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


Comments

Post a Comment

Popular posts from this blog

Obesity Is Complicated, So Is Preventing It. The 28th August #obsmuk chat's blog by Gemma Bridge.

Obesity Is Complicated, So Is Preventing It   The number of people living with overweight and obesity has increased over the past 30 years , and so have associated conditions such as diabetes and dental carries . As a result, prevention is extremely important. But prevention is complex since obesity is the result of a multitude of interrelated forces which act at multiple levels and influence patterns of eating and physical activity .  There are at least four preventive strategies for obesity: Education, regulation, modification of the food supply (availability, reformulation of products) and price changes . Traditionally obesity prevention has focused on individual-level behavioural changes through education, campaigns and commercial weight loss programs . However, such approaches overlook the complicated interaction between societal, environmental and genetic factors inherent to obesity and thus have poor long-term success . Alternative, ‘whole-system’ approach...
Read more

The hardest step - approaching healthcare professionals to ask for help with obesity By Stephanie deGiorgio

Writing this has been something I have been a little nervous about doing. As a GP I intensely dislike reading articles about how bad we are at doing certain things and so I didn’t want to just write one of those. As someone who has been significantly overweight and who talks to others in that position, I am acutely aware that a large part of the health profession and in fact the system as a whole is letting down a large number of those who approach it for help with the chronic disease that is obesity. I should start by explaining that I had a gastric sleeve operation in April 2017. It has been life changing for me and I bring that experience and those of being an overweight patient as well as a GP looking after patients with weight problems into this blog. Like many people I had tried for years to lose weight and had been successful many times. But also like mamy people, in fact 95% of those who are obese and lose weight, it soul-destroyingly all went back on again with extra. ...
Read more

Communicating about weight – can we bring patients and healthcare professionals together in support? #obsmuk blog by Fiona Quigley

Communicating about weight – can we bring patients and healthcare professionals together in support? Obesity is a medical condition described as excess body weight in the form of fat. When accumulated, this fat can lead to severe health impairments. The prevalence of obesity across the world continues to rise, and this is now recognised as one of the most important public health problems facing the world today. Subsequently, conversations about obesity between patients affected by obesity and healthcare professionals is an important and necessary aspect of at least some of their encounters. However, it isn’t easy for healthcare professionals or for patients to talk about weight and we know there are many reasons for this. Research shows that healthcare professionals worry that talking about weight might upset patients, as if they are delivering bad news. In turn, patients of a higher weight can often feel shamed and blamed. More research is needed o...
Read more