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

health inequalities

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