflecting similar findings in other recent weight loss trials.
Prof Bliddal will refer to Public Health England’s announcement on Tuesday expressing concern about excessive heart age in the English population and remind his audience that obesity is linked to a vast portfolio of co-morbidities, the most significant of which are diabetes, vascular disease and osteoarthritis, adding ‘With ageing and heavier populations both Denmark and England are seeing increasing numbers of people with osteoarthritis and diabetes and the healthcare costs are rising rapidly. Achieving weight reduction in those who are overweight and obese is recognised as a ‘core’ feature of osteoarthritis management in European and UK guidelines’.
VLCD Industry Group relaunches as TDMR Europe to become industry voice
The European Very Low-Calorie Diet Industry Group (VLCD IG), the trade body representing manufacturers and distributors of total diet replacements (TDRs) and meal replacement products (MRPs) which provide weight loss programmes for the very overweight and obese, has today relaunched as Total Diet and Meal Replacements (TDMR) Europe under new plans to fundamentally expand its remit.
TDMR Europe has historically worked to campaign in favour of EU regulations that facilitate the sector, rather than regulations which stifle innovation and limit consumer choice. In its new expanded role, it will proactively work to deliver a positive policy environment that furthers the growth of the total diet and meal replacement products sector. It will assume wider responsibilities, becoming a significant voice within the slimming foods industry in dialogue with regulators, policy makers, the media and consumers. TDMR Europe will work to show that against a rising tide of obesity and related diseases, TDRs and MRPs provide thousands of overweight and obese people with an effective, safe and controlled weight loss plan that can deliver immense health benefits, including remission of type 2 diabetes as results of the recent DiRECT study have shown.
Professor Anthony Leeds, Medical Director of the VLCD Industry Group said:
“” The relaunch of TDMR Europe as an expanded, proactive and specialised representative body is a natural step for us to take in order to be more effective at this time of great need for safe, effective solutions for the obesity crisis in Europe.
“Weight problems and weight related diseases are of increasing concern as a public health challenge in Europe. TDR and MRP programmes have been shown to be safe and effective ways to combat to be safe and effective ways to combat obesity and the vast array of obesity related conditions including type 2 diabetes that is becoming increasingly prevalent.”
“We are very excited about our extended and redefined role and working with EU regulators, we very much look forward to further growing our successful industry and offering consumers more rather than less choice over how to tackle their weight related problems.”
More information on TDMR Europe can be found on its new website, www.tdmr-europe.com. Industry members can also get in touch via the trade association’s newly launched Twitter account, @TDMREurope.
80% of dieters believe that the best way to lose weight is through a total diet replacement (TDR) and that no other option is as successful, according to a survey of current and former TDR participants run by the European Very Low Calorie Diet (VLCD) Industry Group.
The survey demonstrates the popularity of TDRs amongst European consumers as a safe, effective way to lose weight ahead of a crucial vote on proposed legislation that risks removing TDRs from the market altogether. The legislation put forward by the European Commission sets specific rules changing how TDRs should be made, which preliminary trials carried out by the Group has found would make TDR products taste awful, have an unappealing texture, turn rancid quickly and be much more expensive for consumers.
The VLCD Industry Group is calling on MEPs to reject the proposed act ahead of a vote in plenary in the European Parliament on Wednesday 13th September, and for the European Commission to reconsider these proposed rules, in order to ensure the continued existence of TDRs, which the survey shows are by far the consumers’ favoured choice to lose weight. 76% of respondents had tried other interventions, including alternative diets such as paleo, low-carb, HCG and intermittent fasting, but stopped the diets because they didn’t lose enough weight, while 33% found the diets too difficult to follow. 69% of users joined a TDR programme specifically because they’d tried various other weight loss plans and nothing worked as well.
The survey also showed that consumers could rely on TDRs to help them keep weight off. 82% of respondents are currently maintaining all or part of their TDR weight loss, 84% feel such programmes are good value for money, and 94% feel their health and quality of life have improved since losing weight on the programme.If the legislation is passed unchallenged, this will leave tens of thousands of obese and overweight people across Europe without one of the safest and most effective options available to lose weight, and is likely to be met with outrage from the weight loss consumer.
Professor Anthony Leeds, Medical Director of the VLCD Industry Group said:
“TDRs have proved time and time again to be effective, safe, convenient and easy to follow. They provide the public with what they need to lose weight and successfully maintain that weight loss. There is no clear rationale in depriving a significant section of the population, of this safe, tried and tested option to better their health and their lives.
It is crucial that this legislation is reconsidered and revised to ensure the continued existence of these vital products and we urge MEPs to take these issues into consideration when the time comes to vote on Wednesday.”
Professor Anthony Leeds, Medical Director of the European Very Low Calorie Diet (VLCD) Industry Group said:
“The EU has misjudged this issue. The very latest published scientific evidence shows that total diet replacement (VLCD and LCD) programmes deliver the amount of weight loss (10 to 20kg) needed to have a huge beneficial impact on Europe’s major health challenges: diabetes, osteoarthritis, and cardiovascular disease. An EU-funded trial in six EU member-states and two others* has shown that people at risk of diabetes can reduce weight by an average 10kg using total diet replacements and over one third are no-longer pre-diabetic. The health-care cost-savings of this are mind-boggling and should have convinced more committee members to vote for this rejection of legislation. It is deeply disappointing that this European collaborative scientific/commercial project between the UK, Sweden and Denmark, where doctors proved that elderly obese could lose 10kg and keep it off for four years, suffering less pain throughout as a consequence, has been set back when all EU countries face pressure to limit the number of knee replacement operations.
“Today’s decision will also have catastrophic effects on ordinary consumers simply wanting to manage their weight loss, and carries a very real risk of forcing them to turn to dangerous, unregulated alternatives such as illegal slimming pills or ‘fad’ diets’ in their desperation to lose weight. It goes completely against the main objective of the Food for Specific Groups regulation to enhance consumer safety, and quite simply, is very likely to escalate the already shocking public health challenge of obesity in Europe.”
“What’s perhaps most frustrating is that these rules are disproportionate and largely unsubstantiated. TDRs have always been overseen by stringent EU food regulation that complies with international standards. They are carefully designed according to scientific research which ensures they consist of compositionally sound food products that provide 100% of recommended dietary allowances, including good quality protein and essential fats. The European Food Safety Authority itself has openly admitted that some of its recommendations are based on theory rather than hard scientific evidence. This legislation is not supported by evidence showing that current compositions are anything other than safe, nor is there hard scientific evidence to show that the new changes would make them safer for consumers.”
“We supported the need for legislation on composition but our repeated requests that the scientific evidence be reconsidered before legislation was made were rebuffed. Obesity and obesity-related conditions are challenging all European countries. A majority of committee members failed in their public duty to insist that the highest standards of scientific evidence should inform the structure of legislation and their increasingly obese constituents will have good cause to reject them at the 2019 polls.”
*Bulgaria, Denmark, Finland, The Netherland, Spain and the United Kingdom, plus Australia and New Zealand.
The European Very Low Calorie Diet Industry Group (VLCD Industry Group) has relaunched its Code of Practice to highlight that consumer safety is a key priority for the industry in light of proposed new legislation that risks wiping out very low calorie diet products (VLCDs) from the market and making weight management products less safe for consumers.
The Code of Practice, which is used to help the industry comply with the body of law related to weight management programmes, is being publicly shared to highlight the steps that the industry has taken to ensure the safety of VLCDs. The Code outlines that VLCDs fall under European food legislation, such as general food safety requirements, and that they are compliant with international standards. It also states that members should be honest and truthful and provide factual information that does not give rise to false expectations, and outlines the steps taken in the rare event of an industry member violating the law, which includes escalating the issue to the relevant authority to ensure consumer wellbeing. The VLCD Industry Group hopes to emphasise the safety of these weight management programmes, particularly in comparison with current weight loss alternatives available on the market – such as risky illegal slimming pills sold on the internet or “fad” diets – that consumers are likely to turn to in the absence of VLCDs.
New legislation put forward by the Commission sets specific rules changing how VLCDs should be made, which the Group has identified would result in VLCDs being very difficult to manufacture, would make them taste unpleasant, have an unappealing texture, turn rancid quickly and be much more expensive for consumers. The new legislation is not supported by any evidence showing that current VLCD compositions are anything other than safe, nor is there scientific evidence to show that the proposed changes would make them safer for consumers.
The VLCD Industry Group is calling on MEPs to reject the proposed act ahead of an expected vote in plenary in the European Parliament in September, and for the European Commission to reconsider these proposed rules.
Professor Anthony Leeds, Medical Director of the VLCD Industry Group said:
““Very low calorie diets are safe and regulated weight loss programmes available to consumers and have been used successfully for more than 30 years. The industry has taken great care to ensure that only safe, effective products are sold to consumers – as the Code of Practice shows. Our efforts risk being undermined, however, by this legislation, which in its current form, makes little sense as it may fail to achieve its primary goal of protecting consumers: it risks leaving them with no choice but to turn to alternative less regulated options that pose a much higher risk to their health. It is also partly unsubstantiated, as the European Food Safety Authority itself has openly admitted that some of its recommendations are based on theory rather than hard scientific evidence.
It is crucial that this legislation is reconsidered and revised to ensure the continued existence of these vital products and we urge MEPs to take these issues into consideration when the time comes to vote in September.”
New legislation currently being considered by the European Parliament could wipe out very low calorie diet products (VLCDs), which amongst a tide of rising obesity will leave tens of thousands of obese and overweight people across Europe without one of the safest and most effective options available to lose weight, warns the European Very Low Calorie Diet Industry Group (VLCD Industry Group).
VLCDs are safe, established, total dietary replacement products specifically formulated to help overweight and obese people lose weight successfully, and are a much more effective method of weight loss than cutting calories using any other conventional food combination. Without them, consumers will be left without a safe and controlled weight loss plan, being forced to turn to unregulated and very often dangerous alternatives, such as nutritionally imbalanced “fad” diets or unlicensed slimming pills.
The changes being considered by the Parliament – outlined in an act sent to it by the European Commission – set specific rules as to how VLCDs should be made. The VLCD Industry Group welcomes clear legislation in this field, but fears that the rules being proposed would make VLCDs almost impossible to manufacture and, where the products could be feasibly produced, they would taste unpleasant, have an unappealing texture, go off quite quickly and be much more expensive for consumers. The removal of such a vital weight loss tool would also undoubtedly lead to even greater levels of obesity rates across the EU.
The VLCD Industry Group is calling on MEPs to reject the proposed act ahead of a possible vote in plenary in the European Parliament this summer, and for the European Commission to reconsider these proposed rules.
Professor Anthony Leeds, Medical Director of the VLCD Industry Group said:
“Weight problems and obesity are of increasing concern as a public health challenge in Europe. The worldwide prevalence of obesity more than doubled between 1980 and 2014, and according to the World Health Organisation, overweight affects up to 70% and obesity up to 30% of adults in European Union countries. VLCDs have historically been one of the most effective weight management programmes, helping to combat not just obesity but also the raft of conditions that come hand-in-hand, such as diabetes. This proposed new legislation is going to have catastrophic effects on ordinary consumers simply wanting to manage their weight loss.
“It is also disproportionate, unnecessary and unsubstantiated as slimming foods like this are stringently regulated by the EU and its Member States. They have been carefully designed according to scientific research which ensures they consist of compositionally sound food products that provide 100% of recommended dietary allowances, including good quality protein and essential fats. These products have been marketed safely in the EU for more than 30 years and are the most – if not the only – regulated diet available on the market.
“It is essential that these rules are looked at again and that a compromise is reached in order to ensure the continued existence of these vital products.”
The loss of very low calorie diet products (VLCDs) will leave tens of thousands of obese and overweight people across Europe without one of the safest and most effective options available to lose weight, making them more likely to turn to less regulated and potentially dangerous alternatives such as fad diets and slimming pills, warns a new report by the European Very Low Calorie Diet Industry Group (VLCD Industry Group).
The report, Protecting Consumers and Delivering a Healthier, Happier Europe, which will launch at a European Parliament event on 3rd May, outlines a body of evidence demonstrating the need for the continued existence of VLCDs and the detrimental impact their loss would have on public health across the continent, using a sample of real-life examples of individuals whose lives have drastically improved while using the products. This is in light of newly proposed legislation that risks wiping out the weight loss programmes.
VLCDs are total dietary replacement products specifically formulated to help overweight and obese people lose weight successfully. Without them, consumers will be left without a safe and controlled weight loss plan, being forced to turn to unregulated and often dangerous alternatives, such as nutritionally imbalanced “fad” diets, including high-protein diets, and even unregulated and unlicensed slimming pills.
Unlike VLCDs, fad diets use combinations of conventional foods and as such do not fall under European legislation, presenting considerable risks to maintaining good health, particularly as they are not specially formulated to ensure the required levels of essential nutrients are provided. Alongside this, slimming pills that are not regulated by the European Medicines Agency and are not backed up clinical research may hold hidden dangers to consumers’ health, and can result in anything from high blood pressure, to liver damage, to death.
VLCDs are at risk of ceasing to exist if new legislation currently being considered by the European Parliament is implemented. The changes, which were outlined in an act sent to the Parliament by the European Commission, set specific rules as to how VLCDs should be made. The VLCD Industry Group has determined that the rules being proposed would make VLCDs very difficult to manufacture and they would taste unpleasant, have an unappealing texture, turn rancid quite quickly and be much more expensive for consumers.
The VLCD Industry Group is calling on MEPs to reject the proposed act ahead of a possible vote in plenary in the European Parliament this summer, and for the European Commission to reconsider these proposed rules.
Professor Anthony Leeds, Medical Director of the VLCD Industry Group said:
“Obesity is one of Europe’s biggest public health challenges. VLCDs and total diet replacement products are one of the most effective weight management programmes and have the potential to help combat not just obesity but also the raft of conditions that come with it, including diabetes. This proposed new legislation is going to limit the choice of ordinary consumers’ simply wanting to manage their weight loss
“In their desperation, there is a very real risk that these consumers will turn to “quick fixes” that have the potential to cause them serious harm. In 2015 alone, the UK Medicines and Healthcare Regulatory Agency (MHRA) seized more than 240,000 doses of pills claiming to be for weight loss, which turned out to contain previously banned medicines associated with increased risks of heart attacks and strokes. That’s just one example – there are many other dangerous alternatives available across the continent. VLCDs are a regulated option available on the market and have been used successfully for more than 30 years, as is evident in the report. What this proposed legislation is effectively doing is putting a, and very large, needy group of people at unnecessary risk as they seek substitute weight loss options that are less likely to work and may be detrimental to their health.”
Jeroen Bertelink, a former VLCD-user said:
“I lost 94kg on my VLCD programme and it’s the best thing I’ve ever done. I had considered all the other options before – the online diets, the weight loss pills, the surgery, but the risks associated with all of them were too big. You hear horror stories every day about people whose bodies suffer great damage because they trusted something on a dodgy website and I was too afraid to become just another news item. The VLCD changed my life, and rather than expose me to any health risks, it helped improve my health in many ways. I’m truly thankful for the existence of VLCDs and think it would be catastrophic if they were no longer available to help people who need them the most.”
