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“Redefining Obesity and Diabetes: Radical new treatments, clear thought and common sense”

Professor Mike Lean, Professor of Human Nutrition at the University of Glasgow, Fellow of Downing College Cambridge and co-principal investigator of the DiabetesUK funded DiRECT diabetes remission trial will give the fourth Howard Lecture at Downing College on Tuesday 6th May at 6pm.

Attendance is free but please register here for tickets: www.eventbrite.co.uk/e/howard-foundation-lecture-professor-mike-lean-tickets-1244612382139

See: https://www.howard-foundation.com/news/

https://www.diabetes.org.uk/about-us/news-and-views/weight-loss-can-put-type-2-diabetes-remission-least-five-years-reveal-latest-findings

Professor Lean was appointed an honorary fellow of Downing College in September 2024

https://www.dow.cam.ac.uk/news/downing-appoints-five-new-honorary-fellows

See also:

https://tdmr-europe.com/2025/01/22/overweight-and-long-covid-how-a-low-calorie-diet-can-help/

https://tdmr-europe.com/2024/05/28/diabetes-remission-after-weight-loss-with-total-diet-replacement-5-year-evidence-and-feasibility-of-use-in-osteoarthritis/

TDMR Europe welcomes World Obesity Day (WOD) 2025. Organised annually by the World Obesity Federation, WOD is a unified day of action that calls for a cohesive, cross-sector response to the obesity crisis.

With the theme “Changing Systems, Healthier Lives”, this year’s WOD shines a spotlight on systems, such as healthcare and government policies, that shape public health. WOD 2025 emphasises that, by working together, governments, health professionals and advocates can transform these systems and create a healthier future for all.

Echoing WOD’s 2025 theme, TDMR Europe calls on governments and public health systems across Europe to tackle obesity by considering all options available, including scientifically sound weight loss programmes that use formula diet products, such as the United Kingdom’s ‘Pathway to diabetes remission’ programmes that are delivered nation-wide in England and Scotland.

Obesity rates continue to increase rapidly

Last week the World Health Organisation’s Regional Office for Europe (WHO Europe) issued the 2024 edition of its European Health Report, which is WHO Europe’s flagship publication produced every three years by the organisation.

The report states that in 2022, in the WHO European Region, 22.6% of adults were living with obesity. This figure is well above the global average of 15.8% and the prevalence of the condition in the region has been increasing steadily over the past 50 years, with a marked increase of over 20% between the years 2006 and 2022.

Moreover, WHO Europe’s analysis of male obesity and overweight show shocking results, with the proportion of men living with either of these two conditions nearing or exceeding 70% in several countries.

Meanwhile, the World Obesity Federation estimates that the rates of overweight and obesity worldwide are set to double from 2010 to 2035, affecting 1.9 billion people, meaning 1 in 4 adults.

Obesity’s economic impact to surpass $4 trillion by 2035

According to WHO Europe, the global economic costs associated with obesity are projected to reach an alarming $3 trillion per year by 2030, while data from the World Obesity Federation show that, in 2035, obesity’s economic impact will reach $4.32 trillion. In the EU, the total cost of adult obesity, including healthcare costs and lost productivity, has been estimated at €70 billion per year.

England’s obesity management policy sets the example for the EU

In January 2025, the UK’s National Institute of Health and Care Excellence (NICE) published its updated guideline on overweight and obesity management. The guideline supported the use of low and very-low energy diets (LEDs and VLEDs) to tackle obesity and overweight as well as to help people with these conditions and type 2 diabetes (T2DM) achieve remission.

NICE’s guideline follows years of scientific research showing the role of LEDs and VLEDs with formula diet products in helping people with obesity or overweight lose weight and improve their T2MD and other comorbidities. More importantly, with its Type 2 Diabetes Path to Remission Programme, the English National Health Service (NHS) has shown that these diet programmes can be used in primary care settings to reduce obesity and  put T2DM into remission.

With the obesity rates in Europe hitting record high, EU policy makers need to take note of these developments and put forward public health initiatives like the NHS Type 2 Diabetes Path to Remission Programme.

TDMR Europe works to help stakeholders, such as policymakers and healthcare professionals, develop a better understanding of formula slimming foods and the role of these products in improving obesity and related diseases. Businesses and organisations in the sector interested in finding out more and supporting our work can reach out to TDMR Europe at secretariat@tdmr-europe.com.

Aris Myriskos

TDMR Europe Secretariat

PR and Media Relations Office

On 10^th February, the House of Commons Library published its research briefing on adult obesity and overweight in the UK. According to the latest data, in England, 64% people have overweight or obesity, showing a 22% increase over the past three decades.

The analysis of obesity and overweight prevalence in Scotland, Wales and Northen Ireland show similar alarming results. Almost a third of adults in Scotland had obesity in 2023, the highest level on record. Research between the years 2022 and 2024 shows that, in Wales, 65% of men had overweight or obesity, compared with 57% of women, while, in Norther Ireland, the percentage of men and women with either of these two conditions was 69% and 60% respectively.

Meanwhile, data from the Organisation for Economic Co-operation and Development (OECD) show that the UK ranks tenth among the countries with the highest measured percentage of people with obesity.

The briefing from the Commons Library follows a publication from Diabetes UK showing that 1 in 5 adults in the UK live with diabetes or pre-diabetes. The charity’s chief executive said the organisation is “concerned that the rise in the number of those living with … obesity is translating into soaring cases of prediabetes and type 2 diabetes across the UK”. According to Diabetes UK “the strongest evidence we have at the moment suggests that type 2 diabetes is mainly put into remission by weight loss. Remission is more likely if you lose weight as soon as possible after your diabetes diagnosis”.

Last month, the National Institute of Health and Care Excellence (NICE) published its updated guideline on overweight and obesity management. The guideline recommends that low-energy diets (LEDs) should be considered “as part of multicomponent overweight and obesity management strategy with long-term support within a specialist overweight and obesity management service (or other services for the management of long-term conditions such as type 2 diabetes)”. NICE recommends that LEDs should be used for people with obesity, with or without type 2 diabetes (T2DM) and adults with overweight and T2DM. The institute also supports the use of very-low energy diets (VLEDs) for people who are living with obesity and have clinically assessed need to lose weight rapidly.

According to NICE, the evidence examined by the committee that made the recommendations showed “that LEDs and VLEDs are effective with results lasting for 3 to 5 years after undertaking the diets if ongoing support is given”. The diets that were used in the analysed studies “were more effective than usual care for both mixed populations (people living with overweight and people living with obesity).” Moreover, NICE stressed that “there was no evidence of adverse events linked with low-energy and very-low-energy diets” and that “the health economic analysis found low-energy diets plus weight maintenance support to be cost-effective in people who are living with obesity, or who are living with overweight and have type 2 diabetes”.

In 2021, the cost of obesity to the UK economy was estimated at an astounding £98 billion, equivalent to almost 4% of the national GDP, while recent research commissioned by Diabetes UK showed that the National Health Service (NHS) spends £10.7 billion a year on diabetes, that is, about 6% of the UK health budget. Explaining the benefits of using LEDs to tackle obesity or overweight and T2DM, NICE has emphasised that “reduced levels of overweight and obesity could reduce the costs of treating related conditions for the NHS and wider systems, such as social care”.

The NHS England is already using a low-calorie diet programme to help people with obesity or overweight and T2DM in selected areas. Analysis of the results of the NHS Type 2 Diabetes Path to Remission Programme has shown that it has been successful and cost-effective. Following these results and in light of NICE’s recommendations to tackle obesity and T2DM and the ever-increasing rates of the conditions, the Government needs to expand the NHS Type 2 Diabetes Path to Remission Programme across the UK.

More information on LEDs and VLEDs can be found here.

TDMR Europe works to help stakeholders, such as policymakers and healthcare professionals, develop a better understanding of slimming foods used for LEDs and VLEDs and aims to increase awareness of the research on the products. Businesses and organisations in the sector interested in finding out more can reach out to TDMR Europe at secretariat@tdmr-europe.com.

Aris Myriskos

TDMR Europe Secretariat

Press and Media Relations Office

Whilst it has been more than four years since the COVID-19 outbreak, the impact of the pandemic is still being felt around the world. In Europe, it is estimated that more than 60% of those previously affected by the disease experience persistent, often severe symptoms months after the initial infection – a condition known as Long COVID.

Studies have found that obesity increases the risk of severe COVID and is also associated with long‐term post‐COVID symptoms. Obesity or overweight can make COVID worse as it can weaken the immune system response, impair lung function as well as cause general inflammation of the body – an overreaction of the immune system which can make COVID symptoms last longer. In addition, research has shown that vaccinated people with overweight are at higher risk of becoming very unwell  from COVID compared to vaccinated people of a healthy weight.

Earlier this month, researchers from the University of Glasgow published the results of the ReDIRECT trial. Funded by the National Institute for Health and Care Research (NIHR), this study investigated whether a remotely delivered structured weight management programme with total diet replacement (TDR) could improve Long COVID symptoms in people living with overweight.

The ReDIRECT trial included 234 adults with Long Covid and a body mass index (BMI) greater than 27 kg m⁻² (or >25 kg m⁻² for South Asians) who nominated the Long Covid symptoms they most wanted to see improve, including fatigue, breathlessness and pain. The intervention group, consisted of 118 participants, who were provided with a 12-week weight loss programme with TDR (850 kcal per day), followed by structured food reintroduction and weight loss maintenance support.

Analysis of the results in 97 participants in the intervention group showed improvement of the primary outcome – which was based on the participant-selected dominant Long Covid symptom score – with no excess of serious adverse events. The mean weight loss in the intervention group was 10kg, which also led to meaningful reductions in blood pressure. As the researchers stressed, “given measured declines in blood pressure and known benefits of weight loss in reducing the risks for multiple other complications, the substantial intentional weight loss, if maintained, could have multiple other benefits for participants whose baseline BMI averaged around 35 kg m⁻²”.

As ReDIRECT was a complex intervention and had several limitations, the authors of the study recognised the need for further research. However, they noted that these “results which represent robust randomised trial evidence that remotely delivered dietary weight management which generates a mean of 10 kg intentional weight loss, is both safe and effective in reducing the symptoms that matter most for people living with Long Covid and overweight”.

TDMR Europe works to help stakeholders, such as policymakers and healthcare professionals, develop a better understanding of slimming foods and aims to increase awareness of the research on the products. Businesses and organisations in the sector interested in finding out more can reach out to TDMR Europe at secretariat@tdmr-europe.com.

More information on TDMR Europe can be found here.

Watch our educational webinars here.

More information on TDR is available here. You can find out more about the latest research on the product here and here.

 

Aris Myriskos

TDMR Europe Secretariat

Press and Media Relations Office

 

TDMR Europe welcomes World Diabetes Day (WDD) 2024. Launched in 1991 by International Diabetes Federation (IDF) and the World Health Organization (WHO) and becoming an official United Nations Day in 2006, WDD is the world’s largest diabetes awareness campaign, taking place annually on 14^th November. This year’s WDD theme is “Diabetes and well-being” stressing that “with appropriate access to diabetes care and support for their well-being, everyone with diabetes has the chance to live well”.

According to WHO, diabetes is one of the most common chronic conditions in the WHO European Region. In fact, it is estimated that 1 in 10 people living in the Region will have diabetes by 2045. Data from the European Commission show that over 33 million people in the EU suffer from diabetes and type 2 diabetes mellitus (T2DM) accounts for more than 90% of all cases of diabetes.

The Commission has stressed that overweight and obesity are among the major risk factors for diabetes and notes that prevention and early and appropriate interventions are indispensable measures to reduce the prevalence and complications of diabetes. According to the Commission, over €1,25 billion have been devoted to support research and innovation on diabetes and related factors, including obesity.

Last month, a manifesto launched by TDMR Europe for the EU’s term 2024 – 2029 emphasises that current obesity policies in Europe place the focus primarily on prevention through healthy eating and exercise, with little consideration towards those who already have obesity or overweight and who are struggling to manage their weight. Moreover, despite EU policy makers’ interest in addressing diabetes and obesity based on relevant research, scientific evidence showing the effectiveness of total diet replacement (TDR) has been overlooked.

Meanwhile, on the other side of the channel, the English National Health Service (NHS) is running a successful diet programme with TDR helping thousands of people with obesity and T2DM lose weight and improve their health. The type 2 diabetes pathway to remission programme, formerly known as the ‘soups and shakes diet’, was based on the DROPLET and DiRECT trials. These ground-breaking studies have shown that not only is weight loss with TDR an efficient measure to tackle obesity, prevent and improve T2DM but also using this product is a cost-effective way to address these conditions. Research from Imperial College London on the pilots of the NHS TDR programme and a study from the Leeds Beckett University evaluating the qualitative aspects of the ‘soups and shakes diet’ support the conclusions of the DROPLET and DiRECT trials and demonstrate the effectiveness of TDR in primary care.

As the EU has entered a new policy cycle – following the European elections and with a new European Commission expected to be fully operational in the following weeks – it is crucial to raise awareness of the ever-increasing obesity and T2DM rates and the need to address these challenges, considering all options available, including formula diet products. Businesses in the sector need to work together to ensure these issues will be on the new policy makers’ agenda for the next five years. As the voice of the industry, following the launch of its manifesto, TDMR Europe will be implementing targeted public affairs campaigns and will be working closely with decision makers in Europe. Slimming food businesses interested in finding out more can get in touch at secretariat@tdmr-europe.com

More information on TDMR Europe can be found here.

You can find out more about the latest research on TDR here and here.

Watch our educational webinars here

 

Aris Myriskos

TDMR Europe Secretariat

Press and Media Relations Office

Last month, TDMR Europe published its Manifesto for the EU’s political term 2024 – 2029. The Manifesto called for a unified EU approach to combat obesity, emphasising the role of total diet and meal replacement products (TDRs and MPRs) as cost-effective, evidence-based solutions for weight loss and maintenance.

Our initiative also emphasised that public health services have started to acknowledge the role of TDRs and MRPs in managing obesity and improving related diseases. For example, the English National Health Service (NHS) introduced a low-calorie diet programme with TDR, to help thousands of people who have obesity and who are living with type 2 diabetes (T2DM) lose weight and achieve T2DM remission.

This year’s UK Obesity Congress featured presentations that demonstrated the effectiveness of the NHS TDR programme and discussed new studies on the product. Researchers from the University of Oxford showed that the NHS Type 2 Diabetes Pathway to Remission programme can be safely implemented without additional screening, as “there was no evidence that TDR increases disordered eating and its impairment compared to usual care in the short term, and in fact, showed significant improvement”.

The UK Obesity Congress also featured a presentation on the Re:Mission study, a three-year research which evaluated the qualitative aspects of the NHS TDR programme. The presentation showed that, at 12 weeks, experiences were largely positive with TDR having provided control with eating behaviours which contributed to weight loss and improved glycaemic control. Also, at 12 months, many participants reported improvements in psychosocial and physical functioning, and continued use of MRP and TDR products as a weight maintenance mechanism was evident.

At the event researchers also shared promising results for the the use of low-energy diet with TDR in adults with obesity and compensated cirrhosis due to metabolic dysfunction-associated steatotic liver disease (CC-MASLD). This was an important study as it is estimated that there are 150,000 people living with CC-MASLD in the UK. Currently there are no licensed treatments, and this trial addressed questions about the use of TDR  in this population. The trial presented at the UK Obesity Congress, showed that participants in the dietary energy restriction group saw reductions in weight, liver fibro-inflammation, and steatosis, and no serious adverse events or changes in physical performance. As a recent publication on the UK Obesity Congress explains, “the preliminary findings of this trial suggest that dietary energy restriction may be safe and help to delay disease progression in this population”.

The oral sessions at the conference also included presentations on “Using Total Diet Replacement, from bench to bedside”. Researchers from the University of Glasgow presented results from the ReDIRECT study, which assessed whether home-delivered weight management with TDR could improve long COVID symptoms in people living with excess weight. In this trial, mean weight change in the intervention group was -10.3 kg at 6 months, compared to -0.7 kg in the control group. Symptoms changed in the intervention group participants with reduced included fatigue, breathlessness, anxiety and depression. The intervention also improved blood pressure and health-related quality of life, with no excess of adverse events.

As obesity rates continue to soar across Europe and policymakers are looking at addressing this challenge, raising awareness of the scientific evidence on the effectiveness of formula diet foods in tackling the condition and improving comorbidities is key to ensure that the products will be part of the solution.

TDMR Europe works to help stakeholders develop a better understanding of slimming foods and aims to increase awareness of the research on the products. Businesses and organisations in the sector interested in finding out more can reach out to TDMR Europe at secretariat@tdmr-europe.com. More information on TDMR Europe can be found here.

Here you can watch our educational webinars.

Here you can find a list of references to studies on TDRs and MPRs.

Aris Myriskos

TDMR Europe Secretariat

Press and Media Relations office

 

TDMR Europe welcomes World Arthritis Day (WAD) 2024. Taking place annually on 12^th October, WAD is a global awareness day aimed towards increasing knowledge of the existence and impact of rheumatic and musculoskeletal diseases (RMDs) among all relevant audiences. This year, WOD is focused on helping people living with RMDs make evidence-informed choices in partnership with their healthcare professionals to improve their overall health and quality of life. In this context, TDMR Europe stresses the need to raise awareness of the role of weight loss in tackling osteoarthritis in people with obesity or overweight.

The role of weight loss in improving osteoarthritis in people with obesity

According to the National Institute for Health and Excellence (NICE), osteoarthritis is more common in people with obesity, among other risk groups. The NICE Guidance “Osteoarthritis in over 16s: diagnosis and management” argues that weight loss can help improve the quality of life and physical function and reduce pain in people with osteoarthritis and obesity. The Guidance also claims that “losing 10% of their body weight is likely to be better than 5%”.

Research shows the effectiveness of low and very-low energy diet

In a recent webinar organised by TDMR Europe, Professor Henning Bliddal, Director of the Parker Institute, a clinical research unit of rheumatology at Frederiksberg University Hospital, Copenhagen, demonstrated that weight loss with total diet replacement (TDR) and meal replacement products (MRPs) can help people with obesity and knee osteoarthritis lose weight and improve their health.

Prof Bliddal presented the results of the CAROT study, a two-year trial that enrolled 192 patients with obesity and knee osteoarthritis. The trial had two phases, the first (16 weeks) consisting of a dietary intervention with low-energy diet (LED) and the second (52 weeks) a randomized, three group controlled study of maintenance of weight loss by either continuing dietary instruction (and use of one meal replacement product daily), exercise, or a control group.

Prof Bliddal showed that at the end of the first phase “two out of three participants had very significant pain relief and better function”.  According to Prof Bliddal, “with a 16-week programme you can make people a lot better in, should we say, no time, in a simple way”.

A three-year follow up study divided participants into two groups, providing either an “ordinary” diet combined with one MRP per day or reintroduction of five weeks of TDR every four months (nine episodes of 5 weeks TDR over 3 years). Prof Bliddal explained that during this trial, the rate of knee replacement was lower than expected and while patients were reluctant to exercise, they managed to maintain their weight loss over those three years.

In order to take the Danish evidence a step further and apply it to the United Kingdom, Versus Arthritis the UK’s largest arthritis charity funded a feasibility trial of a package of care for people awaiting knee surgery, led by Professor Hamish Simpson at the University of Edinburgh.  Published in February 2024 this study showed that a package of care including weight loss giving an average 11.2kg weight loss with TDR (10.4% compared to 1.2% in the control group) was feasible.  Symptoms, including pain, stiffness and physical function improved more in the intervention than the control group. Ten percent of intervention participants cancelled their surgery because symptoms were so improved.  Adherence to interventions was 100% except for exercise therapy and the overall positive effect on participants’ quality of life suggests that this combination of weight loss with TDR, exercise therapy, use of insoles, and analgesia optimisation, should be offered to the many thousands of people in the UK languishing with pain and social isolation due to immobility while they await knee surgery.

Three months later another study exploring the role of low-energy diet (LED) in addressing obesity and knee osteoarthritis was published. The POWER randomised control trial, published in the British Journal of Sports Medicine, examined the effectiveness of a physiotherapist-delivered intensive diet programme for knee osteoarthritis, run in Melbourne, Australia.

The POWER trial is the first study to show that a physiotherapist-delivered 800kcal/d LED incorporating two MRPs daily and an exercise program is safe and effective for weight loss compared to exercise alone in people with obesity and knee osteoarthritis. Participants lost 8.1% body weight over six months (compared to just 1% in control participants).. As the researchers have stressed, “this study provides the first proof-of-concept evidence of an alternate allied health clinician delivery model for weight loss in people with knee osteoarthritis, which may guide future research and policy in the face of rising obesity rates and challenges facing healthcare systems”.

The rising burden of osteoarthritis

Osteoarthritis affects millions in Europe, with the Economist Intelligence Unit estimating that the number of people affected in Western Europe was 57 million in 2019, growing by 54% over the past 30 years.

European countries have reported annual osteoarthritis-related costs in the billions of Euros, with direct and indirect healthcare costs reaching 7.2 and 4.6 billion Euros respectively (Economist Intelligence Unit)

In addition to these substantial healthcare costs, osteoarthritis also impacts Europe’s economy by causing absenteeism and early retirement, necessitating income support or disability allowance payments. Some people with osteoarthritis may also need some degree of nursing and social care.

In the light of these findings, it is urgent for governments across Europe to take note of the research showing the effectiveness of weight loss in tackling osteoarthritis in people with obesity and introduce science-based measures in the public health sector, including TDR and MRP diet programmes.

TDMR Europe works to help stakeholders develop a better understanding of formula diet foods and aims to increase awareness of the scientific evidence showing the effectiveness of these products in tackling obesity and improving related comorbidities. Find out more here

Footnotes:

Total Diet Replacements (TDRs) which include very low calorie diets (VLEDs) and low calorie diets (LEDs), are specifically formulated programmes that are based around formula foods that aim to replace the whole of the daily diet. These formula foods are nutritionally balanced with key vitamins, minerals, high quality protein, essential fats, fibre and other nutrients, and are designed to replace conventional foods for a period to facilitate optimal weight loss. They provide controlled energy intake lower than can be achieved with a reduced intake of normal foods.

Meal replacements (MRPs) are products presented as a replacement for one or two meals of the daily diet. They are used alongside conventional food, as part of an energy restricted diet, to facilitate and maintain weight loss. MRPs are low-calorie meals taken in place of breakfast, lunch or dinner. They contain between 200kcal and 250kcal and come in pre-rationed form. This makes it easier for people who are looking to lose or maintain weight to control their calorie intake, as they no longer need to control their portions like they would need to do with ‘normal foods’.

Aris Myriskos

TDMR Europe Secretariat

Press release

10 October 2024

Sixty percent of Europeans living with overweight and obesity are being let down by the European Commission’s strategy to tackle the condition at a cost of €70 billion per year.

According to a WHO analysis obesity and overweight affect almost 60% of adults across Europe and is the cause of at least 200,000 new cancer cases annually as well as acting as gateway to cardiovascular disease and type 2 diabetes (T2DM). Research shows that associated healthcare costs and reductions in productivity are costing EU Member States €70 billion per year.

TDMR Europe has published a manifesto for the EU’s term 2024 – 2029. The initiative highlights that Europe’s Beating Cancer Plan, EU4Health and the Farm to Fork (F2F) Strategy have primarily focussed on obesity prevention through healthy eating and exercise. TDMR Europe argues that there is no or little consideration of those who already have obesity or overweight and who are struggling to manage their weight and related problems.

While recognising that responsibility for delivery of health care is devolved to national governments, TDMR Europe is calling for the strategy to be rebalanced to include recommendations to utilise all clinically proven options for weight reduction and maintenance programmes including total diet and meal replacement products.

The Group highlights the vast amount of scientific evidence showing the effectiveness of the products, such as the EU funded ‘PREVIEW’ trial, a three-year study conducted on people with obesity and pre-diabetes in Europe and around the world. The study showed that an average of 10% weight loss with total diet replacement (TDR) followed by a low glycaemic index (GI) diet provided better weight loss maintenance than other diets and reduced the development of diabetes to below the expected level.

The manifesto also cites examples outside research settings, such as the English National Health Service (NHS) TDR programme where 27% of 710 participants with T2DM went into remission with an average weight loss of 14.8kg. Patient groups have said that the programme was easy to incorporate into their lives. In addition to weight loss and improved blood glucose levels, they had increased energy, mobility, and functional fitness, and self-esteem improved. Participants said that the diet replacement programme and products gave them a sense of control over their energy consumption that they struggled to manage with their usual conventional-food diet.

Professor Anthony Leeds, Chair of TDMR Europe, said:

“EU leaders now have a wonderful opportunity to lead national governments towards a comprehensive solution for the threat of obesity-related conditions and the suffering and high health care costs that they will cause.  Low-cost, safe, scientifically proven options to facilitate weight loss in the 60% of EU citizens who need to weigh less should be recommended. A comprehensive programme must include TDR programmes because these are proven to deliver diabetes remission and are recommended by Europe’s expert panel (the EASD).” 

“Preventive public health programmes to combat obesity must remain in place, must be rigorously evaluated and then effectively delivered, while those who have already become overweight and obese need safe, scientifically proven and cost-effective interventions.”

 

-Ends-

For more information contact aristeidis.myriskos@whitehousecomms.com

Notes to editors

The TDMR Manifesto calls for:

• Support for a more ambitious role for the EU in public health matters and continue to recognise the complexity of obesity, while ensuring a clear focus on weight management alongside prevention.
• Issue an EU level action plan on obesity management that explores all scientifically proven weight management methods available, including the use of total diet replacements (TDRs) and meal replacement products (MRPs) for weight control.
• Ensure a regulatory environment for TDRs and MRPs that is aligned with the latest scientific evidence.
• Revise the current prohibition on the use of nutrition and health claims for TDRs.

About total diet and meal replacement products

Total diet replacements (TDRs) are diets composed of formula foods and replace the whole of the conventional food intake for a period of weeks to achieve optimal weight loss. Formula foods are nutritionally balanced with key vitamins, minerals, high quality protein, essential fats, and fibre, but with reduced dietary energy content. They provide controlled energy intake lower than can be achieved with a reduced intake of normal foods and have been shown to deliver sufficient weight loss to help people with type 2 diabetes go into remission and improve symptoms and health status in other obesity comorbidities such as cardiovascular disease, osteoarthritis and obstructive sleep apnoea.

Meal replacement products (MRPs) are presented as a replacement for one or two meals of the daily diet. They are used alongside conventional food, as part of an energy restricted diet, to facilitate and maintain weight loss.

About EASD’s recommendation:

Evidence-based European recommendations for the dietary management of diabetes
The Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD)
Diabetologia. 2023 Jun;66(6):965-985. doi: 10.1007/s00125-023-05894-8.

Obesity rates in England have grown exponentially over the past decades. Currently, 26.2% of women and 26.4% of men in England are estimated to have obesity, a significant increase compared to 1980, when 9% of women and 6% of men had obesity. This surge is linked to severe health issues, including cancer, type 2 diabetes, and heart disease. In 2021, the cost of obesity to the UK economy was estimated at an astounding £98 billion, equivalent to almost 4% of the national GDP.

As the new UK Government looks to take decisive action following the general election, Total Diet and Meal Replacements Europe (TDMR Europe) emphasises the crucial importance of incorporating Total Diet Replacement Products (TDRs) and Meal Replacement Products (MRPs) into a holistic strategy to address the obesity crisis. By providing a structured, nutrient-dense approach, TDRs and MRPs offer a cost-effective solution to tackle obesity and improve related health issues.

What Are TDRs and MRPs?

TDRs are comprehensive programmes that replace the entire daily diet with formula foods, designed to provide complete nutrition while facilitating significant weight loss. Whereas MRPs replace one or two meals a day and are used alongside regular food as part of a calorie-restricted diet. Both methods are pivotal in diabetes remission programmes and are gaining traction globally. TDRs and MRPs are crucial for providing the initial phase of safe, rapid, and effective weight loss in these programmes.

Our Call to Action

TDMR Europe urges UK policymakers to adopt a more ambitious role in public health by recognising obesity’s complexity.

The new UK government’s election manifesto focuses solely on tackling childhood obesity. While this is important, TDMR Europe argues that UK policymakers should also aim to address adult obesity.

TDMR Europe offers the following key recommendations to address adult obesity in the UK:

1. Developing an Obesity Action Plan: This plan would explore all scientifically backed weight management methods, including TDRs and MRPs, to effectively tackle obesity.
2. Aligning Regulations with the Latest Science: Ensuring the regulatory environment supports the latest scientific evidence is essential for the success of TDRs and MRPs.

Scientific Backing

Numerous studies highlight the effectiveness of TDRs and MRPs. Among others:

• Diabetes Remission Clinical Trial (DiRECT): This trial found significant weight loss and diabetes remission in participants using TDRs. Those maintaining a loss of more than 10kg showed a two-thirds success rate in diabetes remission after two years. Additionally, data from 85 participants in the original intervention group showed an average 5-year weight loss of 6.1 kg.
• PREVIEW Study: Conducted on over 2,200 individuals with pre-diabetes, this study demonstrated a 10% average weight loss using TDRs, significantly reducing the risk of developing diabetes.

These trials comprise only a fraction of the scientific evidence on record underscoring the potential of TDRs and MRPs as powerful tools in combating obesity and its associated health risks.

Economic and Health Benefits

Obesity in the UK costs the NHS £6.5 billion a year and is the second biggest preventable cause of cancer. By reducing obesity rates, TDRs and MRPs not only improve individual health but also alleviate economic burdens. In the DiRECT trial, nearly half of participants achieved remission of type 2 diabetes after one year by following a low-calorie TDR diet, with significant weight loss contributing to this outcome. Additionally, participants experienced a dramatic fall in blood pressure, averaging a drop of 10 mmHg, and showed improvements in cardiorespiratory fitness and cardiovascular risk, leading to fewer adverse events such as bacterial infections, strokes, and cancers.

The Path Forward

To maximise the benefits of TDRs and MRPs, the UK Government must prioritise evidence-based solutions. This includes supporting regulatory frameworks that reflect scientific advancements and ensuring access for all socio-economic groups. The UK has been a global leader in utilising TDR and MRP programmes and should continue to lead the way. Recently, NHS England introduced a Low Calorie Diet Programme to support thousands of people who are overweight and living with type 2 diabetes to support them to achieve remission. The programme has been a resounding success.

Embracing a New Era in Weight Management

The time has come for policymakers to move beyond prevention and address obesity with proven management strategies. By embracing TDRs and MRPs, the UK can continue to lead a transformative approach to health, ultimately reducing the prevalence of obesity and enhancing quality of life for millions.

TDMR Europe, in line with the European Association for the Study of Obesity’s Venice Declaration, calls for improving access to obesity management services in primary care and evidence-based interventions. TDMR Europe also calls for environmental and socio-economic factors influencing obesity to be addressed. By demanding evidence-based interventions, the full potential of TDR products can be unlocked, paving the way for a healthier future.

Find out more information about TDRs and MRPs here.

Please find a list of references to studies on TDRs and MRPs here.

 

About TDMR Europe:

TDMR Europe works to help stakeholders develop a better understanding of formula diet foods and aims to increase awareness of the scientific evidence showing the effectiveness of these products in tackling obesity and improving related comorbidities. Find out more here.

 

Grant Dunnery

TDMR Europe Secretariat

TDMR Europe has recently organised an online seminar to demonstrate the role of total diet replacement (TDR) in tackling obesity and in improving type 2 diabetes (T2DM) and osteoarthritis.

Moderated by the Chair of TDMR Europe Professor Anthony R Leeds, the webinar featured Professor Mike Lean from Glasgow University and Professor Henning Bliddal, Director of the Parker Institute, a clinical research unit of rheumatology at Frederiksberg University Hospital in Copenhagen.

Prof Bliddal showed that TDR can help people with obesity and knee osteoarthritis lose weight and improve their health, providing an insightful presentation on “Weight loss and medical management of osteoarthritis” the conclusions of which can be found here.

Prof Lean presented the results of a study that he co-directed, the Diabetes Remission Clinical Trial (DiRECT), a ground-breaking five-year research, which showed that weight loss and T2DM remission in people with obesity is possible with a TDR diet.

In this trial participants recruited from general practices (GPs) used a TDR diet for 12 weeks which was followed by a food reintroduction programme focused on weight maintenance for up to two years combined with GP appointments. “Importantly, for the weight loss maintenance phase, we did allow them to use a meal replacement once a day, if they wanted to, as a way of maintaining weight loss and we offered relapse management if they should gain over 2kg in weight – we offered a short period back on TDR to get them back on track” Prof Lean explained, emphasising that “the TDR programme was nutritionally complete and safe”.

According to Prof Lean, the pilot results of DiRECT showed that “almost half of the participants who did exactly what they were asked to do lost over 15kg and most of them did that early on and did well in the long term – they had better maintenance of their weight loss”.

At one year, 46% of participants achieved diabetes remission with mean weight loss 10kg. The second year of the study, the remission rate was 36% and the mean weight loss 8kg. “The effect of weight loss on remissions was well sustained over a two-year period: 15kg weight loss at one and two years both resulted in over 80% remissions. So, nearly nine out of 10 at one year were free from diabetes” explained Prof Lean. “With 15kg weight loss, only 14% failed to get remission and of those, 11% did show improvement in their diabetes” he added.

Discussing participants’ medical treatment for T2DM Prof Lean said “on day one we asked our patients to stop their diabetes and bloop pressure medications” claiming that “TDR and weight loss is a very potent treatment for blood pressure”.  Prof Lean showed that the participants that had not been in medication for blood pressure before the trial saw a reduction in their blood pressure of 15 millimetres of mercury. “That is way greater that any medication can achieve” he emphasised. According to Prof Lean, participants receiving one medication before the study “had slightly less acute drop in blood pressure… for people who were on two or three or in some cases four medications…at the end of the TDR period blood pressure was roughly 10 milometers of mercury below baseline for everybody and that is way greater that can be achieved by any medication for hypertension”.

The conclusions from the DiRECT trial were augmented with a publication of five-year follow up results looking also at clinical outcomes. The researchers found that the weight loss was 6.1kg on average in the intervention group compared to 8kg at two years and the total remissions at five years were 13%. “Many participants had been in remission for large parts of the five years” stressed Prof Lean.  He added: “We found that people who had been through the intervention had half the number of serious adverse events over five years. That’s admissions to hospital for serious problems and free from diabetes related clinical events and that related to longer periods in remission, lower haemoglobin A1c during the five years and sustained weight loss”.

 DiRECT is reproducible in different populations worldwide

Following the study several trials used the DiRECT principle to help T2DM patients with overweight and obesity, providing the same diet programme using TDR for 8 to 12 weeks followed by food reintroduction and weight loss maintenance.

Among others, the STANDBY study recruited individuals of South Asian ethnicity showing 40% T2DM remissions. In Newcastle, the RETUNE trial was conducted on people with 23 – 27% Body Mass Index (BMI) resulting in 70% remissions. The DiRECT trial was carried out also in Australia with 56% remission rate. “This (DiRECT) is a very reproducible intervention in different populations worldwide” commented Prof Lean.

Public health services adopt TDR programme

Prof Lean also presented the pilot results of the NHS Type 2 Diabetes Path to Remission Programme, which was launched in 2020 based on the DiRECT trial, to tackle obesity and improve T2DM via a TDR programme. As Prof Lean explained, pilot data in over 7.000 individuals showed 28% remission rate at 12 months, while weight loss between 15kg and 20kg or more resulted in a 50% remission rate. Following these results, the programme is now being rolled out nationally to benefit patients across the whole of England, doubling its capacity this year.

Prof Lean argued that “the use of formula diets is kind of ratified for medical use” referencing the recommendations from the European Association for the Study of Diabetes (EASD) published last year. According to EASD, a low energy TDR programme is the best way to induce the weight loss necessary to achieve remission of T2DM. Furthermore, EASD recommends that nutritionally complete low energy formulas can be used as a partial diet replacement for weight loss maintenance.

The prevalence of T2DM and its link with overweight

Prof Lean discussed the latest research showing the prevalence of T2DM in Europe. He said that that T2DM affects over 4 million people in the UK, where the rate of diagnosis has increased by 40% in the last six years. “The numbers are rising rapidly in Western countries” he added. According to Prof Lean, in Europe, T2DM is the second most expensive disease. “That is, putting all cancers together, is a close second and it’s overtaken heart disease” he stressed.

Explaining the mortality rate of T2DM, Prof Lean said “it shortens lives by on average about five to six years but if you develop your diabetes under the age of 40 you’ll die 15 years younger than people who don’t have diabetes”.

Discussing the link between overweight and T2DM Prof Lean commented: “we know very well that weight gain is the main cause of the disease. Worldwide most people with T2DM have a BMI between 23 and 27 and that is where the risk is rising really quite dramatically, up to tenfold, by the time they have a BMI of 25”.You can watch the online event here and previous webinars organised by TDMR Europe here.

Find out more information about TDR here.

Here you can find a list of references to studies on TDRs.

Read more about the DiRECT trial here

In a webinar hosted by TDMR Europe on 22^nd May, Professor Henning Bliddal, Director of the Parker Institute, a clinical research unit of rheumatology at Frederiksberg University Hospital, Copenhagen, demonstrated that total diet replacement (TDR) can help people with obesity and knee osteoarthritis lose weight and improve their health.

Prof Bliddal presented the results of a three-phase study that he led which randomised 192 patients to a very-low energy diet (VLED) and a low-energy diet (LED) with formula diet products for eight weeks followed by two months of conventional food re-introduction diet at a low energy level (phase one). This was followed by a one year randomised controlled trial comparing weight maintenance with one meal replacement product (MRP) daily with a ‘knee exercises’ physiotherapy programme (phase two). During the third part of the trial (phase 3) over three years, divided into two groups, participants either followed an “ordinary” diet combined with a low-calorie meal replacement (MRP) per day or reintroduction of five weeks of TDR every four months (nine episodes of 5 weeks TDR over 3 years).

Explaining the impact of the trial on patients’ osteoarthritis, Prof Bliddal showed that at the end of the first phase “two out of three participants had very significant pain relief and better function”. “With a 16-week programme you can make people a lot better in, should we say, no time, in a simple way” he added.

According to Prof Bliddal, follow up evaluation showed that “participants lost fat but little lean body mass”. “As an interesting observation, they became healthier. A mark of this was the level of vitamin D, which was reduced on average in the participants at baseline but got into the normal range during the diet” he explained.

As Prof Bliddal explained, during the third phase of the study, the rate of knee replacement was very low and while patients followed little exercise, for four or more years they could maintain that weight loss.

Moreover, Prof Bliddal stressed: “we know that osteoarthritis is associated with increased risk of cardiovascular diseases in the elderly and people die earlier if they have large BMI and osteoarthritis in combination”. “We learnt the halfway with the first study that when you go to a VLED or LED…you can almost get out of your hypertensive medication, and you can drop the diabetes medicine” he emphasised.

Prof Bliddal also addressed the importance of exercise in people with obesity and osteoarthritis. “People ending up with osteoarthritis and overweight or obesity have very sedentary lifestyle and if you are going to change this you have to do some regular group work motivating people to exercise”. “I think this is a very important issue also with other means of weight loss that you have to take care of, increasing the exercise somehow and this is a job for health professionals, and I don’t think that people can make it on their own”, he added. Prof Bliddal also emphasised that such exercise programmes “must be individualised to some extent”, explaining that aerobic can be helpful but exercise “provoking” the knee (meaning exercise that gives high knee loading like running) should be avoided.

The prevalence of osteoarthritis and clinical management

Presenting existing research on the link between obesity and osteoarthritis, Prof Bliddal showed that an increase of one BMI point increases the risk of developing knee osteoarthritis by 15%. “It seems that having a BMI above 30 will give you almost double risk of acquiring hand osteoarthritis” he added. According to Prof Bliddal, 1kg weight loss decreases osteoarthritis symptoms by almost 3% and a weight loss of 5% can reduce knee replacements by 25%.

A lively Q&A with the audience followed Prof Bliddal’s presentation. Answering a question on whether the approach of his study could be a standard part of the management of osteoarthritis in Parker Institute’s rheumatology department, Prof Bliddal said “it would be wise to include it in the prescriptions you may give to rheumatological diseases, definitely”.

Research has shown that osteoarthritis is estimated to affect almost 40 million people in Europe as well as that the disease is among the fastest growing causes of disability worldwide. According to the National Institute for Health and Care Excellence (NICE), in the UK an estimated 5.4 million people are affected by knee osteoarthritis and 350.000 individuals are diagnosed with the disease every year.

The NICE guidance for osteoarthritis includes weight loss and that, where possible, 10% weight loss is better than 5%. Discussing the NHS soups and shakes programme, the diet programme that uses TDR to help people with obesity and type 2 diabetes improve their health, TDMR Europe Chair, Prof Anthony Leeds has stressed in the Times that “hundreds of thousands of people in Britain are waiting in pain for a joint replacement, and the same NHS soups and shakes programme could be offered to them”.

TDMR Europe works to help stakeholders develop a better understanding of formula diet foods and aims to increase awareness of the scientific evidence showing the effectiveness of these products in tackling obesity and improving related comorbidities. Find out more here.

 

Aris Myriskos

Press and Media Relations Office

TDMR Europe Secretariat

The English National Health Service (NHS) has announced further expansion of its soups and shakes diet programme which uses total diet replacement (TDR) to help people with obesity and type 2 diabetes (T2DM) lose weight and improve their health. Following the success of the NHS Type 2 Diabetes Path to Remission Programme pilots, the soups and shakes diet programme is now being rolled out nationally to benefit patients across the whole of England, doubling its capacity this year.

According to NHS, over 20,000 people living with T2DM and excess weight or obesity have already been offered the programme since it was first piloted in 2020. With the expansion, over 10,000 more people will now benefit from the TDR diet programme, which will be receiving an additional funding of £13 million.

The expansion follows ground-breaking research demonstrating that the soups and shakes diet programme provided value for money and can work successfully to improve people’s diabetes control and weight loss.

Explaining the results of the Type 2 Diabetes Path to Remission Programme, in a webinar hosted by TDMR Europe on 22^nd May, Professor Mike Lean showed that in December 2022, 27% of 710 participants finished the programme with mean weight loss 14.8kg and diabetes remission. As Prof Lean explained, for those who lost more weight (>15kg) achieved remission in 55% of people.

The NHS Type 2 Diabetes Path to Remission Programme was based on two large studies (DiRECT and DROPLET) which showed that, as a result of going on a specially designed programme including a TDR diet, people living with T2DM and obesity or overweight could improve their diabetes control, reduce diabetes-related medication and, in some cases, put their T2DM into remission.

With obesity and T2DM being among Europe’s main public health challenges, policy makers across the continent need to take note of the success of the NHS soups and shakes diet programme and consider TDRs as a powerful tool to tackle these critical challenges.

On 22^nd May, TDMR Europe hosted an online seminar on “Diabetes remission after weight loss with Total Diet Replacement (TDR): 5-year evidence and feasibility of use in osteoarthritis”. The online seminar featured a presentation from Professor Mike Lean, co-director of the DiRECT trial, who explained the results of the research. Professor Henning Bliddal, Director of the Parker Institute joined the event to present the benefits of weight loss with TDR in osteoarthritis. You can find out more and watch the webinar here. More insights following this event will soon be available here.  

 

Find out more about the latest research on the NHS Type 2 Diabetes Path to Remission Programme here.

More information on the DiRECT trial is available here.

You can find out more about the DROPLET study here.

Here you can find a list of references to studies on TDRs.

 

Aris Myriskos

TDMR Europe Secretariat

Press and Media Relations Office

TDMR Europe held a one-hour seminar to review the evidence for efficacy of TDR in delivering the initial weight loss needed for diabetes remission and for sustainability and practicality of TDR based-programmes on Wednesday 22^nd May.

Our Chair, Professor Anthony Leeds briefly described the work of TDMR Europe and summarized its recent activity and current projects.

Professor Henning Bliddal, Director of the Parke Institute then summarized the evidence for the benefits of weight loss in osteoarthritis.

Following this Professor Mike Lean from the University of Glasgow reviewed the need for weight loss in managing type 2 diabetes and the evidence from the DiRECT diabetes remission trial.

There then followed a brief discussion about the roll-out of this diabetes remission programme in other countries and the health benefits including benefits for other obesity comorbidities.

On 22^nd May 2024, from 11:00 to 12:00 BST, Professor Henning Bliddal (Parker Institute, Frederiksburg Hospital) and Professor Mike Lean (University of Glasgow) will be joining a webinar hosted by TDMR Europe to demonstrate the effectiveness of total diet replacement (TDR) in tackling obesity and improving comorbidities.

Prof Lean will present the results of the DiRECT trial, the groundbreaking 5-year research which showed that type 2 diabetes (T2DM) remission in people with obesity is possible with a TDR diet, whereas Prof Bliddal will provide an insightful presentation on “Weight loss and medical management of osteoarthritis” discussing the feasibility of delivery of a ‘package of care’ including TDR for osteoarthritis.

As the levels of obesity and related diseases, such as T2DM, continue to increase at an alarming rate in Europe, this webinar aims to help public health professionals and policy makers gain a better understanding of TDR’s role in addressing these critical challenges that threaten to overwhelm the capacity of public health sector.

Entitled “Diabetes remission after weight loss with Total Diet Replacement (TDR): 5-year evidence and feasibility of use in osteoarthritis” the online seminar will be moderated by TDMR Europe’s Chair, Prof Anthony R. Leeds, who will also provide a brief description of the role of the organisation in ensuring that TDR composition legislation is science based.

The full agenda and free registration are available here.

For more information, please get in touch with the Press and Media Relations office of TDMR Europe at aristeidis.myriskos@whitehousecomms.com

The effectiveness of total diet replacement (TDR) in tackling obesity and improving comorbidities, such as type 2 diabetes (T2DM), has been well established by a number of trials over the last few years. Last month, we saw the publication of a series of ground-breaking studies showing that weight loss and T2DM remission in people with obesity using TDR can also be achieved outside research settings.

On 18^th April, at the 2024 edition of the Diabetes UK Conference, Professor Jonathan Valabhji, from Imperial College London, presented the remission rates of T2DM at one year for participants in the English National Health Service (NHS) Type 2 Diabetes Path to Remission Programme pilots (formerly known as the NHS Low Calorie Diet Programme), from September 2020 to December 2022. Based on the DiRECT and DROPLET trials, these pilots included an initial 12-week TDR phase, followed by support with food re-introduction and weight maintenance for a total programme duration of one year.

Prof Valabhji explained that 27% of 710 people who had finished the programme by December 2022 had achieved diabetes remission. For participants achieving remission, the mean weight loss was 14.8kg. According to Prof Valabhji, those who lost more weight (>15kg) achieved remission in 55% of people. Following the success of the pilots, the Type 2 Diabetes Path to Remission Programme is to become available across the whole of England.

Meanwhile, on 17^th April, the British Journal of Diabetes published 6 papers detailing the findings of the Re:Mission study. Led by Professor Louisa Ells of Leeds Beckett University, this three-year research evaluated the qualitative aspects of the NHS TDR programme. The Re:Mission study demonstrated that the programme provided value for money and can work successfully to improve people’s diabetes control and weight loss.

The study showed that the programme has been life-changing for some participants, it was easy to incorporate into their lives and it helped them achieve their goals. According to the research, the aspiration of not requiring diabetes-related medication as well as potential for improvements to current health and fear of future poor health were viewed by participants as key-drivers for starting the programme.

Participants reported rapid improvements in their weight and blood glucose levels during the TDR phase and some reported significant levels of weight loss of up to 20% of starting body weight. Other reported outcome measures included feelings of increased energy, mobility, functional fitness and improved self-esteem.

Moreover, participants reported that using TDR gave them a sense of control over their energy consumption that they struggled to manage within their standard diet and some stated that they might continue using TDR products outside the programme specification for convenience and to sustain weight loss. By the end of the food reintroduction phase, 15 of the 43 participants were either actively using TDR products or expressed an intention to continue doing so.

Diabetes UK, a leading charity, estimates that more than five million people in the UK are living with diabetes, a disease that costs NHS £10 billion a year, which is about 10% of its entire budget. With its Type 2 Diabetes Path to Remission Programme, the NHS England has set the example for European public health authorities on how to help individuals with obesity and T2DM improve their health in a primary care setting as well as on how to reduce health-care expenditure related to these health conditions.

On 22^nd May, from 11:00 to 12:00 BST, TDMR Europe will be hosting a webinar on “Diabetes remission after weight loss with Total Diet Replacement (TDR): 5-year evidence and feasibility of use in osteoarthritis” featuring key experts in the field to discuss the latest evidence regarding the efficacy of TDR in delivering the initial weight loss needed for T2DM remission as well as the sustainability and practicality of TDR-based programmes. The seminar will include guest speakers Professor Mike Lean, from Glasgow University, who co-directed the DiRECT trial,  as well as Professor Henning Bliddal from the Parker rheumatology Institute, Copenhagen. You can find out more and register here.

Aris Myriskos

TDMR Europe Secretariat

PR and Media Relations Office

TDMR Europe welcomes World Obesity Day (WOD) 2024 taking place today, 4^th March. This year’s campaign theme is ‘Let’s Talk About Obesity And…’ and is aimed at starting conversations between collaborators, and encouraging stakeholders to share knowledge and view obesity from a different perspective.

Research from the World Health Organization (WHO) shows that 59% of European adults have overweight or obesity. These two conditions are among the leading causes of death and disability, with recent estimates suggesting they cause more than 1.2 million deaths annually, which corresponds to more than 13% of the total mortality in the Region. Moreover, analysis has shown that the impact of obesity on Europe’s economy is between 0.5% and 1.6% of GDP while the Organisation for Economic Co-operation and Development (OECD) has estimated that obesity and related comorbidities account for over 8% of total health expenditure.

Echoing WOD’s 2024 theme, TDMR Europe stresses that there is no such thing as a “one size fits all” approach, that obesity is a complex health condition, and that its treatment requires tailored methods based on people’s individual needs.

If we are to adequately and substantially reverse obesity rates, it is crucial for politicians and decision makers to consider all options available, including scientifically proven weight loss programmes that use total diet replacement (TDR) and meal replacement products (MRP), taking into account the vast evidence demonstrating the effectiveness of these products in helping people with obesity lose weight effectively and safely and improve comorbidities, such as type 2 diabetes (T2DM).

On 23^rd February, the research team that led the DiRECT trial, a landmark 5-year study that explored the use of TDR to help people with obesity and T2DM lose weight and improve their health, published the latest research results. The study not only showed that T2DM remission is possible with a TDR weight loss programme but also suggested wider health benefits including a smaller number of illnesses needing hospital admission and fewer diabetes-related conditions when weight loss is maintained, an effect with clear economic benefits.

Interviewed by the Chair of TDMR Europe, Professor Anthony Leeds, Professor Mike Lean who led the DiRECT trial together with Professor Roy Talyor, explained on EWAZ TV that the medical care costs of people who went through the TDR weight management programme “were substantially less than the people who didn’t”. “Part of it was patients who went through the programme had less serious adverse events and they ended up in hospital less often”, he added.

According to Professor Lean “new drugs being developed for obesity and T2DM are exciting, but they should not be prescribed without sound dietary weight-management”.

The DiRECT trial is among the many scientific studies that have shown the effectiveness of TDR in addressing obesity and improving comorbidities, such as cardiovascular disease, osteoarthritis, and obstructive sleep apnoea as well as T2DM.

TDMR Europe works to help stakeholders develop a better understanding of formula diet foods and aims to increase awareness of the scientific evidence showing the effectiveness of these products in tackling obesity and improving related comorbidities. Find out more here.

More information on the DiRECT trial can be found here.

More information on the use of TDR for weight loss and diabetes remission and prevention is available here.

Here you can find a list of studies in which weight loss was achieved with TDR.

Aris Myriskos

TDMR Europe Secretariat

The increasing levels of obesity and comorbidities such as type 2 diabetes (T2DM) in Europe threaten to overwhelm the capacity of public health sector to address these challenges. In this context, it is more important than ever for slimming food businesses to join forces to help policy makers gain a better understanding of the role of their products in helping people with overweight and obesity lose weight and improve their health.

The DiRECT trial provides a clear example of how total diet replacement (TDR) can help reduce obesity and T2DM levels cost-effectively. In this study, almost half of those (46%) who went on a low-calorie diet with TDR achieved remission of their T2DM after one year and 36% at two years. A quarter of participants achieved a 15kg or more weight loss, and of these, 86% put their T2DM into remission. Interviewed by TDMR Europe Chair, Professor Anthony Leeds, Professor Mike Lean who led the DiRECT trial together with Professor Roy Talyor, explained the results of the study on EAWAZ TV, stressing that “participants lost 15-20 kg in about eight or 10 weeks…eight or nine out of 10 were no longer diabetic in that short time”.

To provide a better understanding of the longer-term benefits of the programme, DiRECT was extended for a further three years. In the extension study, 95 participants from the original DiRECT intervention group continued to receive support and advice from their GP surgery to help them maintain weight loss and those who regained more that 2kg during the three years continued the TDR diet. Data available from 85 participants of the original intervention group revealed an average 5-year weight loss of 6.1kg. Furthermore, 48 people from the intervention group were in remission at the start of the three-year extension study, while 11 of these (23%) were still in remission at five years, and their average weight loss was 8.9kg. The importance of these findings become even more clear by the fact that no trial using medication to treat T2DM in people with obesity has achieved similar results.

Discussing the issue of medication for T2DM, Prof Lean said “we have seen patients who have taken insulin or powerful glucose-lowering drugs but then they have a lot of side effects; they risk hypoglycaemia and indeed mortality is increased in people who pursue normal glycemia by the conventional medications”.

According to Prof Lean, in the DiRECT study the participants saw a dramatic fall in their blood pressure. “That can be quite alarming for patients who are on blood pressure medication” Prof Lean said. He explained that “overall in DiRECT in that period on the formula diet there was a drop in blood pressure of 10 millimetres of mercury on average. So, half the patients lost more than that in blood pressure. That’s a very big fall in blood pressure and that is why we also elected to ask our patients to stop taking their anti-hypertensive and diabetic medications on day one”. Prof Lean added “we told them that because we knew that was likely to be a case that losing weight if they followed our diet programme was more effective than the drugs they were taking. Now that is true for those who followed the programme carefully and actually did lose all that weight”.

Secondary analyses from the original two-year DiRECT trial have shown cardiometabolic improvements, including cardiorespiratory fitness as well as lower cardiovascular risk. Moreover, in DiRECT, serious adverse events were 54% less common at five years in those randomized to weight loss. Contributing to this were fewer bacterial infections, strokes, and notably fewer cancers.

Also, among the benefits of using slimming foods to tackle obesity and improve T2DM is the possibility of long-term use of these products as opposed to antidiabetic medication, such as, semaglutide, which, as the National Institute for Health and Care Excellence (NICE) has recommended, can only be used for a maximum of two years.

Prof Lean also presented the economic analysis of the results of the DiRECT trial. The researchers analysed all the medical costs during the first two years of the study, including hospital admissions for serious and minor problems, physiotherapies as well as attending general practitioners for infections and colds. “All those things we costed up and what we found was the medical care costs of people who went through this weight management programme were substantially less than the people who didn’t, and part of that was the cost of the drugs of course, because diabetes drugs nowadays and anti-hypertensive drugs are quite expensive, and we were able to stop nearly all of them after two years”. Prof Lean said. “Part of it was also patients who went through the programme had less serious adverse events they ended up in hospital less often. And so, we’re beginning already to see clinical benefit from substantial weight loss” he added.

The cost-effectiveness of using TDR for weight loss in people with obesity and overweight has been demonstrated by previous studies such as the DROPLET trial. The DROPLET research showed that delivery of 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.

The full interview with Prof Lean is available here.

More information on the use of TDR for weight loss and diabetes remission and prevention is available here.

A list of studies in which weight loss was achieved with TDR can be found here.

TDMR Europe works to help stakeholders develop a better understanding of formula diet foods and aims to increase awareness of the scientific evidence showing the effectiveness of these products in tackling obesity and improving related comorbidities. Find out more here.

Aris Myriskos

TDMR Europe Secretariat

Taking place on 14^th November, this year’s World Diabetes Day (WDD), organised by the International Diabetes Federation, is focused on raising awareness of the risk factors for developing type 2 diabetes (T2DM) to help prevent the condition and highlighting the impact of diabetes-related complications as well as the importance of having access to the right information and care to ensure timely treatment and management.

The global prevalence of diabetes has nearly doubled since 1980, rising from 4.7% to 8.5% in the adult population. In Europe, while, the prevalence of diabetes appears to have stabilised in Nordic countries, it has continued to go up in southern European countries as well as in central and eastern Europe. These upward trends reflect an increase in associated risk factors, such as being overweight or obese.

The European Parliament’s resolution on the “Prevention, management and better care of diabetes in the EU”, introduced on World Diabetes Day 2022, stresses the importance of preventing obesity, emphasising that the condition is “one of the major determining risk factors for developing type 2 diabetes”. Nevertheless, in the EU, we haven’t yet seen any policy initiative to help people that already have obesity and T2DM improve their health.

On the UK side, the success of the English National Health Service’s (NHS) “soups and shakes” diet programme has demonstrated that weight loss with total diet replacement (TDR) is a cost-effective solution to tackle obesity and improve T2DM. According to the latest data, over 2,000 people have improved their health through the programme with participants losing an average of 13kg in three months, which was maintained at six months. The NHS TDR programme was based on several scientific studies, including the PREVIEW, DROPLET and DiRECT trials, showing the effectiveness of this product in weight loss and T2DM prevention and remission in people with obesity.

In the PREVIEW trial TDR delivered an average 10.3 kg weight loss in 8 weeks and the study demonstrated the crucial role that such weight reduction can play in diabetes prevention. Undertaken in a primary care setting, the DROPLET trial has shown similar weight loss results and T2DM improvement.

The latest results of DiRECT showed that, in the three-year extension of the study, nearly a quarter (23%) of participants who were in remission from T2DM at two years in the original trial remained in remission at five years. The original DiRECT study ran for two years and saw almost half of those (46%) who went on a low-calorie diet with TDR achieve remission of their T2DM after one year and 36% at two years. A quarter of participants achieved a 15kg or more weight loss, and of these, 86% put their T2DM into remission.

Interviewed by TDMR Europe Chair, Professor Anthony Leeds, Professor Mike Lean who led the DiRECT trial together with Professor Roy Talyor, said on EAWAZ TV that the formula diet that was used “was very carefully designed to give all the vitamins and minerals” and emphasised that “the diet is perfectly safe”. “Participants lost 15-20 kg in about eight or 10 weeks…eight or nine out of 10 were no longer diabetic in that short time” stressed Prof Lean.

Discussing weight maintenance after weight loss with TDR in the DiRECT trial Prof Lean said “after having lost that weight the next phase is to maintain that weight loss, gradually replacing meals one by one until they are back up to hopefully three main meals a day. In some cases, patients elected to use a meal replacement for one of the main meals, using a low-calorie meal replacement in the long term as a way of controlling their total calorie intake. That isn’t absolutely necessary but it’s certainly one strategy which is effective”.

With T2DM and obesity rates in Europe reaching a record-high, governments across the continent need to introduce weight loss programmes in healthcare to tackle these conditions effectively. It is equally important to ensure that such health initiatives will be based on sound science and consider all options available, including the use of TDRs.

More information on the use of TDR for weight loss and diabetes remission and prevention is available here.

You can find more information on diabetes remission and maintenance after weight loss with TDR here.

A list of studies in which weight loss was achieved with TDR can be found here.

TDMR Europe works to help stakeholders develop a better understanding of formula diet foods and aims to increase awareness of the scientific evidence showing the effectiveness of these products in tackling obesity and improving related comorbidities. Find out more here.

Aris Myriskos, TDMR Europe Secretariat

On 29^th September, TDMR Europe Chair, Professor Anthony Leeds, was featured in the Health Chats programme of EAWAZ TV, discussing the role of weight loss with total diet replacement (TDR) in improving fertility in men with obesity. Prof Leeds interviewed Doctor Channa Jayasena, consultant in reproductive endocrinology and andrology at Imperial College and Hammersmith Hospital in London, to discuss his recent research on this issue.

Published last month, Dr Jayasena’s study “Improvements in Sperm Motility Following Low – or High -Intensity Dietary Interventions in Men with Obesity”, provides strong evidence that TDR is a promising solution in addressing infertility in men with obesity. “What we have is enough (evidence) to say to couples, given how safe weight loss is and how beneficial it is to your overall health, … if you are affected by obesity and infertility then tackle that obesity with some form of intervention, such as a low energy diet, which is very convenient and also gets results in the short to medium term over a year.” said Dr Jayasena. “The time is right to tell couples that this is certainly something that offers promise” he added stressing that “there is absolutely no drug out there at this time to improve the quality of sperm”. “Couples really need results within a year”, Dr Jayasena emphasised.

Dr Jayasena’s trial demonstrated that men with obesity following a TDR diet, lost 12kg over three months, saw improvement in their semen quality and reduced the damage to their sperm. Discussing the reasoning behind his study, Dr Jayasena explained that, while bariatric surgery is an efficient treatment for severe forms of obesity, which can help restore ovulation, menstrual cycles and fertility in woman, “in men in the first year (after surgery) it paradoxically reduces fertility even further”. Answering Prof Leeds’ question on whether there are any other lifestyle interventions that might be beneficial in addition to weight loss with TDR, Dr Jayasena advised light regular exercise, such as brisk walking, swimming or running two to three times a week, stopping smoking and moderation of or cutting out drinking. “You need to be your best healthiest self to stand the best chance of parenthood” he added.

Prof Leeds also discussed with Dr Jayasena the link between obesity and the increasing prevalence of infertility worldwide. Dr Jayasena claimed that infertility affects 10-15% of couples on a global scale and noted that research on this issue has shown a 55% drop in recorded sperm count since 1970. “With obesity, at least, we are very clear on the major contribution it plays; in fact, it is likely to be affecting up to 25% of men with infertility” Dr Jayasena said.

The full interview is available here.

Read more about the research on the role of TDR in addressing male obesity and infertility here.

A list of studies in which weight loss was achieved with TDR can be found here.

TDMR Europe works to help stakeholders develop a better understanding of formula diet foods and aims to increase awareness of the scientific evidence showing the effectiveness of these products in tackling obesity and improving related comorbidities. Find out more here.

Aris Myriskos, TDMR Europe Secretariat

The English National Health Service (NHS) has announced that it will further expand its “soups and shakes” diet programme, which provides weight loss with total diet replacement (TDR) for people with obesity and type 2 diabetes (T2DM), following positive results. Currently available in 21 areas of England, the programme will be expanded to provide access to patients in every part of the country by March 2024. According to the latest data, over 2,000 people have improved their health through the programme with participants losing an average of 13kg in three months, which was maintained at six months.

This announcement also follows new scientific evidence further demonstrating the effectiveness of TDR in helping people with obesity improve their T2DM. The findings from a three-year extension of the DiRECT study showed that nearly a quarter (23%) of participants who were in remission from T2DM at two years in the original trial remained in remission at five years. The original DiRECT study ran for two years and saw almost half of those (46%) who went on a low-calorie diet with TDR achieve remission of their T2DM after one year and 36% at two years.  A quarter of participants achieved a 15kg or more weight loss, and of these, 86% put their T2DM into remission.

To provide a better understanding of the longer-term benefits of the programme, DiRECT was extended for a further three years. In the extension study, 95 participants from the original DiRECT intervention group continued to receive support and advice from their GP surgery to help them maintain weight loss and those who regained more that 2kg during the three years continued the TDR diet.  Data available from 85 participants of the original  intervention group revealed an average 5-year weight loss of 6.1kg. Furthermore, 48 people from the intervention group were in remission at the start of the three-year extension study, while 11 of these (23%) were still in remission at five years, and their average weight loss was 8.9kg.

Featured in The Times, TDMR Europe Chair, Professor Anthony Leeds emphasised that the DiRECT study and the NHS TDR programme show that T2DM remission can be listed as a potential beneficial effect of weight loss with TDR alongside reduced blood pressure, reduced cardiovascular risk, reduced pain in osteoarthritis and reduced inflammatory markers.

With obesity and related comorbidities being among Europe’s main public health challenges, policy makers across the continent need to take note of the NHS programme success and consider TDRs as a powerful tool to tackle these challenges.

TDMR Europe raises awareness of the beneficial impact of members’ products not only via the effective communication channels that it has established with policy makers in the EU and the UK over the years, but also with the delivery of insightful educational events. Find out more here.

TDMR Europe Chair, Professor Anthony Leeds is featured in the Health Chats programme of EAWAZ TV, discussing the role of weight loss with Total Diet Replacement (TDR) in type 2 diabetes (T2DM) remission for adults with obesity.

In the video interview, Dr Leeds discusses the ‘DiRECT’ diabetes remission trial with Professor Mike Lean from Glasgow University. Undertaken in a primary care setting, DiRECT saw almost half of those who went on a low-calorie diet with TDR achieve remission of their T2DM after one year. A quarter of participants achieved a 15kg or more weight loss, and of these, 86% put their T2DM into remission.

The ‘DiRECT’ trial was a study largely on white British participants and the speakers emphasised the need for similar studies in other population groups. In this context, Professor Lean touched on the STANDBY trial, another study run by the University of Glasgow that used TDR to help people of South Asian ethnicity with obesity and T2DM lose weight and improve their T2DM. In this trial, UK-based South Asians were recruited through primary care and social media, and randomised to commence a TDR programme. According to the results of the study, 35% of the participants lost over 10% bodyweight and 43% achieved T2DM remission.

The DiRECT and STANDBY studies are part of the increasing evidence showing the potential of TDRs to address obesity and improve related diseases in Europe. Decision makers need to prioritise tackling obesity and look into all available options, including TDRs. Businesses in the sector meanwhile need to work together to help policy makers develop a greater understanding of these products.

TDMR Europe works to help stakeholders develop a better understanding of formula diet foods and aims to increase awareness of the scientific evidence showing the effectiveness of these products in tackling obesity and improving related comorbidities. Find out more here.

More information on the use of TDR for weight loss and diabetes remission and prevention is available here.

You can find more information on diabetes remission and maintenance after weight loss with TDR here.

Find out more about the DiRECT trial here.

Total Diet & Meal Replacement (TDMR) Europe welcomes World Obesity Day (WOD), which will return this year with the message “Changing Perspectives: Let’s Talk About Obesity”. Taking place tomorrow 4^th March, 2023’s campaign aims to help correct misconceptions and acknowledge the complexities around obesity, and push for collective action. In this context, it is crucial to raise awareness of the need for prevention and management of obesity to go hand-in-hand.

Although obesity is rising on the European political agenda, initiatives aiming to address the issue have so far focused mostly on preventive measures, putting in second place the millions of individuals across Europe that are already obese. Obesity rates have meanwhile tripled in many European countries in the last few decades, with the 2022 WHO European Regional Obesity Report indicating that 59% of adults are overweight or living with obesity in the Region.

Against this backdrop, it is more urgent than ever for EU decision makers to consider all available options, including formula diet products. Total diet replacements (TDRs) and meal replacement products (MRPs) are scientifically proven safe and cost-effective options to deliver the amount of weight loss needed to tackle obesity and achieve major improvements of related comorbidities. TDRs and MRPs programmes have been used for several decades and can fill the gap between weight loss advice, often used for smaller weight loss (2-5 kg), and bariatric surgery for larger weight losses (25-40 kg).

Not only does a growing body of scientific literature prove that TDRs and MRPs can provide economical, viable and effective solution to tackle obesity – including PREVIEW, DROPLET and DiRECT –, public health services have also acknowledged the effectiveness and safety of TDRs to manage obesity and related diseases. In 2020 the NHS England launched its soups and shakes diet programme, which provides a low-calorie diet treatment with TDR for people who are overweight and living with type 2 diabetes (T2DM). With this programme, over 2,000 people have improved their health with participants losing an average of 13.4 kg in three months.

TDMR Europe reiterates the need for EU policy makers to:

– Support a more ambitious role for the EU in public health matters and continue to recognise the complexity of obesity, while ensuring a clear focus on treatment as well as prevention.

– Explore all options available, including the use of TDRs and MRPs, while understanding healthcare costs and potential savings from using formula foods.

– Make more funds available for research into obesity treatment and management, while creating more opportunities for industry to share their best practices.

 

Read TDMR Europe’s position paper on obesity here.

More information on TDRs and MRPs is available here and here.

For further information on the DiRECT trial click here.

More information on the PREVIEW study is available here.

Find out more about the DROPLET trial here.

About TDMR Europe

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 base 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.

TDMR Europe has announced further growth with Bariatrix Europe’s recent addition to its membership. Bariatrix Nutrition is a leading international company that has provided weight management and wellness products in Europe since 2005.

Bariatrix Europe joins TMDR Europe ahead of a series of upcoming regulatory changes in the EU and the UK that may affect its product portfolio, which includes total diet replacements (TDRs) and meal replacement products (MRPs). With its consistent expansion, TDMR Europe is uniting the slimming foods industry to facilitate exchanges of knowledge and effectively utilise on-the-ground information to tackle regulatory challenges for the sector in Europe.

Professor Anthony Leeds, Chairman of TDMR Europe said:

“We’re delighted to see TDMR Europe’s continued expansion with Bariatrix Europe being the latest company to join our association. As a member of TDMR Europe, Bariatrix will contribute to our targeted campaigns aiming to secure a fit for purpose European legislation for formula diet foods and help stakeholders gain a better understanding of these products”.

“We are witnessing major regulatory challenges for the slimming foods industry in Europe. The European Commission has just updated composition requirements for total diet replacements (TDRs) after TDMR Europe shared the latest scientific research on these products with them. We also expect regulatory changes that may unfairly impact slimming foods such as the setting of nutrient profiles and a harmonised front of pack nutrition scheme. TDMR Europe is also actively engaged in discussions in the UK where the regulatory framework for TDRs is being reviewed”.

“TDMR Europe is working to ensure that businesses in the sector can inform the legislation that affects their products, combining the industry’s commercial and technical knowledge with TDMR Europe’s decades of experience in policy engagement”.

Ziad Khoury, Scientific and Marketing Director in Bariatrix Europe said:

“Joining TDMR Europe will support our company’s further development and growth. With its scientific expertise, longstanding PR and public affairs experience and the excellent relationships that TDMR Europe has developed with policy makers, target media and other stakeholders in the EU and the UK, the association will help us navigate the fluid and complex legislation governing our products as well as raise awareness of their scientifically proven benefits”.

TDMR Europe is the European association for manufacturers and distributors of total diet replacements (TDRs) and meal replacements (MRPs) which provide weight loss and weight management programmes for people with obesity and overweight. TDMR Europe helps businesses in the sector engage with policymakers, provides members with policy and regulatory advice, and promotes the benefits of TDRs and MRPs for people with obesity and overweight. You can find more information here.

To join TDMR Europe please can it touch via +44 (0)20 7463 0620 or secretariat@tdmr-europe.com

Ahead of the enforcement of the Delegated Regulation amending Delegated Regulation 2017/1798 on Total Diet Replacement (TDR) on 29 November 2022, TDMR Europe released a statement to welcome the review of essential fatty acids (EFA) and magnesium requirements but raises awareness of the need to review the protein requirements next.

TDMR Europe welcomes the review of EU composition requirements for TDR but warns about remaining formulation issues

“Following a targeted campaign that TDMR Europe has implemented over the past five years and our close coordination with Commissioners, Member States’ representatives and MEPs, the European Commission has reviewed the requirements for magnesium and essential fatty acids for the composition of TDRs. This change in the 2017 Delegated Act is crucial to make sure that the manufacturing of TDRs is based on sound science and the products remain shelf stable and palatable”.

“Yet, the industry remains concerned about the protein requirements in Delegated Regulation 2017/1798. The protein levels set out in the regulation are much higher than those in the previous legislation, are not in line with the latest scientific evidence and present important food technology problems for the industry as they impact their products’ texture and palatability”.

“TDR is a product that has been marketed and used safely in Europe for over 35 years and several scientific studies have shown its potential in tackling obesity and improving comorbidities, such as type 2 diabetes, cardiovascular disease, osteoarthritis and obstructive sleep apnoea”.

“TDMR Europe will keep working closely with policy makers to help them gain a better understanding of TDRs and will continue coordinating with stakeholders to secure fit for purpose legislation for these products”.

On 27^th October, the Delegated Regulation 2017/1798 on TDRs composition and labelling requirements that was adopted in June 2017 reviewing the Directive 96/8 started to apply. Today the Delegated Regulation amending Delegated Regulation 2017/1798 was published in the Official Journal and will start to apply on 29 November 2022. With this new regulation the European Commission reviewed the composition requirements for magnesium and EFAs to bring them in line with the 2021 EFSA recommendations. This review took place following a letter from TDMR Europe to the Commission which raised awareness of the latest scientific research on alpha-linolenic acid (ALA), linoleic acid (LA) and magnesium and requested a review by EFSA of their 2015 opinion on TDRs composition.

TDRs, which include very low-calorie diets (VLCDs) and low-calorie diets (LCDs), are specifically formulated programmes that are based around formula foods that aim to replace the whole of the daily diet. You can find more information on TDRs here.

TDMR Europe is the European association for manufacturers and distributors of formula diet products, including total diet replacement (TDRs) and meal replacement (MRPs) which provide weight loss and weight management programmes for people with obesity and overweight. TDMR Europe works to secure appropriate and proportionate European legislation for slimming foods and is in close continuous dialogue with a wide variety of stakeholders such as policymakers and senior officials in the relevant bodies to do this. More information on TDMR Europe is available here.

Aris Myriskos

Press Office, TDMR Europe Secretariat

TDMR Europe’s Chair Professor Anthony Leeds is featured in European Food Law’s article on the upcoming changes to TDRs composition requirements in the EU.

Professor Leeds explained the targeted campaign that TDMR Europe has taken forward for the past five years to ensure the forthcoming changes to Regulation (EU) 2017/1798 regarding TDRs magnesium and essential fatty acids requirements are in line with the latest scientific evidence, and that consumers’ health remain top priority.

In November 2019, TDMR Europe sent a letter to the European Commission to raise awareness of the latest scientific research on alpha-linolenic acid (ALA), linoleic acid (LA) and magnesium and requested a review by the European Food Safety Authority of their 2015 recommendations on TDRs composition. TDMR Europe shared with the Commission scientific evidence demonstrating that the proposed compositional criteria aiming to fundamentally alter the overall nutritional composition of TDR not only were not in line with the latest scientific research but would lead to serious issues with a number of factors, including the texture, taste, smell and overall palatability of the products. TDMR Europe explained that this would result in the disappearance of TDR – a product that has been used safely in Europe for more than  30 years.

TDMR Europe’s successful campaign resulted in a new EFSA assessment supporting the industry’s views and in the implementation of the changes that TDMR Europe requested by the Commission.

However, as Professor Leeds stresses in the European Food Law article, the composition requirements for protein in Regulation (EU) 2017/1798 remain problematic as they also do not follow the latest scientific evidence, as well as presenting significant food technology problems.

TDMR Europe will keep working closely with EU policy makers to ensure that the regulatory framework for TDRs is based on sound science, combining its longstanding experience on policy engagement with the expertise of its Science Committee and knowledge of member organisations.

Ahead of the approval of the TDR Delegated Act by the European Parliament and the Council, businesses in the sector need to come together and actively engage with the regulatory process to provide on-the-ground information to secure fit for purpose legislation.

TDMR Europe is the European association for manufacturers and distributors of formula diet products, including total diet replacement (TDRs) and meal replacement (MRPs) which provide weight loss and weight management programmes for people with obesity and overweight. You can find more information here.

To join TDMR Europe please can it touch via +44 (0)20 7463 0620 or secretariat@tdmr-europe.com

Diabetes is among the main public health challenges that Europe is facing today. According to the International Diabetes Federation (IDF), in Europe an estimated 61 million adults were living with diabetes in 2021. The IDF projects that diabetes prevalence will increase to 13% of the adult population by 2045.

A recent blog post by the European Federation of Pharmaceutical Industries and Associations emphasised that timely prevention and effective treatment are key to addressing type 2 diabetes (T2DM) and stressed the impact of this health condition on the European economy. The author emphasised the importance of the primary care sector in addressing diabetes but gave no clues as to what needed to be done, other than provide more staff, training and resources. As policy makers, healthcare professionals and other stakeholders are looking at how best to tackle T2DM, it is crucial to explore all options available.

Obesity and overweight are the leading risk factors for T2DM, and there is an increasing evidence base within scientific literature showing that weight reduction is the most important component of T2DM prevention, along with increased physical activity and optimal composition of the maintenance diet. While lifestyle and conventional diet changes or, in the more severe cases, bariatric surgery can support weight loss and maintenance, it is important that other options are also reviewed.

Total diet replacements (TDRs) provide safe and effective weight loss for people living with obesity and overweight. TDMR Europe, the trade body representing the sector, has recently organised two educational events to review the latest research on obesity and T2DM.

The online seminars “Diabetes Remission: Maintenance after weight loss with TDR” and “TDR: exploring sustainable weight loss and health benefits, including diabetes remission and prevention” highlighted how weight loss with TDR can help improve and T2DM put into remission. In addition, the webinars showed that TDR provides a cost-effective contribution to the fight against this public health issue, which is important at a time when healthcare service resources are increasingly under pressure.

Experts who spoke at the events explained that the PREVIEW trial provided strong evidence for the use of an initial weight loss with TDR as the first stage of a diabetes prevention programme. All diabetes prevention programmes have shown that the greater the initial weight loss and subsequent weight loss maintained then the smaller the number of people who develop diabletes. In PREVIEW TDR delivered an average 10.3 kg weight loss in 8 weeks. Similarly, the DiRECT study, undertaken in a primary care setting, saw almost half of those who went on a low-calorie diet with TDR achieve remission of their T2DM after one year. A quarter of participants achieved a 15kg or more weight loss, and of these, 86% put their T2DM into remission. A more recent trial that used TDR, called DROPLET and also undertaken in a primary care setting, has demonstrated similar weight loss in people with obesity.

The NHS soups and shakes diet programme which provides a weight loss programme with TDR for people with obesity and T2DM was based on the DiRECT and DROPLET studies. According to the latest data published by NHS, over 2,000 people with T2DM have now improved their health through the soups and shakes diet programme with participants losing an average of 13kg in three months. Following this successful outcome, the NHS has recently expanded its programme which is now available in 11 more regions across England.

Diabetes UK, a leading charity, estimates that by 2030 5.5 million people in the UK will have diabetes, a disease that costs NHS £10 billion a year. With its soups and shakes diet programme the NHS England together with the NHS Scotland, has set the example for European public health authorities on how to help individuals with obesity and T2DM improve their health in a primary care setting as well as on how to reduce health-care expenditure related to these health conditions.

References

Primary health care is key to solving the diabetes challenge (Guest blog) https://efpia.eu/news-events/the-efpia-view/blog-articles/primary-health-care-is-key-to-solving-the-diabetes-challenge/

For further information on the DiRECT trial click here.

More information on the PREVIEW study is available here.

Find out more about the DROPLET trial here.

 

Aristeidis Myriskos, TDMR Europe Secretariat​

Europe is witnessing a dramatic increase in obesity rates and policy makers are looking at how best to tackle this challenge and related health conditions. It is more important than ever for the slimming foods sector to raise awareness of the effectiveness of its products in weight loss and help decision makers gain a better understanding of formula diet foods. This has become more evident in light of upcoming regulatory changes in the EU and the UK aiming to make the food system healthier – such as the EU Farm to Fork Strategy and the UK advertising restrictions on products high in fat, salt or sugar (HFSS).

Businesses in the sector need to join forces to tackle regulatory challenges and effectively increase awareness of their products. TDMR Europe enables slimming foods companies to work together to address issues of common concern, and supports members with its longstanding policy, scientific and PR experience. Benefits of TDMR Europe membership include:

1. A strong voice for the sector and communications support

There is increasing scientific literature regarding the efficacy of total diet replacements (TDRs) and meal replacement products (MRPs) in helping people with obesity and overweight lose weight more rapidly than would otherwise be possible. Several studies also have shown the health benefits of diet programmes with formula foods for weight control for individuals with type 2 diabetes (T2DM), osteoarthritis and obstructive sleep apnoea (OSA). Moreover, recent research has demonstrated that weight loss with TDR may help to improve fertility in men with obesity.

TDMR Europe combines the industry’s technical knowledge, with decades of experience in public affairs and media relations to increase understanding of formula diet foods among policy makers, healthcare professionals and other stakeholders. TDMR Europe raises awareness of the beneficial impacts of members’ products not only via the effective communication channels that has established with decision makers in the EU and the UK over the years but also via a successful educational campaign that includes the delivery of regular insightful educational events.

2. Political influence

The slimming foods sector is facing a challenging period from a regulatory perspective. The front-of-pack nutrition labelling (FOPNL) and nutrient profiles legislation that the European Commission is introducing as part of the Farm to Fork Strategy as well as the upcoming promotional restrictions of HFSS foods in the UK risks unfairly impacting the industry. Unless clear exemptions are introduced for specialist products that are not HFSS, such as TDRs and MRPs, these regulations may fail to recognise the specific use of TDRs and MRPs to provide healthy weight loss for people with obesity and overweight.

In addition, new rules on information and composition requirements for TDRs are set to apply from 27^th October 2022. Delegated Act 2017/1798 sets out that TDRs protein requirements shall be between 75g and 105g. These new requirements are however very problematic from a food technology perspective and not based on the latest scientific evidence.

TDMR Europe helps its members have a say on legislations that affect their business. TDMR Europe works to influence the fluid and complex regulatory framework of formula diet products in the EU and the UK, securing a fit for purpose legislation for members’ products and ensuring proportionate implementation and enforcement.

3. Regulatory updates and support

TDMR Europe members have access to bespoke policy and regulatory advice from a team of experienced advisors and receive early alerts on developments that may impact their products and business in the future.

4. Networking

TDMR Europe membership enables businesses to build contacts with key players and colleagues in the sector and provides excellent opportunities for networking.

TDMR Europe is the European association for manufacturers and distributors of formula diet products, including total diet replacement (TDRs) and meal replacement (MRPs) which provide weight loss and weight management programmes for people with obesity and overweight. You can find more information here.

To join TDMR Europe please can it touch via +44 (0)20 7463 0620 or secretariat@tdmr-europe.com

TDMR Europe has announced an expansion of its membership, as Nualtra, a leading medical nutrition company in the UK and Ireland, joins the association. Founded in 2012 by Registered Dietitian Paul Gough, Nualtra delivers the Altralife shakes and soup mix for weight loss.

Professor Anthony Leeds, Chair of TDMR Europe said:

“We’re delighted to welcome Nualtra to TDMR Europe at a critical point for the formula foods sector.  Just as the huge value of TDR and MRP formula foods in the public health sector has been recognised, new European food regulations will affect composition and labelling of these foods. TDMR Europe uses the industry’s extensive knowledge and practical experience to secure appropriate and proportionate legislation for the sector”.

Emma Coates, Medical Affairs and Regulatory Manager at Nualtra said:

“Being a TDMR Europe member will play an important role for our business strategy and development, and we feel certain that the organisation’s longstanding public affairs, PR and scientific expertise will help our representation and influence go from strength to strength. As obesity and weight related comorbidities in Europe continue to increase, we look forward to joining forces with TDMR Europe and boost our efforts to raise awareness of the effectiveness of formula diet products in weight loss.”.

TDMR Europe is the European association for manufacturers and distributors of formula diet products, including total diet replacement (TDRs) and meal replacement (MRPs) which provide weight loss and weight management programmes for people with obesity and overweight. You can find more information here.

To join TDMR Europe please get in touch via +44 (0)20 7463 0620 or secretariat@tdmr-europe.com

For further information or comment from the Chair of TDMR Europe, Professor Anthony Leeds and from Nualtra please contact Aristeidis Myriskos at aristeidis.myriskos@whitehousecomms.com

You can find more information about TDMR Europe here.

There is a downward global trend in sperm counts in men and, in 50% of couples seeking assisted reproduction there is male infertility.  There are no drug therapies for poor sperm quality and few clinical trials that address the role of obesity and effect of weight loss.

Emil Andersen working in Professor Signe Torekov’s group at the University of Copenhagen recently published evidence for increased sperm count following weight loss with Total Diet Replacement (TDR) in men with obesity.

In this sub-study of the ‘S-Lite’ project (Lundgren JR et al) 47 men with BMI 32-43 kg/m3 followed an 8 week 810kcal/day TDR diet followed by food reintroduction with an option to continue with use of one meal replacement product daily for a further 52 weeks.  In addition all were randomised after the TDR to either daily injections of the GLP-1 agonist Liraglutide with or without exercise or placebo injection with or without exercise.  Semen variables were measured before and after the TDR diet and after a further 52 weeks (Andersen E et al).

The men lost an average 16.5kg body weight during the 8 weeks TDR and at the same time sperm count increased by 40% and sperm concentration by 49%.  By 52 weeks weight loss maintained was an average 11.7kg. Dividing the 37 individuals included at 52 weeks into weight maintainers (those who maintained >11.7kg) and weight regainers (those who maintained <11.7kg) showed that sperm count and concentration were only significantly increased in the weight maintainer group.

In a preliminary report made at ENDO22, the meeting of the Endocrine Society in the USA, Aditi Sharma and colleagues from Imperial College London, showed that in 36 men with low sperm counts randomised to either usual dietary guidance or an 810kcal/d TDR diet for 16 weeks average weight loss was 1.5kg versus 14.3 kg respectively. They measured reactive oxygen species (ROS) in the semen finding that weight loss after TDR was associated with a 12-fold greater reduction of ROS than after the usual (control) diet (Sharma A et al). ROS react with many cellular components including DNA causing structural and functional damage and in semen have recently been shown to be strongly linked to DNA damage in sperm resulting in worse pregnancy outcomes. This first RCT of TDR weight loss in male infertility provides proof of concept that this simple and safe diet could be incorporated into infertility management programmes.

Anthony Leeds, chair of TDMR Europe, said ‘While more research work is needed including trials within fertility programmes, these two papers raise the prospect that a sufficient weight loss, perhaps more than 12kg, may so reduce oxidative stress in men that fertility outcomes may improve. Weight loss with TDR is known to result in larger and faster weight losses than some other methods and shows high compliance in clinical trials.  TDR is in use to achieve the initial weight loss in diabetes remission programmes in the UK and is known to be safe and cost effective.  It is highly likely that TDR will prove to be a useful intervention in male infertility.’

Anthony R Leeds

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

The Imperial College study in men with obesity and oligospermia was funded by an

NIHR Post-Doctoral Fellowship, Imperial Biomedical Research Centre and the Imperial Health Charity and products were provided by LighterLife Ltd UK.

References:

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

Andersen E et al Sperm count is increased by diet-induced weight loss and maintained by exercise or GLP-1 analogue treatment: a randomized controlled trial. Human Reproduction, pp. 1–9, 2022 https://doi.org/10.1093/humrep/deac096

Sharma A et al Weight loss using a formula low energy diet reduces seminal oxidative stress in men with obesity and oligospermia: a randomized controlled study. Abstracts of ENDO2022    J Endocrine Society  Volume 6 Issue Supplement 1 April-May 2022 page A*

 

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.

On 12^th April at TDMR Europe’s online seminar “Diabetes Remission: Maintenance after weight loss with total diet replacement (TDR)”, health experts demonstrated that weight maintenance is possible after rapid weight loss with TDR and showed its crucial role in delivering diabetes remission  type 2 diabetes.

Professor Gary Frost (Chair in Nutrition and Dietetics – Imperial College London) participated in the webinar providing key-insights on the challenges and potential solutions related to successful weight loss maintenance and diabetes remission. Professor Frost stressed that biological, behavioural, and environmental factors conspire to resist weight loss and promote regain, and that effective treatment of obesity requires ongoing attention and support, and weight maintenance-specific counselling, to deliver better long-term weight management.

Maintenance of weight loss and diabetes remission: barriers and solutions

Professor Gary Frost, Imperial College London, England

Long term weight loss and maintenance of weight loss over the life course remains a major unachieved goal (1).  Only 20% of people meet the criteria of long-term weight loss (10% of their initial body weight for one year) (2).  This disappointing statistic is common across all dietary profiles.  There are a number of common traits that are associated with maintenance of weight loss include positive emotional regulation such as low levels of dietary disinhibition and low levels of depression, dietary consistency, weight gain management and high contact with a councillor.  Unfortunately, evidence suggest that physiology starts to work against the maintenance of weight loss maintenance.  Energy balance starts to favour weight regain (1); appetite regulation favours a low appetite suppression tone (3).  In recent year my team have used some of these observations to design a method to nudge anorectic systems to prevent weight gain.  We had achieved this using a short chain fatty acid propionate.  Short chain fatty acids are produced by the microbiome in the human colon.  We have developed a method to deliver propionate to the colon and demonstrated positive effects on appetite regulation, hedonic wanting and liking of food and energy expenditure (4). It is possible such systems could impact on weight loss maintenance.

At the present time there is no high-quality evidenced based guidelines to enhance weight loss maintenance.  There is a number of good practice points that may enhance weight loss maintenance.

1. Maintaining contact with professional support
2. The use of corrective intervention
3. Realistic but clinically important targets
4. Physiological support
5. Methods to support appetite regulation

 

References

• Hall KD, Kahan S. Maintenance of lost weight and long-term management of obesity. Med Clin North Am [Internet] NIH Public Access; 2018 [cited 2022 Apr 12];102:183. Available from: /pmc/articles/PMC5764193/

 

• Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr [Internet] Oxford Academic; 2005 [cited 2022 Apr 12];82:222S-225S. Available from: https://academic.oup.com/ajcn/article/82/1/222S/4863393

 

• Sumithran P, Prendergast LA, Delbridge E, Purcell K, Shulkes A, Kriketos A, Proietto J. Long-term persistence of hormonal adaptations to weight loss. N Engl J Med [Internet] 2011 [cited 2014 May 7];365:1597–604. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22029981

 

• Chambers ES, Morrison DJ, Tedford MC, Frost G. A novel dietary strategy to increase colonic propionate production in humans and improve appetite regulation and bodyweight management. Nutr Bull 2015;40

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 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 base within the scientific literature regarding the efficacy and potential of TDRs and MRPs to address effectively the challenge of obesity and related diseases in Europe. Find out more about TDMR Europe in our media pack and membership leaflet.

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.

Refs:

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

On 12th April, TDMR Europe’s online seminar brought together speakers from Scotland, England and Cyprus to focus on weight maintenance and diabetes remission maintenance after weight loss with total diet replacement.

The webinar was opened by Professor Mike Lean, Professor of Human Nutrition at the University of Glasgow who reviewed research evidence including the DiRECT trial of Total Diet Replacement (TDR) weight loss with behavioural and lifestyle guidance followed by weight maintenance to achieve diabetes remission in people with type 2 diabetes.  Prof Lean also reviewed the extent to which current guidelines refer to the evidence for diabetes remission and forthcoming plans for further guidelines later in 2022.

Introducing the webinar TDMR Europe chair Professor Anthony Leeds said ‘European countries face levels of obesity and diabetes that will overwhelm capacity for healthcare provision. Weight loss has been recognised as the key component for diabetes prevention and key to effective diabetes prevention. All European countries require effective programmes for diabetes prevention, diabetes remission and obesity prevention and reduction and diabetes remission programmes based on the DiRECT research results may help contribute to this.’

TDMR Europe’s online seminar brought together industry stakeholders, academics and others and showed the potential role of TDR in contributing to diabetes remission and prevention and considered the issues relating to weight maintenance, including whether or not dietary glycaemic index and glycaemic load could play a part.

The recording of the webinar will is available here.

More information on TDR is available here.

Professor Mike Lean is a principal investigator of the DiRECT study, chair of the department of human nutrition at the University of Glasgow, visiting professor at Otago University and visiting professor at the University of Sydney. He is a keen fiddle-player and climbs mountains.

FUNDING – The DiRECT trial was funded as a Strategic Research Initiative by Diabetes UK and Cambridge Weight Plan donated all formula diet products.

Abstract

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

Professor Mike Lean, University of Glasgow, Scotland

Until very recently, ‘remission ‘ of type 2 diabetes (T2D) was an unknown concept.  Results from the UK Diabetes Remission Clinical Trial (DiRECT), supported by near-identical findings from DIADEM-1 in Qatar, have challenged and changed the old paradigm of T2D being a permanent condition, treatable by life-long glucose-lowering drugs, an inconvenience of ageing.  The new evidence reveals T2D 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.

DiRECT included people with T2D up to 6 years from diagnosis. A structured dietary programme (Counterweight-Plus: Total Diet Replacement for 12 weeks, transferring to a food-based maintenance diet with about 50% energy from carbohydrate) achieved remission (HbA1c <48mmol/mol (<6.5%) 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%.

With slightly younger participants and shorter diabetes duration, using similar total Diet Replacement and food-based maintenance, DIADEM-1 achieved 61% remissions at 12m.

These are the only randomized controlled trials of diet interventions reporting remissions of diabetes.  Several observational studies have employed low-carbohydrate diets, but while some have led to good weight losses, the remission rates are rather lower.  The large VIRTA-Health study in US achieved 13kg weight loss, but only 19% remissions. A failure to withdraw glucose lowering drugs may have obscured some more remissions, but these results are in, one with evidence that lower carbohydrate diets are associated with higher, not lower HbA1c.

Criteria for remission of T2D entail (1) a cut-off of HbA1c to denote freedom from diabetes, and (2) a duration of non-diabetic HbA1c without glucose-lowering medication.  There are now internationally agreed criteria, by ADA, EASD, Diabetes UK, the Endocrine Society, and the Diabetes Surgery Summit (2021): HbA1c <48mmol/mol (6.5%), >3 months without glucose-lowering medication.

Following publication of DiRECT, the wishes of people with T2D seeking freedom from the disease have been important in stimulating adoption of remission programmes, for local services, in national Clinical Guidelines (eg Australia, New Zealand) and from international organisations such as forthcoming 2022 evidence-based Guidelines from the Diabetes Nutrition Study Group of EASD.

References:

1. Churuangsuk C., et al Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission. Diabetologia (2022) 65, 14–36 https://doi.org/10.1007/s00125-021-05577-2
2. Lean MEJ, et al,. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet (2018) 391(10120) 541-551
3. Thom, G. et al. (2021) Predictors of type 2 diabetes in the Diabetes Remission Clinical Trial (DiRECT). Diabetic Medicine, 38(8), e14395. (doi: 10.1111/dme.14395) (PMID:32870520)
4. Riddle M, et al; Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes. Diabetes Care 1 October 2021; 44 (10): 2438–2444. https://doi.org/10.2337/dci21-0034

Research leaders will testify to the benefits of using total diet replacement (TDR) for weight loss and the impact of this weight loss on improving type 2 diabetes care, in an online event taking place on 12^th April at 1400h BST (1500h CET), organised by Total Diet & Meal Replacements Europe.

The seminar, “Diabetes Remission: Maintenance after weight loss with total diet replacement”, will feature expert speakers Prof Mike Lean (Clinical Senior Research Fellow/Honorary Consultant – University of Glasgow), Prof Gary Frost (Chair in Nutrition and Dietetics – Imperial College London), Prof 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).

Prof Anthony Leeds, Chair of TDMR Europe said:

“Obesity and type 2 diabetes (TD2M) are among the most critical challenges facing Europe’s health and economy. It is important now, more than ever, to help policymakers and healthcare professionals gain a better understanding of the role of TDR in addressing these issues. Several scientific studies have proven the effectiveness of TDR in tackling obesity and have shown that weight reduction is the most important component of T2DM prevention, along with increased physical activity and optimal composition of the maintenance diet. Following a highly successful webinar on the use of TDR for weight loss and T2DM remission and prevention last year, we are delighted to launch this online seminar to review the latest research on the requirements for weight maintenance after weight loss with TDR”.

The panel will review the DiRECT diabetes remission trial and the PREVIEW diabetes prevention trial to identify barriers and potential solutions with regards to successful weight loss maintenance and diabetes remission. The PREVIEW trial has shown that a large initial weight loss of an average 10% of body weight with TDR, followed by a structured diet focussing on glycaemic index and higher protein content, delivered fewer cases of T2DM three years later than would have been expected.

This seminar is aimed at policymakers, healthcare professionals, organisations in the European health industry with an interest in weight management and weight loss, and type 2 diabetes remission and treatment as well as at media stakeholders who are looking to widen their knowledge of scientifically-backed weight management solutions available to Europe today.

The online seminar will take place on 12^th April, at 14:00 – 15:30 BST (15:00-16:30 CET). Participation at the event is free of charge. You can find more information and register here.

Tuesday 12^th April 2022 14:00-15:30 BST; 15:00-16:30 CEST; 16:00-17:30 EEST

European countries face levels of obesity and diabetes that will overwhelm capacity for healthcare provision. Weight loss has been recognised as the key component for diabetes prevention and key to effective diabetes remission.  A recent review (ref1) concluded that the best way to achieve the initial weight loss was with total diet replacement but much needs to be learned about effective weight loss maintenance.  Dietary glycaemic index has been an important part of dietary management of diabetes for some time and recent evidence from the EU funded PREVIEW trial (ref2) indicates low GI/low GL diet facilitated maintenance of weight loss and lower blood glucose. Clinical and public health guidelines are in the process of being reviewed.  All European countries require effective programmes for diabetes prevention, diabetes remission and obesity prevention and reduction.

The aim of the seminar is to review evidence for the requirements for weight maintenance after weight loss with Total Diet Replacement (TDR).

The evidence for achieving diabetes remission with diet and lifestyle will be reviewed and the timetable for forthcoming new guidelines will be indicated. Barriers to successful weight loss maintenance and remission will be described as well as potential solutions.  The evidence for use of low GI/low GL (low glycaemic index and low glycaemic load) diets in improving weight maintenance in the PREVIEW trial will be summarised and the potential benefits of low GI/low GL diets in diabetes management, particularly in Southern Europe will be discussed.

Speakers in the seminar will be:

• Professor Mike Lean, University of Glasgow, Scotland and Principal Investigator of the DiRECT diabetes remission clinical trial;
• Professor Gary Frost, Imperial College London, inventor with colleagues of inulin-propionate and lead investigator of studies on dietary factors in weight management;
• Professor Elena Philippou, University of Nicosia, Cyprus and authority on diet in Southern Europe and on glycaemic index in dietary management.

The seminar will be chaired by Dr Anthony Leeds, Frederiksberg Hospital Copenhagen and University of Glasgow and chair of TDMR Europe who said ‘I’m delighted that we’re now able to offer our fourth web seminar on issues relating to use of total diet replacement in achieving enough weight loss to secure diabetes remission.  Weight maintenance remains a challenge, but solutions will be presented and discussed.’

Participation is free, but registration is essential.

Please make sure you register for the webinar here

Ref 1: Churuangsuk C et al. Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission. Diabetologia 2022; 65: 14–36 doi: 10.1007/s00125-021-05577-2.

Ref 2: Zhu, R.et al. 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 2021; 44(7): 1672–1681  doi.org/10.2337/dc20-3092

Information about previous seminars can be found at:

Reducing future risk: Obesity co-morbidities and nutritional status’  The index page is at: https://tdmr-europe.com/2020/08/04/tdmr-europe-reducing-future-risk-obesity-co-morbidities-and-nutritional-status-index-page/

‘Proven facts versus popular myth about weight loss with TDR’, held on 14^th April 2021.  See: https://tdmr-europe.com/2021/04/22/tdmr-europe-holds-successful-interactive-event-and-highlights-tdrs-impact-on-obesity/

‘Total Diet Replacement: exploring sustainable weight loss and health benefits, including diabetes remission and prevention’ was held on 27^th October 2021 and brought together the three key speakers for three landmark trials: DiRECT (diabetes remission – Prof Mike Lean, University of Glasgow); PREVIEW (weight loss in a primary care setting – Dr Nerys Astbury, University of Oxford); and PREVIEW (diabetes prevention – Prof Jennie Brand Miller, University of Sydney). See the index page at: https://tdmr-europe.com/2021/12/13/tdmr-europe-total-diet-replacement-exploring-sustainable-weight-loss-and-health-benefits-including-diabetes-remission-and-prevention-index-page/

TDMR Europe welcomes World Obesity Day (WOD) which returns this year with the theme “Everybody Needs to Act”. Taking place annually on 4^th March, WOD is a unified day of action that calls for a cohesive, cross-sector response to the obesity crisis. Today a variety of organisations and decision-makers across Europe used the occasion of WOD to talk about their increased efforts to tackle obesity.

The MEP Interest Group on Obesity and Health System Resilience hosted an online event focusing on national action plans for obesity in EU. Since its launch in April 2021, the Group has been investigating the situation of obesity across five EU Member States. In the event “From Words to Action: Addressing Obesity Together”, the Chair of the Group MEP Weiss and the Vice Chairs MEP Cerdas and MEP Solis-Pérez took stock of the past year and discussed how to move forward to support EU Member States in evidence-based policy interventions that can enable them to better address the obesity challenge.

Also ahead of WOD, WHO/Europe launched the “Obesity in Europe” report looking at how to improve awareness and understanding of the causes of obesity and the actions needed to address them. The organisation is focusing on changing the obesity policy in Europe, building the right support systems and prioritising obesity as a health issue.

While obesity has been on the political agenda of Europe for many years now, obesity rates are not only rising but have tripled in many European countries.  Public policy has stepped up efforts to tackle obesity, but current strategies mostly focus on promoting healthy eating and exercise. Although regular exercise and a healthy diet are good advice to prevent overweight and obesity, consideration towards those who are already obese is needed if we are to adequately and substantially reverse obesity rates.

TDMR Europe has recently published a position paper on obesity, stressing that preventive measures alone won’t help reverse the obesity pandemic. Policy makers and governments across Europe need to consider support measures for those who are already obese, and they must look into all available options, including formula foods. TDMR Europe’s obesity position paper explains that total diet replacements (TDR) and meal replacements  (MRP) have scientifically proven to be a safe and cost effective measure to tackle obesity and related comorbidities.

The preliminary results of the soups and shakes diet programme that was launched by NHS England in 2020 to provide a low-calorie diet treatment with TDR for people who are overweight and living with type 2 diabetes (T2DM) show participants each lose 7.2kg on average after one month, and 13.4kg after three months. New data released earlier this year by the NHS show that people on the programme who are eating and drinking the low-calorie alternatives not only lose weight but keep it off over time. Moreover, the NHS low calorie diet programme enabled the participants to better control their blood sugar levels – reducing the need for diabetes-related medication and potentially achieving remission of their T2DM when their levels return to a healthy range.

In its position paper on obesity TDMR Europe urges EU policy makers to:

– Support a more ambitious role for the EU in public health matters and continue to recognise the complexity of obesity, while ensuring a clear focus on treatment as well as prevention.

– Explore all options available, including the use of TDRs and MRPs, while understanding healthcare costs and potential savings from using formula foods.

– Make more funds available for research into obesity treatment and management, while creating more opportunities for industry to share their best practices.

More information on TDRs and MRPs is available here and here.

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 base 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.

Health experts demonstrated that total diet replacements (TDR) offer a cost-effective solution in tackling obesity and health related diseases, in TDMR Europe’s latest webinar “Total Diet Replacement: exploring sustainable weight loss and health benefits, including diabetes remission and prevention”.

Programme

Total diet replacement – amount, safety and sustainability of weight loss

– Anthony Leeds, TDMR Europe, Parker Institute, Copenhagen

Diabetes prevention with TDR and low GI/GL diet (the PREVIEW study)

– Jennie Brand Miller, University of Sydney

Total Diet Replacement in a primary care/community setting – sustainability and health economics (the DROPLET trial)

– Nerys Astbury, University of Oxford

Diabetes remission – update on global roll-out of remission programmes (the DiRECT trial)

– Mike Lean, University of Glasgow

Prof Anthony Leeds, (Chair TDMR Europe) introduces the speakers:

After the event he said:

“We are pleased that our online seminar was attended by more than 100 delegates from the healthcare, policy and media sectors. The increasing levels of obesity and comorbidities in Europe will soon overwhelm capacity for healthcare provision. This timely seminar effectively demonstrated the potential for TDRs to provide a highly effective solution for overweight and obese individuals to lose weight more rapidly than would otherwise be possible, and improve outcomes for type 2 diabetes and other health issues associated with obesity”

To access the four complete contributions, with abstracts, slide sequences and references please follow this link.

The event featured Dr Nerys Astbury (University of Oxford), Prof Jennie Brand Miller (University of Sydney), Prof Mike Lean (University of Glasgow) who reviewed the latest scientific research including the DROPLET, PREVIEW and DiRECT trials and TDMR Europe Chair, Prof Anthony Leeds (Parker Institute, Frederiksberg Hospital, Copenhagen), The full recording of the webinar is available here.

More information on TDR is available here and here.

 On 27th October, TDMR Europe organized the online seminar “Total Diet Replacement: exploring sustainable weight loss and health benefits, including diabetes remission and prevention”. The webinar 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.

Please follow the link to each individual presentation:

 

Diabetes prevention with TDR and low GI/GL diet

– Jennie Brand Miller, University of Sydney

Diabetes remission – update on global roll-out of remission programmes

– Mike Lean, University of Glasgow

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

– Nerys Astbury, University of Oxford

Total diet replacement – amount, safety and sustainability of weight loss

– Anthony Leeds, TDMR Europe, Parker Institute, University of Copenhagen, University of Glasgow and IMU Malaysia

 

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.

Professor Anthony Leeds, senior fellow at the Parker Institute, Copenhagen, and chair of TDMR Europe reviewed the characteristics and mechanism of action of total diet replacement 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. He noted that Total Diet Replacement (TDR) offers a potential additional intervention, especially to bridge the gap between weight losses of 3 to 5kg with conventional reducing diets and losses in excess of 20kg with bariatric surgery. TDR delivers fast rates of weight loss (average 1.3 to 1.5kg/week) which is highly motivating for users and can be delivered in specialist units and primary care and community settings. Safety profiles are fully published and cost-effectiveness especially in older and heavier people has been demonstrated partly through reduced costs of medications.

Prof Leeds added ‘The recent publication by Chaitong Churuangsuk and colleagues in Glasgow of a review of meta-analyses of randomised controlled trials of TDR for diabetes remission concluded that an initial weight reduction with a total diet replacement was the most effective way to achieve type 2 diabetes remission. The challenge of achieving weight maintenance afterwards is addressed by some longer-term maintenance trials such as the DiRECT diabetes remission trial and the LIGHT trial on elderly people with obesity and osteoarthritis in Copenhagen. There are published reports including one by GeorgeThom and colleagues, identifying the characteristics of ‘maintainers’ (recognising maintenance as a lifestyle not a diet, flexible control and diet vigilance) and ‘regainers’ (life stresses, negative mood states, motivational conflicts and self-regulation inconsistency) indicating a clear need to develop proven methods to address the challenges experienced by those who regain weight more easily than others after a good initial weight loss.’

 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.

Professor Anthony Leeds is senior visiting fellow at the Parker Institute, Frederiksberg Hospital, Copenhagen; adjunct professor at the International Medical University, Kuala Lumpur, Malaysia and visiting fellow at the University of Glasgow.  He chairs TDMR Europe.

 

Abstract

Total diet replacement – amount, safety and sustainability of weight loss

Parker Institute, Frederiksberg Hospital, Copenhagen, Denmark;

School of Medicine, Dentistry and Nursing, University of Glasgow, Scotland;

School of Health Sciences, International Medical University, Malaysia.

Formula 800kcal/d low calorie diets (LCD) are composed of nutritionally complete soups, shakes bars and other products, formulated to provide all needed vitamins, minerals, essential fats and protein. They are always offered with a behavioural component and physical activity guidance. When used exclusively LCD are defined as Total diet replacements (TDR) and facilitate 1–2kg weight loss weekly with metabolic improvement in glucose, insulin, blood lipids and blood pressure in people with pre-diabetes, early diabetes, advanced diabetes, osteoarthritis, psoriasis, obstructive sleep apnoea, and heart disease.

In 2016 the American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines recommended target weight losses for a range of obesity co-morbidities for example 5-15% or more to achieve remission or medication dose reduction or improved control in type 2 diabetes.

Very low-calorie diets (<800kcal/d) can give rapid weight-loss especially in men, for example Johansson showed an average 18kg weight loss in 9 weeks in men with moderate and severe obstructive sleep apnoea. Christensen showed that 800kcal/d TDRs typically gave an average eight-week weight loss of 10-12 kg in elderly people with knee osteoarthritis and subsequently showed that one meal replacement or intermittent use of 800kcal/d TDR maintained most of the weight lost over 3 years in those who stayed in the programme. Continued behavioural support, physical activity and ‘rescue packages’ can play an important part in weight maintenance.

Low-calorie and very low-calorie diets are sometimes associated with fatigue initially, constipation, dizziness, and a very small increased risk of gout and very rarely gallstone events. Adjustment of anti-diabetes and antihypertension drugs has been successfully demonstrated in DiRECT and in another GP led study (DROPLET) published with medication adjustment guidelines.

References

Brown A, Leeds AR Very low-energy and low-energy formula diets: Effects on weight loss, obesity co-morbidities and type 2 diabetes remission – an update on the evidence for their use in clinical practice   Nutrition Bulletin 2019 44 (1) 7-24 First published: 20 February 2019| https://onlinelibrary.wiley.com/doi/epdf/10.1111/nbu.12372

Garvey WTE et al. American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines. Endocrine Practice 2016 22 (S3) 2016 1  DOI:10.4158/EP161365.GL

Christensen P, Bliddal, Riecke BF, et al Comparison of a low-energy diet and a very low-energy diet in sedentary obese individuals: a pragmatic randomized controlled trial Clinical Nutrition 2011 1  31- 40 https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1758-8111.2011.00006.x

 

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 27^th 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 27^th 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

Abstract

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.

References:

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 http://dx.doi.org/10.1136/bmj.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  https://doi.org/10.1002/oby.22407

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

Mike Lean, Professor of Human Nutrition at the University of Glasgow reviewed the DiRECT trial of Total Diet Replacement (TDR) weight loss with behavioural and lifestyle guidance followed by weight maintenance to achieve diabetes remission in people with type 2 diabetes in TDMR Europe’s recent webinar. Prof Lean showed that the combination of significant weight loss using TDR followed by weight maintenance can achieve 10-15kg weight loss and diabetes remission in a proportion of participants.  Two-year follow up results were presented and information about the roll-out of remission programmes was given.

Professor Anthony Leeds, chair of TDMR Europe said ‘The team in Glasgow lead by Professor Lean in association with Professor Roy Taylor and colleagues at the University of Newcastle have marked the centenary of the discovery of insulin with landmark papers that may revolutionise the management of diabetes as much as did the first effective use of an insulin extract around one hundred years ago. Revolutions don’t happen quickly.  A huge number of first-rate clinical trials and investigations of mechanism has been undertaken over a number of years, along with health economic analyses of the cost benefits of this intervention. Translation into practice is underway in several countries.  Diabetes and its complications cause much human suffering and cost an appreciable proportion of national drug budgets, and are becoming increasingly prevalent, very rapidly. This may be slowed and the trend reversed over the coming five years or so by introducing effective weight loss and weight maintenance programmes.’

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.

Professor Mike Lean is a principal investigator of the DiRECT study, chair of the department of human nutrition at the University of Glasgow, visiting professor at Otago University and visiting professor at the University of Sydney. He is a keen fiddle-player and climbs mountains.

FUNDING – The DiRECT trial was funded as a Strategic Research Initiative by Diabetes

1. The Cambridge Weight Plan donated all formula diet products.

 

Diabetes remission – update on global roll-out of remission programmes

Abstract

Many people can achieve “remission” from early type 2 diabetes (T2D) through weight loss from dietary changes. Remission (reducing blood sugar and HbA1c to non-diabetic levels without medication) improves wellbeing, reduces heart disease risks and reduces healthcare costs.

DiRECT, and DIADEM-1, both RCT trials, achieved mean weight losses >10kg at 12 months using established formula diets (low-calorie but nutrient-complete soups and shakes), and remissions for 46% or 61% of participants on an Intention to Treat (ITT) basis. Weight loss >10 kg led to remissions for 70-80%, which were well maintained at 2 years by keeping that weight off. Blood pressures fell, so about 30% were able to remain off medication. NAFLD, which often accompanies T2D, improved similarly.  A subset underwent mechanistic studies and MRI, which demonstrated high ectopic fat contents in liver and pancreas at baseline, which fell to normal (restoring normal pancreas morphology) with weight loss and remission.  Insulin production capacity was 50% at baseline, but rose to normal in those sustaining remissions.  Serious adverse events were fewer in the intervention group, and total medical care costs fell, so in a formal health economic analysis, the intervention helped people live longer, feel better and cost less.

Although proponents of low-carb and ketogenic diets are claiming that remission of T2D can be achieved, there is no RCT evidence, and the observational studies show remission rates on 12-20% on an ITT basis.

The DiRECT intervention (Counterweight-Plus) was delivered entirely in the community, and highly cost-effective (predicted cost-saving over >5 years).  However, weight loss maintenance is not easy and many need support to manage stress and cravings, emotional eating and handling relationships with others. Face-to-face support from healthcare professionals proved effective, but has high demands on staff and patients. The same diet intervention is now delivered remotely (via app or online, with video or telephone support) with similar weight loss results, but reduced demands on patients and staff time, and being cheaper can potentially reach more people.

Driven partly by the wishes of people currently living with T2D and partly by the cost-effectiveness analysis of DiRECT, interventions based on the ‘DiRECT Principles’ are now being provided within routine medical care.  In Scotland the evidence-based highly cost-effective Counterweight-Plus programme is provided in every NHS Scotland Health Board.  NHS England is instead offering a number of other interventions to an evaluated 5000 patients.  These programmes aimed at remission of T2D are also available, and popular, remotely-delivered to the public.

References:

1. Lean MEJ et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. The Lancet 391, 541-551 (2018)
2. Lean MEJ et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. The Lancet Diabetes & Endocrinology, 7, 344-355 (2019)
3. Thom G et al. Predictors of type 2 diabetes remission in the Diabetes Remission Clinical Trial (DiRECT). Diabetic Medicine, 38, 8, e14395 (2020)
4. Al-Mrabeh A et al. 2-year remission of type 2 diabetes and pancreas morphology: A post-hoc analysis of the DiRECT open-label, cluster-randomised trial. The Lancet Diabetes & Endocrinology 8 (12), 939-948 (2020)
5. Xin Y et al. Type 2 diabetes remission: 2 year within-trial and lifetime-horizon cost-effectiveness of the Diabetes Remission Clinical Trial (DiRECT)/Counterweight-Plus weight management. Diabetologia 63 (10), 2112-2122 (2020)
6. The DiRECT principles: giving Type 2 diabetes remission programmes the best chance of success. Hopkins MD, Taylor R, Lean MEJ,  Diabetic Medicine 36 (12), 1703-1704 (2019)
7. Churuangsuk C et al. Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission. Diabetologia, 2021

Jennie Brand Miller, Professor of Human Nutrition at the University of Sydney, reviewed the benefits of Total Diet Replacement for weight loss and low GI/high protein diet for weight maintenance and  diabetes prevention in TDMR Europe’s webinar “Total Diet Replacement: exploring sustainable weight loss and health benefits, including diabetes remission and prevention”  held on 27^th October 2021. Presenting the results of the PREVIEW research, Prof Brand Miller showed that the combination of significant weight loss using total diet replacements and a low-glycaemic load diet facilitated diabetes prevention.

Professor Anthony Leeds, chairman of TDMR Europe said “The PREVIEW study has provided strong evidence for the use of an initial weight loss with total diet replacement as the first stage of a diabetes prevention programme. Ninety percent of participants were able to complete the eight-week diet intervention period, losing an average weight of 10.7kg, with 83.5% achieving >8% weight loss.  All diabetes prevention programmes have shown that the more weight loss achieved and maintained the smaller the proportion of participants who develop diabetes. PREVIEW has confirmed the importance of this but has shown the added benefit of using a low glycaemic index/low glycaemic load diet to help reduce weight regain and keep HbA1c as low as possible. This is hugely important evidence that ought to be considered when diabetes prevention programmes are designed.”

On 27^th 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.

Prof Brand Miller is a Principal Investigator of the PREVIEW trial, a landmark three-year multicentre study conducted in eight countries that examined  the impact of TDR followed by a three year weight maintenance programme on type 2 diabetes risk.

The PREVIEW trial was funded through the EU framework programme 7 (FP7/2007–2013) grant agree-ment # 312057, National Health and Medical Research Council – EU Collaborative Grant, AUS 8, ID 1067711 and The Glycemic Index Foundation Australia. The Cambridge Weight Plan donated all products for the 8-week LED period.

 

Diabetes prevention with TDR and low GI/GL diet

Jennie Brand Miller, PREVIEW research team, University of Sydney, Australia

Abstract

The PREVIEW randomised controlled trial was a landmark 3-year multicentre, type 2 diabetes prevention study carried out in 8 countries comparing 2 diets and 2 levels of exercise intensity [1]. In total 2326 adults aged 25-70 years, body mass intake BMI ≥25 and prediabetes were enrolled.  In the first phase, participants needed to lose ≥8% of body weight in 8 weeks using total meal replacements [2] to be eligible for the second phase (34 months) of weight loss maintenance. Eligible adults (79%) received a behavioural intervention including instructions to follow either a conventional healthy diet or the high protein-low glycemic index diet (25%E from protein, 45%E from carbohydrates, GI ≤ 50).  Results: Average weight loss was 11% (11 kg) at 8 weeks. At 12-months, 74% of participants remained and 52% at 3 years.  Among the completers, the incidence of diabetes was much lower than anticipated – only 3 in 100 participants whereas 13.5% was predicted (a relative risk reduction of 77%).  The incidence was the same in centres where the attrition rate was low versus those with high rate. There were no significant differences between the two diets or two exercise groups. In post-hoc analyses, the lowest vs highest tertile of dietary glycemic index and glycemic load re-gained less weight, fat mass and showed smaller increases in HbA1c, independently of weight loss [3]. The findings suggest that the combination of significant weight loss using meal replacements and a low glycemic load diet facilitates diabetes prevention.

References:

1. Raben, A.; Vestentoft, P.S.; Brand-Miller, J.; Jalo, E.; Drummen, M.; Simpson, L.; Martinez, J.A.; Handjieva-Darlenska, T.; Stratton, G.; Huttunen-Lenz, M., et al. The preview intervention study: Results from a 3-year randomized 2 x 2 factorial multinational trial investigating the role of protein, glycaemic index and physical activity for prevention of type 2 diabetes. Diabetes, Obesity and Metabolism 2021, 23, 324-337.
2. Christensen P, Larsen TL, Westerterp-Plantenga M et al 2018 Men and women respond differently to rapid weight loss: Metabolic outcomes of a multi-centre intervention study after a low-energy diet in 2500 overweight, individuals with pre-diabetes (PREVIEW) Diabetes Obes Metab. 2018;20: 2840–2851 https://dom-pubs.onlinelibrary.wiley.com/doi/epdf/10.1111/dom.13466
3. Zhu, R.; Larsen, T.M.; Fogelholm, M.; Poppitt, S.D.; Vestentoft, P.S.; Silvestre, M.P.; Jalo, E.; Navas-Carretero, S.; Huttunen-Lenz, M.; Taylor, M.A., et al. 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 2021, 44, 1672.

Research leaders will review the use of Total Diet Replacements (TDRs) for weight loss and diabetes remission and prevention in an in-depth webinar set to take place on 27th October. The online seminar will bring together industry, academics and other stakeholders and is hosted by Europe’s leading trade body for formula diet products, TDMR Europe. Free registration is open here. 

The event, “Total Diet Replacement: exploring sustainable weight loss and health benefits, including diabetes remission and prevention” will review the most recent scientific studies on TDR’s effect on reducing body weight and delivering health benefits, and features  expert speakers: TDMR Europe Chair, Prof Anthony Leeds (Parker Institute, Frederiksberg Hospital, Copenhagen), Dr Nerys Astbury (University of Oxford), Prof Jennie Brand Miller (University of Sydney) and Prof Mike Lean (University of Glasgow).  

TDMR Europe Chairman Prof Anthony Leeds said:  

“Following a highly successful webinar that debunked the myths surrounding Total Diet Replacements, we are delighted to launch this online seminar to provide delegates with an overview of current research, the findings of which clearly demonstrate the effectiveness of TDR on weight loss and achieving type 2 diabetes remission and prevention. Obesity and overweight are among the most critical challenges for European healthcare and economic sectors. The increasing levels of obesity and co-morbidities that Europe is facing today will soon overwhelm capacity for healthcare provision. Weight loss with TDR is a safe, cost-effective, evidence-based solution that provides rapid results. Most consumers find it easy to comply with this programme. It is important now, more than ever, to raise awareness of the benefits of TDR for weight loss and obesity-related health conditions”. 

The seminar will highlight the importance of large weight losses and their sustainability in delivering improved risk factors and health benefits. Speakers will also provide a thorough overview of the latest trials on weight loss and diabetes remission and prevention with TDR; the panel will discuss the DROPLET research study that examined GP (family doctor) referral for delivery of the diet in a community setting. The PREVIEW and DiRECT studies examined diabetes prevention and diabetes remission.  In all three cases initial weight losses of around 10kg to 15kg were achieved with TDR. The webinar will also review recent evidence for weight maintenance after TDR within each major trial. TDMR Europe aims to use the event to provide healthcare professionals, journalists, NGOs, policy makers and regulators with an improved understanding of the relevance of TDR in bringing down the incidence of obesity and related comorbidities. 

The event will take place on 27th October at 14:00-15:30 BST (15:00 -16:30 CEST). Participation at the event is free of charge. Please follow this link to register. 

The full agenda of the event will be available soon on the website of TDMR Europe. 

More information on TDR can be found here.  

TDMR Europe is proud to support Food Matters Live 2021, inspiring and connecting the global food, drink and nutrition community via a wealth of new opportunities.

Food Matters Live continues to be an ever-growing global community of people working in sustainable food innovation, nutrition, and health.

Running three times a year, Food Matters Live events provide information and insights through an unrivalled education programme, which focuses on topics such as the public health issue of obesity and the future of nutrition and health.  In addition, Food Matters Live provides a unique platform that connects international ingredient innovators with innovation teams from across the UK. Discover innovative NPD solutions, connect with your peers, and gain rich and reliable data from experts within your industry at the next live digital event, which will take place from 16 to 17 November 2021. Plus, be a part of the Future Ingredients Competition 2021, recognising the most pioneering ingredients of the year with winners announced at the event in November.

Among other issues, the Food Matters Live November content streams will address the topic “Reducing obesity: policy and practice”. You can find out more information at www.foodmatterslive.com.

 

It has been over a year and half since the COVID-19 outbreak began, and a major lesson learned from the pandemic is the need to make obesity a public health priority. While elderly people and those with immune disorders were quickly recognised as the main groups at increased risk for severe COVID-19 outcomes, several studies have shown that obese and overweight individuals are also at high risk of developing severe illness due to COVID-19.

Obesity is one of the most prevalent health conditions among hospitalised COVID-19 patients. Scientific evidence shows that obese people (including young adults) hospitalised with COVID-19 experience substantially higher rates of severe outcomes, such as requiring intensive care treatment, mechanical ventilation, and death. According to the World Health Organization, the European Region is the most affected by obesity-related morbidity and mortality. The pandemic has reinforced the need to prioritise the fight against obesity, which is recognised in the European Programme of Work 2020–2025 of the WHO Regional Office for Europe.

The impact of COVID-19 on obesity

Obesity is known to significantly impair the immune system’s ability to fight against diseases. Several potential mechanisms explain severe COVID-19 outcomes in obese and overweight people, including compromised lung function and increased levels of chronic inflammation. As the Obesity Action Coalition notes, obesity results in fat in the abdomen pushing up on the diaphragm, which can cause restricted airflow to the lungs and shortness of breath or difficulty breathing. This can become even worse after contracting COVID-19, and the situation is made more complicated by comorbidities associated with obesity, such as diabetes, obstructive sleep apnoea and cardiovascular disease, which are also contributing factors to the worst COVID-19 outcomes.

The socio-economic impact of the pandemic may further increase obesity levels and make it more difficult for the overweight and obese to lose weight. Self-isolation can lead people to use delivery services and consume fast food more than before, while increased stress can also result in greater consumption of unhealthy processed food due to comfort and night eating. Studies have shown that stress can disrupt the sleep schedule, which in turn may change eating habits due to an increase in hunger hormones. This can lead people to consume food late at night and/or eat more throughout the day.

Addressing the obesity challenge

So far, the EU and the UK have focused their efforts on preventing obesity and overweight via strategies focused on healthy eating or consumer information. We have seen this in the European Commission’s Farm to Fork Strategy and the British Government’s legislation to restrict the promotion of products high in fat, sugar and salt (HFSS). Yet, such policies are insufficient in addressing the complexities of obesity and in offering solutions to those that are already obese.

Public policy needs to turn its attention to these people, millions of whom are already struggling with being obese or overweight and face an increased risk of severe illness and death owing to COVID-19. This shift in the efforts to tackle obesity requires a focus on available solutions. There is increasing scientific evidence on the beneficial impacts of total diet and meal replacement products (TDR and MRP) for obese and overweight people.

Some well documented benefits of TDR programmes include fast weight loss – of between 1.3 and 1.5 kg per week – and weight loss maintenance of more than 10% of initial body weight . Moreover, recent studies have shown that TDR diets can result in the prevention and remission of type 2 diabetes as well as improvement in other obesity comorbidities, such as osteoarthritis.

An MRP diet plan also offers significantly better weight loss compared to a food-based diet plan (rates of up to 17 kg in 24 weeks). In addition, the benefits of using MRPs for weight loss include improvements in a number of health-related variables during weight maintenance, such as inflammation and oxidative stress, two key factors recently shown to underlie most common chronic diseases.

TDRs and MRPs from responsible manufacturers provide a safe, reliable and cost-effective solution in tackling the skyrocketing obesity rates in Europe. Against the background of the alarming link between COVID-19 and obesity, it is absolutely necessary that policymakers and professionals from the healthcare sector gain a better understanding of this option.

More on COVID-19 and obesity can be found here.

Find out more about TDRs via this link.

More information on MRPs is available here.

On 14 April 2021 TDMR Europe organised the online seminar “Proven Facts versus Popular Myths about weight loss with Total Diet Replacement (TDR)”. The event presented the potential benefits of using TDR for weight loss, including cost-effectiveness and addressed myths and misinformation that slow the acceptance of TDR as an effective solution in the European strategy to tackle obesity and overweight. The webinar featured expert speakers Professor Anthony Leeds (TDMR Europe Chair), Dr George Thom (University of Glasgow), Dr Kelly Johnston (King’s College London) and Mark Gilbert (TDMR Europe Science Committee).

Please follow the link to each individual presentation:

Total Diet Replacements – update on latest clinical trial evidence 

– Anthony R Leeds, TDMR Europe and Frederiksberg Hospital, Copenhagen, Denmark

Physiological and behavioural factors involved in weight loss maintenance

George Thom, University of Glasgow

Is there any scientific basis for Myths about TDR? 

Kelly Johnston, King’s College London

TDR Myths – Does Rapid Weight Loss Cause Undue Losses of Lean Body Mass?

Mark Gilbert, TDMR Europe Science Committee

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.

TDMR Europe has released a video with highlights from its online seminar “Proven facts versus popular myth about weight loss with Total Diet Replacement” that took place on 14^th April 2021.

In this webinar Professor Anthony Leeds (TDMR Europe Chair), Dr George Thom (University of Glasgow), Dr Kelly Johnston (King’s College London) and Mark Gilbert (TDMR Europe Science Committee) debunked common popular myths about weight loss and presented the potential benefits of using Total Diet Replacement (TDR) for weight loss.

The increasing prevalence of obesity, overweight and type 2 diabetes in Europe, which also increase the risk of adverse outcomes in COVID-19 infection, could soon overwhelm the capacity for healthcare provision. This webinar highlighted how TDR can be an effective solution to tackling alarming obesity and overweight rates in Europe.

The online seminar is available here.

Mark Gilbert from TDMR Europe’s Science Committee spoke at the recent on-line seminar “Proven Facts versus Popular Myth about weight loss with Total Diet Replacement (TDR)”.  Mark Gilbert debunked myths about the relation between weight loss and lean body mass. As he stressed, there is an “undeserved negative mythology surrounding the use of TDR and the loss of lean body mass”. The presentation showed that rapid, substantial weight loss with TDR does not increase the proportion of lean body mass losses when compared to moderate weight loss.

TDR Myths – Does Rapid Weight Loss Cause Undue Losses of Lean Body Mass?

Mark Gilbert, TDMR Europe Science Committee

Abstract

A concern often expressed about low-calorie diets (LCD), total diet replacement (TDR) and other means of rapid, substantial weight loss is that they may cause a disproportionate amount of lean body mass (LBM) loss. A key goal of weight loss is to maximise the loss of undesirable and metabolically-unhealthy fat. Another is to retain LBM, and in particular, skeletal muscle, because it is associated with healthy aging and increases metabolic rate (although this later advantage is relatively negligible). However, it should also be noted that muscle is only one component of LBM and some loss of other LBM constituents may actually be desirable.

Several studies have looked at rapid weight loss with TDR versus gradual weight loss. Seimon, et al. split a group of 101 obese women into a 30% kcal deficit for 12 months or a 70% kcal deficit for four months. They found that LBM loss was in proportion to total weight lost in both the gradual and rapid weight loss groups and furthermore that muscle strength was not compromised more so in rapid weight loss. In female subjects, a group that lost twice as much weight over eight weeks had almost identical proportions of LBM loss as compared to the ‘gradual’ group. A similar outcome occurred in rapid versus gradual weight loss in older adults. In a 2018 study, subjects who lost nine percent of their body weight over four weeks versus those who did so in eight weeks, had the same LBM losses and, after a one-month maintenance phase, only the RWL group significantly increased their LBM. So the published evidence on weight loss with TDR versus other dietary interventions suggests that LBM loss is proportional to the amount and proportion of weight loss.

An additional important and rarely-addressed consideration is that much of LBM loss is water, skin, connective tissue and old or damaged cell components and so not functional, skeletal muscle and may be in need of elimination or repair. This breakdown process that results from caloric deficit is called ‘autophagy’. The large and growing body of science around caloric restriction and fasting has brought attention to this process, demonstrating that it is a regenerative activity that recycles old or decrepit tissue and may be the key mechanism behind the multiple benefits of fasting, low-calorie diets and TDR. Indeed, Madeo, et al. noted that the autophagy, triggered by energy deficit, leads to “a cytoplasmic recycling process that counteracts the age-associated accumulation of damaged organelles and proteins as it improves the metabolic fitness of cells”.

References with web-links to original papers

Seimon RV, Wild-Taylor AL, McClintock S, Harper C, Gibson AA, Johnson NA, Fernando HA, Markovic TP, Center JR, Franklin J, Liu PY, Grieve SM, Lagopoulos J, Caterson ID, Byrne NM, Sainsbury A. 3-Year effect of weight loss via severe versus moderate energy restriction on body composition among postmenopausal women with obesity – the TEMPO Diet Trial. Heliyon. 2020 Jun 24;6(6):e04007.

Coxon A, et al. Rapid weight loss and lean tissue: evidence for comparable body composition and metabolic rate in differing rates of weight loss. Int J Obes. 1989;13 Suppl 2:179-81.

Ard JD, et al. Impact on weight and physical function of intensive medical weight loss in older adults with stage II and III obesity. Obesity (Silver Spring). 2016;24(9):1861-1866

Coutinho SR, et al. The impact of rate of weight loss on body composition and compensatory mechanisms during weight reduction: A randomized control trial. Clin Nutr. 2018 Aug;37(4):1154-1162.

Bosy-Westphal A, et al. Contribution of individual organ mass loss to weight loss-associated decline in resting energy expenditure. Am J Clin Nutr. 2009 Oct;90(4):993

Madeo F, Zimmermann A, Maiuri MC, Kroemer G. Essential role for autophagy in life span extension. J Clin Invest. 2015;125(1):85-93.

Dr Kelly Johnston from King’s College London spoke at the Group’s on-line seminar “Proven Facts versus Popular Myth about weight loss with Total Diet Replacement (TDR)”. Dr Johnston focused on the misinformation and myths about TDR. Her presentation pointed out the urgency of tackling these myths as they slow the wide acceptance of TDR as an effective and safe obesity treatment. As Dr Johnston stressed, “false beliefs about TDR are widespread and ultimately affect the effort within public health systems to fight obesity as well as the allocation of research resources on this issue”.

Is there any scientific basis for Myths about TDR?

Weight maintenance and attrition

Kelly Johnston, King’s College London

Abstract

Many presumptions about the use of total dietary replacement for weight control (TDR) as a treatment for obesity persist despite the absence of supporting scientific evidence, and indeed in the presence of evidence to the contrary.

Several research studies have shown that there is no substance in the claim that longer-term weight loss maintenance as a result of weight loss using a TDR is any harder to achieve when compared with that achieved after more gradual weight loss. One such study, which looked at data after an exceptionally long follow-up duration of 144 weeks was able to demonstrate that obese individuals who had lost at least 12.5% of their initial body weight via rapid weight loss, did not regain significantly more weight than those who had lost their initial weight more gradually.

In addition, there exists the belief that attrition from TDR programmes is significantly greater than those based on conventional food, which has also been refuted. Research findings from a study which explored the efficacy and acceptability of very low energy diets in overweight or obese adults with Type 2 diabetes demonstrated that attrition rates did not differ between the TDR diets and the comparator arms at any measurement point. Indeed, similar findings from other research studies further support good compliance in a TDR weight loss arm when compared with other, more gradual weight loss interventions. Finally, the assertion that a greater incidence of weight loss related adverse events are observed after a period of rapid weight loss has also been investigated with data showing that there are no significant differences in recorded adverse events between the TDR and the usual care group.

These widely promulgated yet unsubstantiated beliefs, which ultimately adversely affect both clinical and public health advice, and which negatively impact on the allocation of scarce research resources, must be addressed in order that effective obesity treatments are made available as required.

References with web-links to original papers

Purcell K et al The effect of rate of weight loss on long-term weight management: a randomised controlled trial Lancet Diabetes Endocrinol. 2014;2(12):954-62.

Vink RG et al The effect of rate of weight loss on long-term weight regain in adults with overweight and obesity Obesity (Silver Spring) 2016;24(2):321-7.

Christensen P et al Long-term weight-loss maintenance in obese patients with knee osteoarthritis: a randomized trial Am J Clin Nutr. 2017;106(3):755-763.

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

Rehackova L et al Efficacy and acceptability of very low energy diets in overweight and obese people with Type 2 diabetes mellitus: a systematic review with meta-analyses Diabet Med, 2016;33(5):580-91

Lean M et al Feasibility and indicative results from a 12-month low-energy liquid diet treatment and maintenance programme for severe obesity. Br J Gen Pract 2013;63:115–24.

Dr George Thom, a Registered Dietitian who works as a Research Associate within the Human Nutrition team at the University of Glasgow presented some of the key physiological and behavioural factors involved in weight loss maintenance during a recent TDMR Europe webinar.

Dr Thom emphasised in his presentation that several recent large-scale trials have demonstrated the effectiveness of TDR-led interventions in inducing initial average weight losses of 10-15% body weight, but the main challenge is preventing longer-term weight regain. Among factors that may undermine behaviour change maintenance, Dr Thom specifically highlighted the seemingly unfavourable increases in appetite that accompany significant weight loss, as well as adaptive reductions in energy expenditure.

Physiological and behavioural factors involved in weight loss maintenance

George Thom, University of Glasgow

Abstract

Despite widespread recognition that changes in the global food system are the driving force behind the obesity epidemic, individually focussed interventions remain the cornerstone of obesity management strategies. Several recent large-scale trials have demonstrated that a Total Diet Replacement led approach can reliably induce weight losses of 10-15% body weight. These findings are important given that remission of co-morbidities such as type 2 diabetes, sleep apnoea and osteo-arthritis, and the increasing numbers of people with a BMI >40, require weight losses of this magnitude.

However, maintaining weight losses and health benefits over the long-term continues to be the main challenge for the field. The problem of weight regain is often considered from distinct perspectives, predominantly split into fields of nutrition therapy, integrative physiology and behavioural psychology. This talk addressed why it is often difficult for people to maintain weight losses, and a range of influences, including changes in appetite and food reward, adaptive reductions in energy expenditure, and psychological influences on behavioural maintenance will be highlighted. Consideration was also given to how practitioners may support individuals living with obesity to optimise weight loss maintenance outcomes through effective behavioural approaches.

References with web-links to original papers

Anderson, J. W., Konz, E. C., Frederich, R. C. & Wood, C. L. 2001. Long-term weight-loss maintenance: a meta-analysis of US studies. American Journal of Clinical Nutrition, 74, 579-584.

Fothergill, E., Guo, J. E., Howard, L., et al. (2016). Persistent Metabolic Adaptation 6 Years After “The Biggest Loser” Competition. Obesity, 24, 1612-1619.

Greaves, C., Poltawski, L., Garside, R. et al. (2017). Understanding the challenge of  weight loss maintenance: a systematic review and synthesis of qualitative research on weight loss maintenance. Health Psychology Review, 11, 145-163.

Kwasnicka, D., Dombrowski, S. U., White, M. et al. (2016). Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories. Health Psychology Review, 10, 277-296.

Lean, M. E. J., Leslie, W. S., Barnes, A. C. et al. (2018). Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet, 391, 541-551.

Leibel, R. L., Rosenbaum, M. & Hirsch, J. 1995. Changes in energy-expenditure resulting from altered body-weight. New England Journal of Medicine, 332, 621-628.

Sumithran, P., Prendergast, L. A., Delbridge, E., et al. (2011). Long-Term Persistence of Hormonal Adaptations to Weight Loss. New England Journal of Medicine, 365, 1597-1604.

Taheri, S., Zaghloul, H., Chagoury, O., et al. (2020). Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial. Lancet Diabetes & Endocrinology, 8, 477-489.

Thom, G., Lean, M. E. J., Brosnahan, et al. (2020). ‘I have been all in, I have been all out and I have been everything in-between’: A 2-year longitudinal qualitative study of weight loss maintenance. Journal of Human Nutrition and Dietetics, 34(1):199-214. doi:10.1111/jhn.12826

Thom, G., Messow, CM., Leslie, WS., et al. Predictors of type 2 diabetes remission in the Diabetes Remission Clinical Trial (DiRECT). Diabetic Medicine (published online, September 1st 2020).

The Chairman of TDMR Europe, Professor Anthony Leeds, spoke at the Group’s successful online seminar entitled “Proven Facts versus Popular Myths about weight loss with Total Diet Replacement (TDR)”. This webinar addressed the myths and misinformation that surround the use of Total Diet Replacements and enabled stakeholders in both the public policy and healthcare sectors to gain a better understanding of TDR.  Prof Leeds shared updates on the latest research on TDR and presented the potential benefits of using TDR for weight loss, including type 2 diabetes (T2DM) prevention and remission.

Total Diet Replacements – update on latest clinical trial evidence 

Anthony R Leeds, TDMR Europe and Frederiksberg Hospital, Copenhagen, Denmark

Abstract

Formula liquid 800kcal/d low calorie diets (LCD) are composed of nutritionally complete soups and shakes formulated to provide all needed vitamins, minerals, essential fats and protein, and are always offered with a behavioural component and physical activity guidance. When used exclusively LCD are defined as Total diet replacements (TDR) and facilitate 1–2kg weight loss weekly with metabolic improvement in glucose, insulin, blood lipids and blood pressure.

The Diabetes Remission trial (DiRECT) is a cluster-randomised trial of weight loss in a primary care setting of usual care versus TDR for 12 to 20 weeks followed by structured weight maintenance in people with early type 2 diabetes. At one year in the TDR treated group (n=149) 24% maintained 15kg weight loss and 46% were in remission while at two years 11% maintained 15kg loss and 36% were in remission. Usual care delivered 15kg weight losses in 0% and 2% of people and diabetes remission in 4% and 3% at 1 year and 2 years respectively (n=149). Remission was most likely in those who lost most weight and maintained most weight loss at all stages.

The Diadem-1 study is an intensive intervention using TDR for the initial weight loss in 147 people (73% were men) with early type 2 diabetes from the Middle East and North Africa studied in Qatar. In this first TDR study on non-Europeans 70 people lost and sustained an average 12kg weight loss at 12 months with 61% in remission, compared to 4kg in a best practice control group and 12% in remission.

The PREVIEW study was a 3-year weight maintenance study of low and high GI, low and high protein diets and two exercise levels preceded by an 8-week TDR initial weight loss in 2224 people with prediabetes and obesity. Average weight loss by 8 weeks was 10.7kg, weight loss maintained at 3 years was 4.6 to 4.9kg in the four groups. Overall, 6.3% developed diabetes by 3 years, less than expected.

Formula diet TDR programmes deliver, in a short period of time, the amounts of weight loss needed to achieve major health improvements and are a safe, cost-effective proven option for diabetes prevention and remission and other obesity comorbidities.

References with web-links to original papers

Very low-energy and low-energy formula diets: Effects on weight loss, obesity comorbidities and type 2 diabetes remission – an update on the evidence for their use in clinical practice Brown A, Leeds AR. Nutrition Bulletin 2019;44:(1) 7-24

Lean MEJ et al Primary care-led weight management for remission of type 2 diabetes
(DiRECT): an open-label, cluster-randomised Trial The Lancet 2018;391:541–551

Lean MEJ etal Durability of a primary care-led weight-management intervention for
remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes and Endocrinology 2019;7(5):344-355

Taheri S et al Effect of intensive lifestyle intervention on bodyweight and glycaemia in
early type 2 diabetes (DIADEM-1): an open-label, parallel-group, randomised controlled trial Lancet Diabetes Endocrinol 2020;8:477–489

Christensen P et al Men and women respond differently to rapid weight loss: Metabolic outcomes of a multi-centre intervention study after low-energy diet in 2500 overweight, individuals with pre-diabetes. Diabetes Obes. Metab. 2018; 20(12):2840-2851

Raben A et al PREVIEW – Results from a 3-year randomised 2 x 2 factorial multinational trial investigating the role of protein, glycemic index and physical activity for prevention of type- 2 diabetes. Diabetes Obes Metab. 2021;23:324–337. doi:10.1111/dom.14219

Experts debunk myths about weight loss with TDR and show its effectiveness in reducing obesity and overweight.

In a webinar organized by TDMR Europe on 14^th April Professor Anthony Leeds (TDMR Europe Chair), Dr George Thom (University of Glasgow), Dr Kelly Johnston (King’s College London) and Mark Gilbert (TDMR Europe Science Committee) highlighted how Total Diet Replacement (TDR) can be an effective solution to tackling alarming obesity and overweight rates in Europe. The on-line seminar titled “Proven Facts versus Popular Myth about weight loss with Total Diet Replacement” focussed on debunking common popular myths about weight loss and presented the potential benefits of using TDR for weight loss.

Professor Anthony Leeds, Chairman of TDMR Europe, said:

“It is time for policymakers to acknowledge that obesity prevention strategies aiming to change consumers’ food behaviours are not enough. They need to focus on providing solutions for people with obesity. TDRs can be instrumental in the efforts to bring down the incidence of obesity and overweight.”

Sharing updates on the latest research on TDR Prof Leeds highlighted its impact on type 2 diabetes, stressing that “TDR programmes deliver, in a short period of time, the amounts of weight loss needed to achieve major health improvements such as type 2 diabetes prevention and remission and other obesity related diseases”.

Although several recent large-scale trials have demonstrated that TDR-led interventions can induce initial average weight losses of 10-15% body weight, Dr Thom cautioned that “preventing weight regain over the longer-term remains the major challenge”. Focusing on physiological and behavioural factors involved in weight loss maintenance, Dr Thom said that “some degree of weight regain is normal for a variety of reasons, and conveying this message sensitively to people seeking to maintain weight can not only reduce shame and blame, but facilitate pro-active relapse management.” Dr Thom also provided interesting suggestions on how practitioners may support individuals living with obesity to improve weight loss maintenance. He argued that “there is no single mechanism to explain weight loss maintenance. Yet, increases in appetite and adaptive reductions in energy expenditure may undermine self-regulation of eating and long-term behaviour change”.

An insightful discussion on misinformation and myths on TDR followed, with Dr Johnston pointing out the urgency of addressing these myths as “they slow the acceptance of what could be a powerful ally in tackling obesity”. Dr Johnston argued that false beliefs about TDR are widespread and ultimately affect the public health’s effort to fight obesity as well as the allocation of research resources on this issue. “There is a huge amount of misinformation about TDR in the public domain, with some of it coming from those very organisations and professionals who should be helping educate consumers as to benefits of this very well evidenced, safe solution. As a matter of priority, and so that this effective obesity treatment becomes more widely, this must be addressed” Dr Johnston said.

Mr Gilbert from TDMR Europe Science Committee also said that there is an “undeserved negative mythology surrounding TDR”. Discussing proven facts on weight loss with TDR, Mr Gilbert argued that “rapid, substantial weight loss with TDR does not increase the proportion of lean body mass losses when compared to moderate weight loss, and muscle quality is not compromised”.

 

TDMR Europe welcomes the World Health Organisation’s ‘World Health Day’ that commemorates the founding of WHO in 1948.  This year the theme reflects the disparities in healthcare available to different groups across the globe, brought into sharp focus by the COVID19 crisis, and reflects a desire to make healthcare truly universal.

Recognising that the burden of suffering of type 2 diabetes mellitus (T2DM) and related health-care costs will rise disproportionately in low and middle-income countries, TDMR Europe notes that effective prevention and early T2DM remission ought to be a part of any national healthcare programme.  Several T2DM prevention programmes show that weight reduction is the most important component of T2DM prevention, along with increased physical activity and optimal composition of the maintenance diet.  The more weight that can be lost the greater the reduction in numbers of people developing T2DM we can expect to see.  Despite this clear evidence, there are only a few T2DM prevention programmes that effectively deliver large weight losses (7-10% of body weight).  The PREVIEW diabetes prevention programme has shown that a large initial weight loss of an average 10% body weight with Total Diet Replacement (TDR) followed by a structured diet focussing on glycaemic index and higher protein content, delivered fewer cases of T2DM 3 years later than would have been expected.  The next practical challenge is to introduce PREVIEW-style initial weight loss with TDR and lower GI, lower glycaemic load and higher protein maintenance diet into the T2DM prevention programmes of many more countries.

Early T2DM remission programmes, that incorporate an initial large weight loss with TDR, could also be offered in more countries than is currently the case.  Within the UK, Scotland and England currently have such programmes in early stages, as does Abu Dhabi and Qatar in the middle East, and there are a small number of diabetes remission clinics in South East Asia.

However, there is clearly much more to do. In addition to generating first class clinical trial evidence there is a need to share knowledge and experience in the use of TDR weight loss followed by effective weight maintenance.  To this end TDMR chairman, Professor Anthony Leeds recently spoke to Professor Mike Lean, principal investigator of the DiRECT diabetes remission trial, in two programmes on the EAWAZ TV channel.

Introducing the programmes Professor Leeds said ‘I am greatly encouraged by the interest shown globally in this type of intervention especially in parts of the world with very high rates for obesity and T2DM, such as Malaysia and the Arabian Gulf States. I am glad that Prof Shahrad Taheri has conducted the DIADEM-1 study in Qatar demonstrating that people of Middle Eastern and North African origin were able to successfully follow TDR weight loss and maintenance and go into T2DM remission in many cases. The stage is set for weight loss with TDR followed by structured weight maintenance programmes to help address this global challenge.’

 

Watch the interviews with Professor Mike Lean at:  https://youtu.be/4WKd8sB5nhs  and https://youtu.be/qcjgFU2jhDA

For further information on diabetes remission and the DiRECT trial see:

https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/type2-diabetes-remission

https://www.diabetes.org.uk/research/research-round-up/research-spotlight/research-spotlight-low

https://www.diabetes.org.uk/guide-to-diabetes/enjoy-food/eating-with-diabetes/whats-your-healthy-weight/low-calorie-diets

For a diabetes risk calculator go to: https://riskscore.diabetes.org.uk/start

For more details and references on the PREVIEW study go to: https://tdmr-europe.com/2020/11/25/prevention-of-diabetes-through-lifestyle-intervention-in-europe-and-australasia-preview/

For more details on the DiRECT study go to:  https://tdmr-europe.com/2020/08/04/reducing-future-risk-obesity-co-morbidities-and-nutritional-status-mike-lean/

For more details on the DIADEM-1 study go to: https://tdmr-europe.com/2020/05/22/intensive-life-style-intervention-including-initial-weight-loss-with-tdr-delivered-60-diabetes-remission-in-people-with-early-type-2-diabetes-mellitus-from-the-middle-east-and-north-africa-studied-i/

An online event will be held on April 14^th at 15:00 CET (14:00 GMT) to address the myths and misinformation that surround the use of Total Diet Replacements (TDR). Organized by TDMR Europe, the webinar entitled: Proven Facts versus Popular Myths about weight loss with Total Diet Replacement (TDR), will enable stakeholders in both the public policy and healthcare sectors to gain a better understanding of TDR. Speakers will be Professor Anthony Leeds (TDMR Europe Chair), Dr George Thom (University of Glasgow), Dr Kelly Johnston (King’s College London) and Mark Gilbert (TDMR Europe Science Committee). This webinar aims to debunk popular myths about TDR weight loss as well as present the potential benefits of using TDR for weight loss, including cost-effectiveness.

Please follow this link to register.

The increasing prevalence of obesity, overweight and type 2 diabetes in Europe, which also increase the risk of adverse outcomes in COVID-19 infection, could soon overwhelm the capacity for healthcare provision. This webinar will present evidence that TDR programmes offer an effective solution to the increasing challenge of managing obesity and overweight in Europe.

Professor Anthony Leeds, Chairman of TDMR Europe, said: “We aim to give stakeholders in the public policy and healthcare sectors a better understanding of Total Diet Replacement as a cost-effective way to help improve the health of Europeans. Today Europe struggles with increasing obesity rates and overweight levels as well as with related health issues, including type-2 diabetes, cardiovascular disease and osteoarthritis, which cause ill-health and pose a serious challenge to European economies and productivity. There is an urgent need to raise awareness of the significant contribution that TDR can bring to European efforts to address the public health problem of obesity and overweight. This seminar will break-down the barriers to successful use of TDR by presenting scientific evidence that busts the myths.”

The webinar will specifically address myths that slow the acceptance of TDR as an effective solution in the European strategy to tackle obesity and overweight. The presentations will show that:

• Rapid weight loss does not lead to excessive lean body mass loss and, with careful maintenance, does not lead to rapid weight regain;
• After rapid weight loss it is not as difficult to maintain a new lower body weight as is commonly believed;
• Weight loss with TDR can be sustained;
• People who start a TDR can use it for long enough to lose meaningful amounts of weight;
• TDR diets are not dangerous, rarely cause gout and gallstones and very rarely cause other potentially serious problems.

The event is addressed to policy makers, journalists and professionals in the public health sector in Europe. Please follow this link to register and join the debate on the relevance and role of TDR in bringing down the incidence of obesity and overweight.

Programme 

Proven Facts versus Popular Myth about weight loss with Total Diet Replacement (TDR)

14^th April, 15:00 -16:30 CET

Total Diet Replacements – update on latest clinical trial evidence (15 minutes)

Professor Anthony Leeds, Chairman of TDMR Europe, Frederiksberg Hospital, University of Copenhagen

Physiological and behavioural factors involved in weight loss maintenance (20 minutes)

Dr George Thom, University of Glasgow

 Is there any scientific basis for Myths about TDR? (30 minutes)

Dr Kelly Johnston, King’s College London and Mark Gilbert, TDMR Europe Science Committee

 Q & A and concluding summary (20 minutes)

For more information about TDMR Europe or a comment from Professor Anthony Leeds, please contact Aristeidis Myriskos via email: aristeidis.myriskos@whitehouseconsulting.co.uk or call +44(0) 20 3855 5760 / +44 (0)7719883318

ENDS

Notes to editors:

About TDMR Europe

Total Diet and Meal Replacements Europe (TDMR Europe) is the European trade body for manufacturers and distributors of formula diet products, including total diet replacements (TDRs) and meal replacement products (MRPs) which provide weight loss and weight management programmes.

TDMR Europe works to secure appropriate and proportionate European legislation for TDRs and MRPs and is in close continuous dialogue with a wide variety of stakeholders such as policymakers and senior officials in the relevant bodies. It also aims to increase awareness and understanding of specialist weight management foods such as TDRs and MRPs and coordinate detailed technical and regulatory expertise of members to develop common industry positions that help to support European public policy and regulatory decisions.

Please find more information in the TDMR Europe 2021 Media Pack

tdmr-europe.com

Twitter: @TDMREurope

LinkedIn: TDMR Europe

As part of World Obesity Day, on 4^th March, a variety of organisations and decision-makers across Europe talked about their increased efforts to tackle obesity.

The Joint Research Centre (JRC), the European Commission’s science and knowledge centre, launched a dedicated obesity section on its Health Promotion and Disease Prevention Knowledge Gateway website. The service provides facts and figures as well as policy guidelines on the prevention of obesity and related illnesses. Commenting on the initiative, the European Commissioner for Innovation, Research, Culture, Education and Youth, Mariya Gabriel, argued that the scientific data gathered by the JRC will significantly contribute to finding the best measures to tackle obesity.

Also this week, a number of prominent MEPs – Marc Tarabella, Alex Agius Saliba and João Ferreira – raised awareness of the increasing prevalence of obesity in Europe in Parliament Magazine. MEP Ferreira stressed that prevention strategies are not enough, and that there is an urgent need to help the millions of people that already struggle with being obese or overweight.

Meanwhile, the UK Government announced new specialised support to help those living with obesity to lose weight. The Government will allocate a £100 million budget to help children, adults and families to achieve and maintain a healthier weight.

The Government of Ireland also announced a concerted approach by the Department of Health, the Health Service Executive and Health Research Board to obesity prevention and care for people living with overweight or obesity. This new way forward includes community-based programmes and health interventions in areas of socio-economic deprivation and enhanced community care resources, including the recruitment of additional dietitians for weight management and chronic disease management across the country. The Minister of Health, Stephen Donnelly, stressed that obesity negatively impacts many other conditions, including type 2 diabetes, some forms of cancer and COVID-19. The Minister also acknowledged that the solution to obesity is possible only through a more coordinated approach.

All these announcements point to an increased awareness of the need to tackle obesity, and to do so urgently. But this issue has been on the political agenda of Europe for many years now and obesity rates are not only rising but have tripled in many European countries.

The first set of facts and figures published by the JRC on World Obesity Day were shocking, showing that more than half a million deaths each year in the EU can be attributed to a higher than ideal body mass index (BMI) and that 59% of adults were estimated to have pre-obesity and obesity in 2016. The Organisation for Economic Co-operation and Development (OECD) estimates that in the next three decades overweight will claim as many as 92 million lives in the OECD area, and, that the total health expenditure attributed to overweight will correspond to 8.4% of the entire health budget of OECD countries between now and 2050.

The developments on the policy level are certainly positive news. But policy makers across Europe need to take a step forward to actively tackle the obesity challenge; Moving beyond policies that aim to bring superficial behavioural changes among consumers, European governments need to boost cooperation among public policy, the scientific world and the business sector, and look at  options that are already available to support millions of citizens who live with obesity and overweight – as well as related conditions.

The National Health Service (NHS) in the UK has set an example, by introducing a programme which provides a formula-based low calorie, total diet replacement programme for overweight and obese people with type-2 diabetes. The rollout of this programme was based on the results of two large studies, namely, DiRECT and DROPLET, which showed the efficacy of total diet replacements in improving diabetes control, reducing medication and, in some cases, putting type-2 diabetes into remission. Total diet replacement (TDR) and meal replacement products (MRP) are safe, effective and cost-effective. They comply with applicable legislation and have a proven track record of helping people lose weight and subsequently maintain their weight loss. Given Europe’s obesity pandemic, it is absolutely essential that health professionals and policy makers gain a better understanding of the relevance, role and application of TDRs and MRPs.

The current research on obesity has shown that, firstly, obesity is a complex issue associated with decreased life expectancy and other serious health issues. Secondly, obesity is a public health problem that affects European society and its economy. And finally, the increasing prevalence of obesity shows that prevention strategies are not enough; rather there is an urgent need for combining the latter with treatment solutions now. This will only be possible through coordinated action, bringing together expertise from the scientific, business and policy sector.

Weight reduction and maintenance, along with increased physical activity are key elements of type 2 diabetes prevention. No-one disputes this, but the best way to lose and maintain weight and maintain higher levels of physical activity is not clear.

With the impressive results from the Diabetes UK funded DiRECT trial (see Lean MEJ et al) there is increasing acceptance of the use of Total Diet Replacement (TDR) with formula diet to achieve an initial weight loss of 10-15kg. There is also evidence from the DiOGenes trial that after an initial TDR weight loss a higher protein and lower glycaemic index (GI) diet gave better weight maintenance at six months than a moderate protein, higher GI diet (see Larsen TM et al).  It was logical to repeat the DiOGenes diet in those with prediabetes to determine whether a higher protein, lower carbohydrate and lower GI diet after a TDR weight loss would deliver a reduced rate of conversion to diabetes.

More than 2200 people with pre-diabetes based in six EU countries as well as Australia and New Zealand took part. Average baseline weight was 100kg (1504 women mean weight 96kg, 720 men mean weight 109kg).  An 800kcal/d low energy diet of formula foods was given to all participants regardless of individual energy requirement.  Two thousand and twenty individuals (91%) completed the eight-week diet. Women lost an average 10.2kg and men an average 11.8kg. Mean fat free mass loss was proportionately greater in women at 3.2kg, than in men at 1.9kg and the authors wondered if this may influence the outcome of weight maintenance. 35% of participants with impaired fasting glucose reverted to normo-glycaemia after weight loss (see Christensen P et al).

Those who lost 8% or more of their initial weight during the ‘pre-randomisation’ weight loss phase followed one of two diets, either a higher protein (25% energy), lower carbohydrate (45% energy), lower GI (<50) diet or moderate protein (15% energy), higher carbohydrate (55% energy) and higher GI (>56) diet and one of two exercise programmes: moderate physical activity or higher physical activity. Participants were seen monthly up to six months then with decreasing frequency as time progressed towards the 3 year end point.

Compliance with the dietary programme was good and reasonably consistent throughout but was not quite up to the targets set. At year three differences between the groups were only 9g for protein and 3.3 units for GI though glycaemic load (GI x g carbohydrate daily) was 13.6 units different.  Dietary energy consumption, from diet records, at three years was about 2000kJ less in both dietary groups from baseline values around 8800kJ/d on average. Drop out from the maintenance programme was 26%, 15% and 7% during years 1, 2 and 3, suggesting that the maintenance intervention needed extra measures especially immediately after the initial weight loss.There was no significant difference between the four groups at 3 years in terms of weight maintenance which ranged from 4.6 to 4.9kg weight loss maintained.  This represented around 57-46% of weight loss maintained on average (see Raben A et al).

By the end of 3 years 62 participants had developed type 2 diabetes (3.3% of 1857 who started but 6.4% of 962 completers) a lower number than was expected based on three-year results in other diabetes prevention studies.  Three-year changes in body weight were significantly correlated with fasting glucose, 2h glucose, insulin and HbA1c but no numerical details were given.  Despite highlighting the different fat free mass losses in men and women following TDR initially, results for men and women were not presented separately for the three-year maintenance programme.

This paper suggests that an initial large weight loss with TDR may help reduce risk of developing type 2 diabetes.  The study did not demonstrate that higher protein lower GI diets are more effective than lower protein higher GI diets in this design and setting, however further examination of compliant versus less compliant participants may reveal some variations in their responses. In the DiRECT study greater weight loss and better weight maintenance was associated with remission and better metabolic responses.  In the PREVIEW study 200 participants maintained more than 10% weight loss for three years.  More details of how those who maintained more weight loss compared to those who maintained less weight loss differed metabolically at three years is eagerly awaited.

Anthony R Leeds

References

Lean MEJ etal Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes and Endocrinology  2019; 7 (5): 344-355. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30068-3/fulltext

Larsen TM et al Diets with high or low protein content and glycemic index for weight-loss maintenance  N Engl J Med 2010;363(22):2102-13. doi: 10.1056/NEJMoa1007137.

Christensen P et al Men and women respond differently to rapid weight loss: Metabolic outcomes of a multi-centre intervention study after a low-energy diet in 2500 overweight, individuals with pre-diabetes (PREVIEW)  Diabetes Obes Metab. 2018;20: 2840–2851  https://doi.org/10.1111/dom.13466

Raben A et al The PREVIEW intervention study: Results from a 3-year randomized 2 x 2 factorial multinational trial investigating therole of protein, glycaemic index and physical activity for prevention of type 2 diabetes.  Diabetes Obes Metab. 2020;1 –14. doi:10.1111/dom.14219  October 2020

The PREVIEW study was funded by the EU Framework programme 7, Grant/Award Number: 312057 and other agencies see https://dom-pubs.onlinelibrary.wiley.com/doi/epdf/10.1111/dom.14219 and Cambridge Weight Plan Ltd, Northants, UK  provided product (gratis) for the initial 800kcal/d weight loss phase.

TDMR Europe is proud to support World Diabetes Day 2020, held on Saturday, November 14.

World Diabetes Day is the world’s largest diabetes awareness campaign reaching a global audience of over 1 billion people in more than 160 countries. The campaign draws attention to issues of paramount importance to the diabetes world and keeps diabetes firmly in the public and political spotlight.

Weight management including weight reduction is a key component of diabetes prevention programmes and most prevention trials have shown that greater weight losses lead to more effective prevention. Greater weight losses can be achieved using LED (low energy diets) sometimes using formula diet products as a total diet replacement (TDR).   Increasing physical activity and improving diet quality are also important changes to make to prevent diabetes.  A large study designed to test the effect of TDR followed by 3 years of diet maintenance with increased physical activity has taken place in six European countries as well as in Australia and New Zealand (PREVIEW).

TDMR Europe works alongside other organisations at World Diabetes Day in the fight against 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, including diabetes. The programmes are specifically formulated and replace the whole of the individual’s daily diet with nutritionally balanced soups, shakes and bars consisting of all essential vitamins, minerals, high quality protein, essential fats, and fibre. TDRs are strictly regulated and have been sold safely in the UK and the EU for over 30 years.

Total Diet & Meal Replacements Europe (TDMR Europe) is happy to announce that its newest member is CWP výživové poradenství s.r.o.

Based in the Czech Republic and also distributing products in Slovakia, CWP výživové poradenství s.r.o. provides nutritionally complete products (specially formulated meal replacement bars, drinks, shakes and soups) consumed as part of daily nutrition for fast, predictable weight loss or combined with conventional food for more gradual weight loss and weight maintenance.

TDMR Europe is delighted to welcome this new member and is encouraged by the steady growth in recognition that there is a greater need for businesses to collaborate in the public health sectors and to join forces to deliver high quality products based on the safety and ethical standards the trade association promotes.

Professor Anthony Leeds, Chair of TDMR Europe, said:

“We are delighted to welcome CWP výživové poradenství s.r.o to TDMR Europe and very much look forward to a fruitful collaboration with them in the years to come. TDMR Europe has been growing steadily in the past months, with more companies willing to support our role as a leading voice for slimming food manufacturers, distributors and users in Europe.

“We will work hard alongside our members to engage responsibly with key policy stakeholders on our commitment to increase understanding of specialist weight management foods in the fight against obesity and related comorbidities in Europe.”

CEO of CWP výživové poradenství s.r.o, Pauline Janebová, said:  

“The Czech Republic and Slovakia are facing rising numbers of people with overweight and obesity, and related health problems, as is happening in all other European countries. I’m so glad that we can now work with colleagues across Europe to ensure fair legislation and better education about how total diet replacement and meal replacements can become part of the European solution for this huge challenge to the wellbeing of the people of Europe.”

CWP výživové poradenství s.r.o joins Slimmerlife and Belgium based Equibre3 as TDMR Europe’s latest recruits. TDMR Europe represents the European trade body 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 the overweight and obese. It is the voice of the slimming foods industry in dialogue with regulators and policy makers, campaigning in favour of proportionate EU legislation that is optimal for consumer protection and industry efficacy.

Last week, the NHS in England announced plans to facilitate access to total diet replacement programmes (TDRs) for thousands of obese and overweight people, as part of the Type II diabetes remission programme. The TDR programme is backed by plenty of scientific research, which demonstrates increasing evidence regarding the efficacy of TDR As a result, TDR programmes are becoming more widely accepted, having been given more credibility as part of  the UK government’s strategy to combat obesity  and related co-morbidities.

TDRs are specifically formulated products which provide all daily dietary needs and are used in place of conventional meals. These food products  are nutritionally balanced with key vitamins, minerals, high quality protein, essential fats, fibre and other nutrients, and when used as TDR are designed to replace all conventional foods to facilitate optimal weight loss. TDRs have been proven to put Type 2 diabetes into remission for some people recently diagnosed with the condition, and will now be provided to 5,000 more patients in 10 areas in England as the first stage in an NHS drive to increase access to this life-changing programme.

Proposed changes in European legislation, however, pose a threat to the availability of TDRs. A Commission Delegated Regulation requiring compositional changes for TDR products is in place to come into effect in October 2022 following publication of an EFSA opinion on TDR composition in 2015. The legislation includes recommendations which could render TDR less palatable and more expensive to make, endangering this hugely important public health initiative. Given the health and economic importance of the recent NHS advocacy of TDR programmes, it is important that any changes in composition are supported by strong evidence. To view a summary of a presentation made last week at the International Congress on Obesity as well as the poster presentation and published abstract describing the technical difficulties , please click here.

Obesity remains one of the UK’s worst public health issues, with over 63% of adults in England either obese or overweight[1]. Moreover, diabetes is estimated to cost the NHS £10 billion a year, while almost one in 20 prescriptions written by GPs is for diabetes treatment[2]. Across Europe obesity rates range from as high as 32% of the adult population, but the UK is in the top 5 countries at 28%. Health-care costs related to obesity and related comorbidities such as diabetes and osteoarthritis are predicted to rise as European populations become older and more obese.

TDMR Europe is the European trade body for manufacturers and distributors of formula diet products, which provide weight loss and weight management programmes for the overweight and obese. Such products and programmes can also be used to prevent and treat type 2 diabetes.

 

 

[1] https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-obesity-physical-activity-and-diet/england-2020/part-3-adult-obesity-copy

[2] https://www.independent.co.uk/news/health/diabetes-nhs-prescription-gp-type-2-diet-complications-a8625221.html

Cafes and restaurants saw an unprecedented number of visitors this week, as customers all over the nation took advantage of the ‘Eat Out to Help Out’ scheme in its final few days. Yet obesity remains one of the UK’s worst public health issues. With 63% of adults in England either obese or overweight, the obesity epidemic costs the NHS around £6bn a year. Over 40 serious health conditions are linked to obesity, ranging from type 2 diabetes to cardiovascular disease, osteoarthritis, liver disease, obstructive sleep apnoea and an increased risk of cancer.

TDMR Europe wpromotes 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, including osteoarthritis. The programmes are specifically formulated and replace the whole of the individual’s daily diet with nutritionally balanced soups, shakes and bars consisting of all essential vitamins, minerals, high quality protein, essential fats, and fibre. TDRs are strictly regulated and have been sold safely in the UK and the EU for over 30 years.

Read the full analysis of the Eat Out to Help Out scheme from the Whitehouse Consultancy here.

 

TDMR Europe is delighted to support the Food Matters Live 2020 virtual event, which will provide an engaging and inclusive opportunity for the global food, drink and nutraceutical community to imagine, learn, connect and explore what’s possible in truly digital experience.

Taking place on 13 and 14 October 2020, the Food Matters Live virtual experience will provide you with an opportunity to explore the latest innovative ingredient and nutraceutical solutions, hear food and drink experts discuss the latest insights via live webcasts and Q&A sessions, and make valuable connections through the hosted buyer programme via virtual 1-2-1 meetings.

For more information, please follow this link.

When: 13-14 October 2020

Where: virtual event

Join the Food Matters digital community:

Twitter: @FoodMattersLive

LinkedIn: https://www.linkedin.com/company/food-matters-live

The European Commission unveiled its much-awaited Farm to Fork (F2F) strategy, following several postponements due to the Covid-19 pandemic. The strategy is at the heart of the European Green Deal, and aims to make food systems fair, healthy and environmentally friendly. While public health remains a responsibility of member states, the commission has decided to tackle the issue of obesity in a top down way which is an acknowledgement of the seriousness of the issue.

The Commission aims to reverse obesity trends by 2030 across the EU – a key element which has become even more important in recent years, given both the prevalence of overweight and obesity in the EU and what we know about their impact on vulnerability to COVID-19.

The strategy states: “Obesity is also rising. Over half of the adult population are now overweight, contributing to a high prevalence of diet-related diseases (including various types of cancer) and related healthcare costs. Overall, European diets are not in line with national dietary recommendations, and the ‘food environment’ does not ensure that the healthy option is always the easiest one.”

Chair of TDMR Europe, Anthony Leeds, welcomed the new strategy: ‘I am delighted to hear that the European Commission aims to reverse trends in obesity across Europe.  This noble intention to improve citizen’s health and limit rising healthcare costs will require improvements to the built environment and appropriate transport, food retaining and advertising policies, as well as healthy diets and safe, effective ways to achieve weight loss and maintenance.’

Weight management through a healthy and sensible diet and healthy lifestyle choices is a commendable goal that should be a pillar of the F2F strategy, however, the strategy must also ensure that the focus remains on supporting the larger part of the EU population that is already obese and overweight, taking into account their different needs and circumstances.

While TDMR Europe supports regulators and the wider food industry’s efforts to make food products healthier, it is known that individuals find it exceedingly difficult to achieve weight loss with conventional foods while maintaining nutritional requirements, once daily consumption falls below 1200kcal. Total diet replacements (TDRs) and meal replacements (MRPs) are nutritionally complete and proven in high quality scientific studies to deliver the amount of weight loss and weight maintenance needed for health benefits including diabetes remission.

Citizens of the EU can minimise the risk of obesity and maintain a healthy lifestyle by considering these weight management programmes.

TDMR Europe is the European trade body for manufacturers and distributors of formula diet products, which provide weight loss and weight management programmes for the overweight and obese.

The DiRECT trial of weight loss in obese people with early type 2 diabetes with TDR followed by food reintroduction then a structured weight maintenance programme has established beyond reasonable doubt that the weight changes and diabetes remission can be sustained in a proportion of participants for two years.  Mechanisms of the effect are beginning to be understood with reduction of inflammation as well as blood pressure and insulin resistance, but thus far all work has been done on European populations.  Obesity, diabetes and other comorbidities affect middle eastern populations to a greater extent than the people of Europe and this paper fills the gap for hard evidence in this non-European population.

Professor Taheri and his colleagues at the Weill Cornell Medicine Qatar, studied 147 eighteen to 50 year old participants with early diabetes (3 years or less since diagnosis and 73% were men) in a primary care and community setting, 70 receiving the intervention programme starting with a 12 week Total Diet Replacement (TDR) programme providing just over 800kcal per day in four nutritionally complete formula food products followed by gradual food reintroduction and weight maintenance.  There was a strong element of behavioural therapy (focussing on self-monitoring, goal setting, stimulus control, planning, etc) provided by dietitians and physical activity support from sports trainers. The control group followed usual best practice with usual medical management of risk factors and diabetes education and support.

The average greatest weight loss from an average baseline of 101kg in the intervention group occurred at 6 months but the sustained weight loss at 12 months was just under 12kg whereas in the control group it was just a little under 4kg.  Diabetes remission at 12 months was 61% in the intervention group with about half of those having normal blood glucose levels and half having ‘pre-diabetic’ levels, compared to 12% remission in the control group (4% with normal blood glucose levels).

Physical activity monitoring showed 40 minutes/day less sedentary time in the intervention group, compared to 69 minutes more in the control group, while a measure of walking equivalence increased by 21 minutes daily in the intervention group and decreased 33 minutes in the control group.  There was a 90% and 40% reduction of anti-diabetes and antihypertensive medication use respectively in the intervention group, contrasting with an 11% and 37% increase of anti-diabetes and antihypertensive medication use respectively in the control group.

Commenting on the results Professor Anthony Leeds, Chairman of TDMR Europe said “This paper confirms that diabetes remission after weight loss with TDR followed by a strong maintenance programme is possible in a high proportion of participants with type 2 diabetes  from the Middle East and North Africa. The weight losses and metabolic changes were consistent with findings from the DiRECT and DROPLET studies. This is a landmark study on a population that has not previously been studied and as such it has enormous significance for the whole of the Middle East and North Africa. The key to this success is the combination of a large weight loss with TDR, intense behavioural therapy guidance and a structured physical activity programme provided by a team of dietitians, sports trainers and doctors.”

Referring to next steps Prof Leeds said that he hoped WHO and health departments in Middle Eastern and North African countries would take note of these results and consider ‘rolling-out’ the intervention as is being done in the UK by NHS England and NHS Scotland.  He added ‘European countries with north African and Middle Eastern communities can now consider this approach to diabetes remission for these high-risk groups.’

Effect of intensive lifestyle intervention on bodyweight and glycaemia in early type 2 diabetes (DIADEM-I): an open-label, parallel-group, randomised controlled trial. Taheri S etal Lancet Diabetes Endocrinol 2020;8: 477-489 DOI: https://doi.org/10.1016/S2213-8587(20)30117-0

The protocol is described at: Diabetes Intervention Accentuating Diet and Enhancing Metabolism (DIADEM-I): a randomised controlled trial to examine the impact of an intensive lifestyle intervention consisting of a low-energy diet and physical activity on body weight and metabolism in early type 2 diabetes mellitus: study protocol for a randomized controlled trial. Taheri S et al. Trials 2018; 19:284 https://doi.org/10.1186/s13063-018-2660-1

The study was funded by the Qatar National Research Fund and used Cambridge Weight Plan TDR products.

 

 

 

With over half the world in lockdown – and this number steadily increasing as the days go by – physical activity, whether by governmental restriction or societal encouragement, is seeing large rates of decline. While there has been an increase in exercising indoors to maintain an active lifestyle, as well as a concerted effort to stick to a healthy diet amongst some experts fear that the Covid-19 pandemic will worsen already alarming rates of global obesity[1].

The onset of the Covid-19 crisis saw a sudden rush to stockpile from supermarkets and online delivery services. As households hoarded to prepare for weeks of isolation, tinned, processed and dry foods, such as pasta and rice, were favoured options due to their longevity and relative low cost. Unhealthy diets, combined with physical inactivity and overeating, are the leading causes of nutrition- and obesity-related diseases, such as heart disease, cancer, and type 2 diabetes[2]

With regards to physical activity, social distancing and home orders reduce the opportunities for exercise, particularly for those living in smaller flats or houses with no outdoor spaces. Furthermore, sedentary activities such as watching television and playing video games are expected to increase under social distancing orders. Increased screen time is associated with greater prevalence of overweight and obesity, which is in part due to the association between this type of activity and increased snacking on unhealthy foods.

With a global increase in the number of people with type 2 diabetes and the rising costs of overall medication, treatment and insulin associated with this, the UK and all European countries need a safe, effective way to reduce both the morbidity and the spiraling health-care costs caused by type 2 diabetes. It is feared that that public health bodies will struggle to manage the ever-increasing rising number of people who have type 2 diabetes[3], who already represent a vulnerable group in the context of Covid-19.

Consumers can look to minimise these risks and maintain good habits by considering weight management programmes which utilise formula foods, as they provide an effective way of helping overweight and obese individuals lose weight more rapidly than would otherwise be possible. TDRs have also shown promising results in helping people with type 2 diabetes. However, anyone who has had a COVID-19 experience or potential symptoms of the infection should always seek medical guidance before looking to lose weight. TDMR Europe is the European trade body for manufacturers and distributors of formula diet products, which provide weight loss and weight management programmes for the overweight and obese.

[1] https://www.abc.net.au/news/2020-04-12/coronavirus-lockdown-risk-to-australian-growing-obesity-levels/12139292

[2] https://cspinet.org/eating-healthy/why-good-nutrition-important

[3] https://www.theguardian.com/global-health-progress/2020/apr/06/global-health-policy-can-we-manage-the-ever-increasing-rise-of-diabetes

The World Health Organization recently described obesity as a global epidemic and one of society’s “most blatantly visible yet neglected public health problems”. Recent reports on the rise of this life-threatening condition across the globe have been shocking. A total of 107.7 million children and 603.7 million adults were considered to be obese in 2015. Now, research shows that obesity is even more common than these reports suggest and that in most countries many people are now living with obesity.

TDMR Europe is proud to support World Obesity Day 2020, held on Wednesday, March 4. World Obesity Day brings together healthcare, patient and political communities who are keen to raise awareness of obesity and the many other diseases which it influences.

In Europe, World Obesity Day 2020 is supported by the European Association for the Study of Obesity (EASO). EASO’s aim is to increase knowledge and understanding of the need for action at both European and national levels to improve prevention, treatment and care. At the same time, the campaign supports European citizens who are overweight or have obesity to make lifestyle changes to manage their weight and improve their overall health and quality of life.

TDMR Europe works alongside other organisations at World 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, including osteoarthritis. The programmes are specifically formulated and replace the whole of the individual’s daily diet with nutritionally balanced soups, shakes and bars consisting of all essential vitamins, minerals, high quality protein, essential fats, and fibre. TDRs are strictly regulated and have been sold safely in the UK and the EU for over 30 years. There is increasing supportive evidence of their effectiveness in a wide range of obesity-related conditions, as well as combatting obesity itself.  Used properly TDR and MRP can contribute globally to ameliorating the consequences of obesity.

The argument for Total Diet Replacements

In the United Kingdom, the number of people with type 2 diabetes has doubled to 3.8 million in the last 20 years. In just 5 years’ time more than 5 million people will be affected. Diabetes care costs account for about 10% of the total NHS budget and this is estimated to rise to 17% in 15 years’ time. It is possible that NHS and even social care budgets could soon be overwhelmed by a tsunami of diabetes and other obesity-related costs. The UK desperately needs safe, effective low-cost solutions for diabetes prevention and remission.

Total diet replacements (TDRs) are designed to replace conventional foods to facilitate optimal weight loss for the overweight and obese, and the prevention and treatment of type 2 diabetes. The programmes are specifically formulated and replace the whole of the individual’s daily diet with nutritionally balanced soups, shakes and bars consisting of all essential vitamins, minerals, high quality protein, essential fats, and fibre. TDRs are strictly regulated and have been sold safely in the UK and the EU for over 30 years. There is increasing supportive evidence of their effectiveness in a wide range of obesity-related conditions.

The DiRECT type 2 diabetes remission trial conducted in Glasgow and Newcastle, funded by the patient-centered charity Diabetes UK, used the liquid low-calorie diet (a TDR) for 12 to 20 weeks to achieve initial weight loss. This was followed by a carefully managed re-introduction of conventional food with education and behavioural change. In those showing weight regain ‘rescue packages’ were used – these reinforced behavioural change with short-term use of meal replacements. Two thirds of those maintaining 10% weight-loss, and 83% of those maintaining over 15kg loss, remained free from diabetes, without need for medications, two years after starting the diet. NHS England is currently planning a roll-out of this type of intervention to achieve diabetes remission for 5000 people in primary care. All the NHS boards in Scotland are already starting to use this approach. In Copenhagen research teams have shown in published trials that 10% weight loss can be maintained for four years after this type of weight loss and others in Copenhagen have shown that the gut and body can adapt to reduce the drive to regain weight to the ‘set-point’. Ultimately, the success of TDRs will depend on greater recognition of their effectiveness, their wider availability and realization of the health-care cost savings that may be possible.

 

Watch Professor Mike Lean (University of Glasgow) discuss the DiRECT diabetes remission study. https://tdmr-europe.com/2019/06/10/the-direct-diabetes-remission-trial/

Watch Dr Seamus Kent (University of Oxford) discuss the cost-effectiveness of TDR delivered in a primary care based setting (Droplet study) https://tdmr-europe.com/2019/07/15/seamus-kent-the-droplet-study/

 

Total Diet Replacement proven to be effective in insulin-treated type 2 diabetes

TDMR Europe welcomes the publication of a clinical trial that confirms that total diet replacement (TDR) can be used safely and effectively in people with more advanced insulin-treated diabetes as well as those with early diabetes who can be put into remission by TDR followed by effective weight maintenance, as shown in the DiRECT trial.

Our chairman, Professor Anthony Leeds a co-author of the study, has provided a short description of the work:

An 800kcal/d total diet replacement (TDR) was used for 12 weeks followed by food reintroduction with behaviour modification and exercise in insulin-treated people with type 2 diabetes and was compared with a standardised dietetic intervention that aimed at a 600kcal/d deficit over 12 months (there were 45 people in each group). In the TDR group mean weight lost at 1 year was 9.8kg compared to 5.6kg in the standardised care group, and nearly 40% were no longer using insulin one year later, compared to 6% in the standardised care group. The TDR group also showed a greater improvement in blood glucose control and a significant improvement of quality of life. Episodes of hypoglycaemia were no more frequent in the TDR treated group than in the standard diet group.

With increasing numbers of people with type 2 diabetes, increasing overall medication and treatment costs and increasing costs of insulin treatment the UK and all European countries need a safe, effective way to reduce the spiralling health-care costs, and the suffering, caused by type 2 diabetes.

The evidence for the efficacy of TDR in early and insulin-treated diabetes should be reviewed by authorities who generate clinical guidelines. Educational programmes to help doctors, dietitians and nurses to use TDR effectively need to be developed further (see: https://www.phc.ox.ac.uk/research/diet-plans/tdr-resources-for-health-professionals ). Collaboration between healthcare providers and the commercial sector should be developed further based on the results of the DROPLET trial (see: https://tdmr-europe.com/2019/07/08/dr-nerys-astbury-the-future-of-tdrs/ ) and it’s health economics analysis ( see: https://tdmr-europe.com/2019/07/15/seamus-kent-the-droplet-study/ ).

Low-energy total diet replacement intervention in patients with type 2 diabetes mellitus and obesity treated with insulin: a randomised trial. Brown A, Dornhorst A, McGowan B, Omar O, Leeds AR, Taheri S, Frost G. (2020). BMJ Open Diabetes research and Care doi:10.1136/bmjdrc-2019-001012 (published 28 01 2020) https://drc.bmj.com/content/8/1/e001012

The study was funded by Cambridge Weight Plan Ltd., a member of TDMR Europe, and used Cambridge Weight Plan products.

TDMR Europe welcomes the opportunity to support this year’s theme ‘Family and Diabetes’ on World Diabetes Day.  People world-wide are encouraged to test their diabetes knowledge with an on-line tool for self-assessment of diabetes risk noting that over 50% of diabetes is preventable.  If left untreated diabetes can lead to complications including heart attack and stroke.

Weight management including weight reduction is a key component of diabetes prevention programmes and most prevention trials have shown that greater weight losses lead to more effective prevention. Greater weight losses can be achieved using LED (low energy diets) sometimes using formula diet products as a total diet replacement (TDR).   Increasing physical activity and improving diet quality are also important changes to make to prevent diabetes.  A large study designed to test the effect of TDR followed by 3 years of diet maintenance with increased physical activity has taken place in six European countries as well as in Australia and New Zealand (PREVIEW).

After extensive screening 2224 people with pre-diabetes began an 800kcal/d formula low energy diet (a TDR) which they followed for eight weeks. 91% of participants successfully completed the diet programme losing 10.7kg on average over 8 weeks (average weight loss in men was 11.8kg and in women was 10.2kg).  83.5% (1857 participants) achieved 8% or more weight loss enabling them to enter the three-year maintenance programme in which high exercise levels were compared with moderate exercise, and high-protein low-glycaemic index diets were compared with moderate-protein moderate-glycaemic index diets.  Publication of the 3 year results is still awaited but it is understood that there were no differences between the dietary groups in terms of weight maintenance at three years, though the number of participants who developed diabetes by three years was low compared to other diabetes prevention trials.  The fully published results of the TDR weight-loss phase (Christensen P, etal, 2018) showed that TDR is a safe effective method of achieving a good weight loss of more than 8% as the first phase of a diabetes prevention programme.

The larger weight losses achievable with TDR have been used as the first phase of a major diabetes remission trial (the DiRECT trial) undertaken in Glasgow in Scotland and Newcastle in England.  This cluster randomised controlled trial in overweight and obese people with type 2 diabetes of no more than 6 years duration was based in primary care practices. One year after commencing the intervention, that included a strong behavioural and educational programme led by dietitians and practice nurses, as well as an initial weight loss with TDR, 3 out of every 4 participants who maintained 10kg weight loss at one year were in diabetes remission (Lean M et al 2018).  The programme continued for a second year at the end of which nearly 60% of those who maintained 10kg weight loss were still in remission (Lean M et al 2019).

Professor Anthony Leeds, chairman of TDMR Europe said ‘the evidence base for the use of TDR in diabetes and related co-morbidities grows steadily as more high-quality studies, are published. The three-year PREVIEW results are eagerly awaited as are results of a trial of TDR in people with insulin-treated type 2 diabetes.’

Professor Mike Lean describes the DiRECT trial in an interview at: https://tdmr-europe.com/2019/06/10/the-direct-diabetes-remission-trial/

On the event of World Osteoarthritis Day, dozens of healthcare professionals will meet in Brussels to discuss this disease. Surgeons, nutritionists, researchers, fitness trainers, veterinarians and other specialists will welcome members of the general public to SQUARE in Brussels on 14 and 15 September 2019. What treatment is available? How can the disease be prevented? What medical advances have been made in the fight against this disease? Specialists will answer as many patient questions as possible during this free-of-charge event which is open to all.

 

To find out more about the event and secure your place, please visit the website.

 

Professor Anthony Leeds, chairman of TDMR Europe, discusses the benefits of meal replacements in the global fight against obesity.

TDMR Europe is this year 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 day dedicated to creating cross-sector connections focused on the future of food, drink and sustainable nutrition.

To register and secure your place, follow this link: http://fml2019.reg.buzz/website

“The PREVIEW-study is one of the largest and longest randomized interventions 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 a total diet replacement strategy during the first two months 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.”

Mikael Fogelholm is a professor in public health nutrition at the University of Helsinki. His previous research includes a systematic review to study the relative health risks of poor cardio-respiratory fitness in normal-weight people compared with obesity in individuals with good cardio-respiratory fitness, and the long-term effects of weight loss on muscle strength and bone mineral density in adults who are overweight or obese.

In his interview, Fogelholm discusses the PREVIEW-Study. PREVIEW is an acronym of PREVention of diabetes through lifestyle intervention. The project is a large multi-national diabetes prevention project, with the primary goal of identifying the most efficient lifestyle pattern for the prevention of Type-2 diabetes in a sample of pre-diabetic overweight or obese individuals.

Fogelholm attributes the high success rates of total diet replacement programmes (TDR) in his studies to the frequent group meetings and support for the participants. Furthermore, he suggests that TDRs yield good results because participants are drawn to programmes which bring tangible results relatively quickly. Interestingly, his research has shown that during the three year maintenance phase, those who followed a high protein diet and pursued more physical activity did not maintain better weight loss than those in the other groups.

However, the study did show a low diabetes rate at three years compared with other major trials on the same subject. For the future, Fogelholm would like to pool his data together with other studies, such as the Diabetes Prevention Study in Finland, to take a closer look at individuals who have similar metabolism and then track their progress after their weight management programmes. This would allow for greater accuracy concerning the development of our knowledge of diabetes prevention and remission.

Professor Anthony Leeds, chairman of TDMR Europe notes that the PREVIEW results were also discussed at the American Diabetes Association meeting in June.  Results of the TDR weight loss phase on 2,224 people with pre-diabetes in 8 countries showed that 8 weeks of TDR was completed by 91% of participants (an unusually high compliance rate) and average weight loss in that time was 10.7kg. (see Christensen P,et al Diabetes Obes. Metab. https://doi.org/10.1111/dom.13466). Reporting the ADA presentation Professor Ian Macdonald, University of Nottingham,  said that 2020 participants achieved the 8% weight loss goal that justified entry into the three-year weight maintenance programme and 962 of those completed the three year programme at which point only 62 of 962 had developed diabetes.   Macdonald added ‘….combining an initial low-calorie diet to establish significant weight loss followed by a maintenance diet and physical activity program with evidence-based advice on achieving behaviour change can achieve longer term maintenance of weight loss and reduce the risk of developing type 2 diabetes.’ (see: http://www.diabetes.org/newsroom/press-releases/2019/weight-loss-from-low-calories.html )

Commenting on the results Professor Anthony Leeds, chairman of TDMR Europe added ‘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…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.”

 

 

“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.”[1]

Seamus Kent, health economist at the University of Oxford, presents his findings concerning the cost effectiveness of total diet replacement programmes (TDRs) in the DROPLET study, in which patients are referred to a TDR by their doctor, compared with nurse-led behavioural support.

The results

Compared with regular weight loss support from a practice nurse, a programme of weekly behavioural support and TDR seems to be tolerable and leads to substantially greater weight loss. At current retail prices and with plausible long‐term weight regain trajectories, TDR is projected to be cost‐effective in adults with obesity and should be considered as an option to treat obesity in routine health care settings.

he study estimated that, for every 100,000 people referred to the TDR programme, 50 coronary heart disease events, 75 strokes, 900 cases of type 2 diabetes, and 25 cancers could be avoided. As a result, people are expected to live longer and in better health, with lower use and costs of healthcare services. The TDR programme is expected to cost an additional £13,000 for every year of life lived in full health which is gained as a result of the treatment. In the UK, healthcare interventions are generally considered cost-effective if they provide such a benefit for less than £20,000.

Reactions to the study

Following these results, Professor Susan Jebb, Professor of Diet and Population Health in University of Oxford’s Nuffield Department of Primary Care Health Sciences, Chief investigator of the DROPLET trial, said: “It is great to see the NHS Long Term Plan taking this research evidence and translating it into new clinical services for people who are obese. Our study provides great confidence that this programme is a cost-effective treatment, which could improve the health of large numbers of people who are affected by obesity.”

Professor Anthony Leeds, chairman of TDMR Europe, said of the results of the study: “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.”

[1] Kent, 2019, https://www.clahrc-oxford.nihr.ac.uk/news/low-calorie-meal-replacements-are-a-cost-effective-routine-treatment-for-obesity-in-the-nhs

 

“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 Nerys Astbury, senior researcher at the department of primary care at the University of Oxford, is interested in how dietary manipulations affect weight management and the regulation of energy intake. She is currently working on developing a weight loss toolkit which will utilise total diet meal replacements (TDRs) to help people manage their weight, including for the attenuation of weight gain during pregnancy. Her previous research has shown that TDRs followed by food reintroduction and a solid maintenance programme can be used effectively in a community setting after being referred by a GP practitioner.

The DROPLET trial successfully demonstrates that TDRs are an acceptable form of treatment to be delivered in routine care after a referral

Dr Astbury discusses what makes the DROPLET trial different from its predecessors. Previously, trials involving TDRs for diabetics and overweight patients have been carried out in controlled situations, such as intense research settings or specialist obesity clinics. The DROPLET trial successfully demonstrates that TDRs are an acceptable form of treatment to be delivered in a community setting after referral in routine care.

So, what does the future hold for TDRs? Co-payment as a solution to offset some of the cost of the treatment

Dr Astbury says that, given the results of the DROPLET study and others that have come before it – particularly the DiRect study led by Professor Mike Lean – we know that TDRs can be an effective treatment for obesity and Type 2 diabetes. As a result of this, the NHS has committed to piloting a scheme for 5000 people to trial the use of TDRs. Dr Astbury admits that payment of the programmes may be an issue, suggesting co-payment as a possible solution. Co-payment is a fixed amount for a covered service, paid by a patient to the provider of service before receiving the service, to offset some of the cost of the treatment. In the UK, eye care and dental care have already set the precedent for co-payments.

More investment in research is needed to further explore effective treatments, but also focus on prevention

Dr Astbury advises that we should be investing more in research, in order to discover new and effective treatments to tackle obesity and its related problems. But as well as innovative treatments, it is important to investigate preventative measures that stop people become overweight and obese in the first place.

For more updates and news, follow us on Twitter @TDMREurope

 

“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.”

Joe McSorley provides an insight into a patient’s perspective and experience of meal replacement programmes (MRPs). Joe was diagnosed with Type 2 diabetes and took part in a 12-week meal replacement trial followed by food reintroduction and weight maintenance. So, what has he taken from the programme? We highlight a few key points.

• The biggest challenge is the start

Patients often find the idea of doing a total meal replacement programmes challenging but actually easier than expected and Joe was no different. However, as he remarks, “I found, because everything was laid out…I found that part of it easy because I had no decisions to make over what I was eating”.

• Slow and steady wins the race

Food reintroduction comes after the stage in which the patient has been consuming meal replacements and must be done stepwise over several weeks to allow the body to adapt to a more substantial diet. Joe notes that he introduced small, conventional meals on a gradual basis in order to give his body the smoothest transition possible.

• Exercise everywhere

Joe keeps up his weight management by walking, cycling and playing football – always making sure he has done a substantial amount of exercise each day. Joe’s top tip: consult with personal trainers, whose services are often included in gym membership fees and who can help people to devise a personal weight management programme that works for each individual.

• Portion control is key

Portion size plays an important role in weight management. Once people have begun to reintroduce conventional foods after the meal replacements, it is important to be aware of the nutritional characteristics of foods regularly consumed. Personal consultants are available with all MRPs, ensuring the patient has an awareness of portion control and nutritional value. Expert guidance on food reintroduction is provided by dieticians and specially trained nurses in health care settings and trained consultants in commercial settings to ensure support and education to advise on weight maintenance after finishing the MRP programme.

• More support is needed

Joe feels that the government needs to support sufferers of obesity and Type 2 diabetes by learning from studies such as the DiRect diabetes remission clinical trial and the DROPLET study, in order to understand how to effectively tackle obesity and diabetes. NHS England has already committed to piloting a Type 2 diabetes remission programme in 2019 similar to DiRect and NHS Scotland is busy rolling out programmes right now.

 

 

“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.”

Carel Le Roux, professor of metabolic medicine at University College Dublin, proposes in his interview that officially recognising obesity as a disease will change our understanding and approach to treating it. This, he argues, would allow medical professionals to examine obesity in separate stages: causes, symptoms, and complications. Once the symptoms of obesity are targeted, there is a greater chance of successful weight management.

So, what would be achievable if other countries were to officially recognise obesity as a disease? Portugal officially classified obesity as a chronic disease in 2014, but still remains the only country in Europe to do so. Doctors in the UK have been outspoken in their convictions that obesity should be designated a disease and should no longer be considered a lifestyle choice – they called on the government to enforce this reclassification so that patients can receive specialist care.

Classifying obesity as a chronic disease would allow the creation of formal policies to improve care in the medical field, so that preventative measures can be put in place. Le Roux also believes sufficient legislation is an essential step towards tackling the stigma of obesity, a statement echoed by the President of the Royal College of Physicians: “It is important to the health of the nation that we remove the stigma associated with obesity”. This stigma, Le Roux argues, only compounds the problem. Not everyone has control over their lifestyle; access to healthy food, exercise and information around nutrition has become something of a privilege.  Furthermore, many well-known conditions are lifestyle-related, such as heart disease, yet patients suffering from these conditions are not blamed to the extent that diabetes patients often are. Often not triggered by lifestyle factors, diabetes can be caused by health inequalities, genetic influences and social factors – all causes that are largely out of the patient’s control.

The decision to prescribe total meal replacement diets (TDRs) on the NHS is a positive sign that the medical field recognises obesity as a disease that can be treated and controlled by healthcare professionals. Professor Jonathan Valabhji, National Clinical Director of Diabetes and Obesity for the NHS in England said: ““Our work so far in this area has been producing really positive results and today’s announcement will allow us to go even further –  it will help patients who have Type 2 diabetes to achieve remission and importantly, help more of those who are at risk to not get it in the first place.”

Le Roux’s approach to TDRs is very simple: If a patient is responding well to a diet approach, it is beneficial to continue; if a patient does not seem to respond well, then the medical professional may look at modifying the diet or considering alternative options. Members of TDMR Europe take care to carry out extensive consultations with people who wish to lose weight in order to design a tailored weight management programme that works for them. In choosing the right option, different factors should be taken into account: the amount of weight to lose, the general health and fitness of each individual and the cost-effectiveness of the proposed solution, as well as personal preferences

TDMR Europe is delighted to announce it has partnered with Innovations in Food Europe conference 2019. ACI’s Innovations In Food Europe conference will take place in London, UK on the 23rd and 24th of October 2019.

The conference will discuss new policies and regulations in the food industry, how to keep up with changing demands and trends, addressing opportunities in the market brought by lifestyle changes, as well as how to thrive in the industry as both a start-up, or a larger company. These are all very current topics and should be a great asset to players in the food & beverage industry.

>> View Agenda <<

TDMR Europe members are entitled to a discount on registration.  For more information and discount registration please contact Mayar Raouf on +44 (0)20 7463 0698 or mayar.raouf@whitehouseconsulting.co.uk.

“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.”

Professor Mike Lean, professor of human nutrition at the University of Glasgow and consultant physician at Glasgow Royal Infirmary, discusses the DiRECT diabetes remission clinical trial, a research study investigating whether offering an intensive programme of weight loss with TDR and weight maintenance could help place with Type 2 diabetes into remission. The first study of its kind, it has to the potential to revolutionise the way Type 2 diabetes is managed in the future.

The trial aimed to assess how many people can become non-diabetic through a 15kg weight loss. All participants were followed for at least two years, to see how many remained in remission and how that related to their weight. The latest findings revealed that more than a third of people with Type 2 diabetes who took part in the intensive weight management programme (starting with TDR) were in remission two years later. These results build on the initial findings, which showed that 46% of patients were in remission after twelve months.

Professor Lean emphasised that it’s a well-known fact that diabetes remissionis strongly linked to weight loss and maintenance. Remission of diabetes allows patients to stop taking anti-diabetes drugs, improving their quality of life and saving on treatment costs. The drugs themselves can cause side-effects, and cost healthcare services in the UK around £800m per year. For people who can achieve a long-term remission, the effect upon their future health and wellbeing is expected to be very beneficial.

Inspired by the results of the DiRECT study, NHS England has committed to piloting a Type 2 diabetes remission programme in 2019, and NHS Scotland is rolling out programmes right now. These studies have the capacity to investigate on a larger scale and provide more evidence to support weight management programmes for achieving diabetes remission. But the DiRECT trial itself has much more to give. Some participants of the original study are being followed for another three years, and more research is being done into the cost-effectiveness of the programme. A significant challenge will be to distinguish between responders (those who achieved remission) and non-responders (those who did not) and develop ways to help those who struggle to achieve and maintain diabetes remission.

For more information on the DiRECT trial go to: https://www.directclinicaltrial.org.uk/

For more information on Professor Mike Lean’s presentation, please contact TDMR Europe.

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.

Food Matters Live 2019 returns to ExCeL, London on 19–20 November. Follow

@FoodMattersLive #FoodMattersLive2019

 

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 18^th 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 16^th 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.