medwireNews: Many participants of DiRECT found reintroduction of food and subsequent weight-loss maintenance to be more challenging than the 800 calorie total meal replacement phase, the investigators report.
DiRECT included 198 people with type 2 diabetes. Up to 34 of these people, aged between 32 and 65 years, were interviewed at four timepoints between baseline and 1 year.
Lucia Rehackova (Newcastle University, UK) and study co-authors note that fewer participants were interviewed at the later timepoints, with those not interviewed tending to be people who had gained weight and/or not achieved diabetes remission.
“The results therefore need to be interpreted in light of these findings,” they write in Diabetic Medicine.
The participants reported various issues during the 12-week total-meal-replacement phase, including fluctuating hunger levels and boredom with the extremely repetitive diet, which led some to adopt methods such as adding low-calorie vegetables or sourcing alternative meals of equivalent calories.
During this phase, a brief break in the diet due to an event such as a wedding was, with careful planning, not detrimental, whereas a longer break such as a pre-planned holiday often created a setback.
But the rapid improvements in weight and blood glucose provided ongoing motivation during this phase, and for all the challenges of undertaking an 800 calorie/day diet, participants found the reintroduction of food and the weight maintenance phase to be markedly harder.
Indeed, many opted for an 8-week extension of total meal replacement to maximize weight loss before attempting to reintroduce usual food, which they described as an anxious period. After food reintroduction, participants frequently returned to the soups and shakes to exert easier control over their calorie intake, and when they wanted a break from the ongoing effort of weight-loss maintenance.
The participants also adopted behaviors such as keeping a food diary, reading product labels, regularly weighing themselves, and being more physically active. They often found they had settled into a weight maintenance routine after 4 or 5 months, but were aware that it would require lifelong effort and some doubted their ability to stick to it in the longer term.
Weight loss maintenance “is an ongoing struggle requiring compromises and a flexible approach to eating,” observe the researchers.
“Acceptance of this may remove the negative affect of evaluating lapses as failures, preserving psychological resources that may become depleted with continuous effort.”
They also highlight the value for the participants of the behavioral support received from the healthcare professionals (HCPs) involved in DiRECT, during regular appointments.
“The participants’ sense of accountability to the HCPs and the research team provided additional motivation and commitment,” they say.
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