Total Diet Replacement


Welcome to this @obsmuk twitter chat. Before we start it is important to firstly understand the terminology that we are going to be using within this Blog and during the twitter chat. Within the literature the terms very low ‘calorie’ and very low ‘energy’ have often been used interchangeably. As calories are units of energy; ‘energy’ should therefore be used. Formula diets are divided according to energy. Very low energy diets (VLED) provide <800kcal/day, whilst low energy diets (LED) provide between 800-1200kcal per day. When replacing a person's total daily dietary intake known as total diet replacement (TDR), or some meals, a partial diet replacement (PDR). Research predominately uses liquid diets including sachets of powder, which are reconstituted into shakes and soup. To simplify these terms, we use ‘formula diets’ to cover both very low energy (VLED) and low energy diets (LED).



Formula diets have been around for a number of years and have evoked much heated debate. With the publication of the Diabetes Remission Clinical Trial (DiRECT) in December 2017, there has been rising interest in the use of formula diets for the treatment of obesity and type 2 diabetes (T2D). With this interest comes many opposing views for the role of formula diet programmes in weight management services. Discussing and debating people’s concerns is an important part of ensuring we continue to move forward in a way that is both evidence-based and benefits those living with obesity. With this knowledge we must continually revisit ‘why’ formula diet programmes could be complementary to the current weight management offering, e.g. lifestyle interventions, pharmacotherapy and bariatric surgery.



Formula diet programmes can achieve clinically significant weight loss (10-15kg) is the short-term, and for many people this can be highly motivating to take the next step to making changes to their lifestyles and can help support weight loss maintenance for up to 4 years. While maintenance is seldomly complete, we can still offer evidence based, and non-judgemental care for individuals to maintain weight loss, as a method of limiting complete weight regain.  This is where the support and behavioural components of interventions become a priority. Building on this, we can continue to work on new solutions for weight loss maintenance, so that we are continuously improving the provision of clinical services overtime.



Like all new paradigm shifts, we must continue to go back to basics, and ask ourselves why formula diets could be a helpful option for people and use evidence and continuous improvement to inform what the future holds for solutions to the obesity epidemic.



In this chat, we will discuss the pros and cons of formula diets, explore, people’s views and experiences for weight loss and maintenance and also obesity co-morbidity resolution.



Specifically, we will discuss:



·         What is the evidence for and against the use of formula low and very-low energy diets as a weight management option?

·         What are people experiences of using formula diets for weight loss and how sustainable is this weight loss in the long-term?

·         What is the role of formula diets in the treatment and management of obesity related medical conditions?

·         What are the concerns do you have about the safety and possible side effects of using formula diets?

·         What other component are needed for a successful formula diet programme?

Adrian Brown and Naomi Brosnahan


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