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Study: GPs 'should support' patients on meal-replacement weight-loss programmes

GPs can confidently support patients on total diet replacement programmes as they may be a safe and effective way for obese patients to lose weight, a study has suggested.

Obese patients who went on a program of total diet replacement with behavioural support lost more weight than patients who received usual care, the study found.

The study was carried out by researchers at the University of Oxford and looked at just under 300 patients who sought help from their GP to lose weight.

Around half of the patients were assigned to receive standard care, including dietary advice and behavioural support from their practice nurse, and half were assigned to a program of total diet replacement (TDR).

The TDR intervention included using calorie-controlled meal replacement products for eight weeks before scaling down to using one product a day, in addition to behavioural support from a counsellor up until 24 weeks. The products and counsellors were supplied by Cambridge Weight Plan UK, who also part-funded the study.

The researchers found that at 12 months after starting the interventions, patients in the TDR group had lost, on average, around 11kg, compared to 3kg in the usual care group. They also found that the TDR group had greater reductions in HbA1C levels and diastolic blood pressure compared to the usual care group.

They noted that GPs tend to be ‘wary’ about supporting people who choose total diet replacement programmes, but said that their study should provide reassurance.

They said in the paper: ‘Current clinical guidelines recommend that this type of diet is reserved for people in whom short term weight loss is a priority—for example, before bariatric or knee replacement surgery, and they are not recommended as routine weight loss interventions. This presumably reflects concerns that weight loss is short lived.

‘This trial shows that TDR leads to greater weight loss at one year than an intervention based on usual food.’

Dr Rachel Pryke, GP and RCGP clinical advisor on obesity and nutrition, said that the study could give GPs more confidence if patients choose to follow TDR programmes, but queried how feasible it would be to incorporate TDR in to wider obesity strategies.

She said: ‘Mass rollout is not yet in any way realistic because the programme clearly needs long-term behavioural support alongside the TDR – which is not typically available by GPs. The staff giving that support need training, time and a structured clinic environment. So how this could be provided is the next vital question. I hope the study will create more noise about funding of obesity services in general.

‘If the behavioural support continued to be available then perhaps this would be a real way forward. However in light of current financial constraints, I think the true potential of this study may be limited by the ability of the NHS to fund the necessary services for it to be effectively delivered long-term.’

BMJ 2018; available online 27th September

Readers' comments (24)

  • Straw man? you're refusing to deal with the elephant in the room, which is patient responsibility. I'll counter your points directly. There are conditions which are non-self-inflicted which need medications to treat which might not be as clean to take and we rightfully do so. I would draw that line at socialised medicine at all but that's just me. The answer to your 2nd qsn is that the end result is actually WORSE. Increased health budget/state intervention/taxation HARMS a society, not to mention taking more and more responsibility away from the public. You're being close minded. Do the GPs in the East 'fail' their patients by not 'Totally replacing their meals to help them lose weight'? No. I'm quite happy to appear as a mature GP who treats patients like adults, and to consider the bigger picture, when deciding on how to spend SOMEONE ELSE'S money. As others have stated, I would bet that this study/treatment has no longterm benefits or efficacy that justifies the spending either. Rather than expand this study, like all government bureaucracy would like to do, lets look at the study groups 10, 20 yrs down the line, and see if they really reduce diabetes, cardiovascular risk etc

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  • @christopher ho

    You still haven't addressed either one of the points.

    1) are you saying you draw the line at diet supplements because you view this as socialized medicine?

    That's fine if that's the case, but we are working in a socialised system where of course this route of treatment will garner interest.

    2) are you saying that this will increase costs?

    Where is the data for this claim? Isn't this why further studies / trials should be done?

    What would your position be if further studies demonstrated a cost benefit?

    Just as an aside- no one can force patients to do anything. No one is advocating treating patients like children. No one is saying that patients should be forced to have treatments that they don't want.

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  • Personally I would draw the line at government subsiding only emergency treatment and access to primary care. Which is already more than what is provided in most countries in the world. Professionally, I go with my regulating body and advice from supposedly more learned institutions but there is still leeway in between for me to exercise common sense and rationality. Just because we are working in a socialised system now doesn't mean it would be permanent. Its only been in place half a century. Undoubtedly it would increase costs. How much does this cost per person per year? And if we treat ALL obese patients, that's at least 25% of the adult population. And whether there is a cost benefit, there is a non-economical cost that the patient pays in giving up their own personal responsibility. Reliance on the state should be avoided until absolutely necessary. Subsidising things for people is treating them like children. Its offering them 'candy'. Oh I'm not advocating forcing anyone to do anything. But if there is a cost to this program, you're advocating forcing the taxpayer to pay for it then aren't you?

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  • Great, at least now I understand your position which you are absolutely entitled to hold ( and you obviously don't need me to say that! :) ).

    My position is that if there is a cost benefit then this should be looked into further. I don't know if there is, but it should be studied further.

    My gut says that even if you treat lots of people it'll probably reduce the number of strokes/MIs/obesity related cancers etc, so will likely be cheaper than what we do now. I also feel (don't know for a fact) that this would probably be able to be done by less specialised healthcare professionals if rolled out.

    Off tangent: This conversation reminds of how certain countries don't offer needle exchange programmes to prevent HIV spreading. However it does reduce costs for society. There are a lot of second order effects however, such as in San Francisco where the streets are littered with used needles. So I agree the second order effects of widespread intervention is something that should be scrutinised and analysed.

    With regards to social Vs private etc. My perspective as a NHS doctor and someone who has dabbled in my fair share of business is that certain things need to have government regulation and ideally the regulations which are in place should be such that a thriving economy can be nurtured.

    I'm guessing we could talk at length about our differing perspectives but this probably isn't the forum for this.

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