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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)

  • “Meal replacement products”? Anyone remember Slimfast et al? Brilliant success that was back in the day. And now (presumably) we’ll be expected to prescribe this rubbish? Look, it either won’t work, or any temporary effect will reverse on their next Benidorm holiday. We should have nothing to do with this short term trendy nonsense. If patients want to fritter away their own cash on such items then fine, but GPs shouldn’t touch it with a barge pole.

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  • All that spare time we have in Primary care.
    Ivory Towers again.

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  • DO these GP actually work and see patients? Haven't these so called ivory towers GPs heard of "PRIORITIES". NHS funding is in dire state. peoples operations are being postponed for months. Waiting times are as long as they can be. CCG have started rationing and these ....heads wants us to support meal replacement weight programme on NHS. I think they need to go and see psychiatrist.

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  • Ivory tower socialists/leftists are being entirely logical. They just want to buy patient's votes by taking their responsibility and fking everyone else over. Makes sense really if you know what the left/socialists want.

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  • @the four lunatics who have already posted above be.

    What are you talking about? If ANY anti diabetic drug had as good of an outcome as meal replacements it would be mandatory to prescribe and use it.

    If ANY drug had as much benefit with is few side effects then it would be touted as a wonder cure and there would be plenty of funding for it.

    This is exactly the type of thing that should be supported in primary care and I'm surprised at my colleagues attitudes / responses.

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  • The study authors have made a gross error in generalising inappropriately.
    Their study actually showed that patients should be supported by Cambridge Counsellors and Practice Nurses, but there is NO evidence from this study for ANY benefit from support from GPs.
    This is poor quality science.

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  • @The Man' Daddy.- Before you start calling names to your colleagues. 1) The above study is not limited to diabetic it is for general obese patients.
    2) Diabetic are already supported well by help of dietitian support / specialized diabetic nurses. If they want to support patient to loose weight by giving them gold shakes let it come from special funding. We have no problem with that
    3) My problem is making genralisation . Every obese patient will ask for this replacement diet, then what are you going to do? Most of these replacement diet shakes cost around 100 £/ person / month. Considering 25 % of population is obese in community are we going to fund this at the cost of cutting down our heart & knee operations?

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  • Clearly TheManNANNY doesn't care about the ever-growing health budget or overworked GPs. All evidence also shows that if you eat little enough you would lose weight. Therefore, 'failure to lose weight' is a lack of effort/self-inflicted. How about letting these patients take more responsibility instead of NANNYING them every step of the way. You might be happy for your tax to be frittered away on this, but I'm not.

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  • @pradeep

    Diabetic nurses can't take clinical responsibility for novel approaches, that's why doctors exist and everything isn't nurse led.

    My point is that we should be fighting for resources that can help the patient.

    We are under resourced at the moment but we should be fighting for more.

    The cost you point out for diet replacement meals is negligible compared to the long term costs of diabetes/obesity and complications such as IHD and stroke.

    In other words you're being short sighted and not thinking.

    @christopher ho

    The health budget will get even worse if obesity and all of its associated health conditions aren't tackled. So your argument is already a non starter.

    Also, you as a GP are already helping patients who have made poor lifestyle choices by giving them antihypertensives, providing antidiabetic agents, referring to dieticians, referring for gastric operations etc.

    So WHY have you drawn the line at providing dietary supplements etc. Why have you decided that this is precisely where we should draw the line in providing care?

    We're in the game of providing healthcare. If you think there's a socialist agenda or something by providing proven care to our patients then perhaps you should reconsider your profession.

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  • @ManNanny, its you who are being short sighted. Nannying the patient is not 'helping' them. Oh I draw the line way further upstream, therefore before I give anyone antihypertensives, antidiabetics, etc I rationalise to them lifestyle advice, personal responsibility, the state of our budget both healthcare and welfare, before I TAKE responsibility away from them. There is a clear socialist agenda when we're continuing to increase our healthcare budget despite the Treasure being bankrupt. Oh I believe I provide BETTER healthcare by enabling people to take more responsibility for their own health, and not rely on the state. Maybe you should reconsider what you are actually doing by furthering the socialist agenda at the cost to everyone else.

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