Total diet replacement approach achieves weight loss goals
medwireNews: Obese primary care patients referred to a total diet replacement program run by a commercial provider achieve substantial amounts of weight loss a year later, show findings from a randomized trial.
The DROPLET trial, which is published in The BMJ, used a similar approach to last year’s DiRECT study, although only around 15% of the DROPLET participants had diabetes, and it achieved similar results.
Study participants who were randomly assigned to undertake the total diet replacement consumed 810 kcal/day from soups, shakes, and bars; 750 mL of skimmed milk; and a fiber supplement for 8 weeks, with support from a counselor that included goal-setting, encouragement, and problem-solving. They gradually reintroduced conventional foods between weeks 8 and 12, and then entered a weight maintenance phase lasting another 12 weeks, during which they were encouraged to attend monthly appointments.
Notably, 9% of the 138 participants in the diet replacement group chose to pay for additional diet products or support during the weight maintenance phase, and at the 12-month follow-up 68% of 104 questioned were actively trying to lose weight and 26% remained in contact with the total diet replacement provider.
A primary care referral to a program that results in weight loss can therefore “be an important stimulus to ongoing self management,” say the researchers.
At this point, the participants had lost an average of 10.7 kg. This was a deterioration from the greatest weight loss of around 15 kg at 6 months, but was significant relative to the 3.1 kg 12-month weight loss achieved by 140 participants assigned to undertake their primary practice’s usual weight management protocol.
In total, 73% of the total diet replacement group lost at least 5% of their bodyweight, compared with 32% of the usual care group. The corresponding values were 45% versus 15% and 22% versus 4% for the proportions who lost 10% and 15% of their bodyweight, respectively.
The participants’ average age was around 48 years and the average BMIs were 37.6 and 36.8 kg/m2 in the intervention and control groups, respectively. The researchers note that they “used a similar recruitment method to other trials and achieved a similar uptake,” contrary to concerns that total diet replacement programs “are unacceptable to most people.”
Participants following the total diet replacement approach had a significantly larger reduction in glycated hemoglobin than those in the control group, by 2.2 mmol/mol, and also achieved significantly larger improvements in diastolic blood pressure and triglycerides, but not in systolic blood pressure or other lipid measures.
The findings were consistent regardless of age, sex, and socioeconomic status, and, given that the program was operated via a commercial provider, this suggests that it could be easily scaled up and rolled out, with “benefits realised across the population,” says the team.
However, writing in an accompanying article, DROPLET principal investigator Susan Jebb (University of Oxford, UK) argues that these results are little cause for celebration in the context of a healthcare culture in which patients are rarely offered support to lose weight, because of a perception that they will not welcome the offer or will fail to lose weight even with support.
“For too long the narrative has been that people will ‘fail’ in their weight loss efforts, but the evidence increasingly points to the system ‘failing’ to offer people support for weight loss,” says Jebb.
She points to evidence from a recent obesity-screening study, showing that very few people objected to an unprompted discussion about their weight and subsequent referrals to support programs led to weight loss for around a quarter of people.
“We need to seize these opportunities to treat obesity and in so doing, to prevent subsequent disease,” says Jebb.
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