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Hundreds of thousands of people will receive help to battle obesity and Type 2 diabetes under radical new NHS plans to trial very low calorie diets for the first time.

It’s also good to see the NHS rapidly adopting a programme to improve patient care based on evidence from very recent clinical trials conducted in the UK.
- Professor Susan Jebb, University of Oxford

Very low calorie diets that have been shown to put Type 2 Diabetes in remission in those recently diagnosed with the condition will be trialled for the first time as part of the NHS long term plan.

Overweight patients will be prescribed a liquid diet of just over 800 calories a day for three months and then a period of follow up support to help achieve remission of their Type 2 diabetes.

The plans follow two recent studies of very low calorie diets, DROPLET and DiRECT, where overweight individuals achieved significant weight loss.

DROPLET study lead author and CLAHRC Oxford Theme lead, Professor Susan Jebb from the Nuffield Department of Primary Care Health Sciences, said: The news that very low calorie diets will be available on the NHS offers real hope for people with diabetes. It’s also good to see the NHS rapidly adopting a programme to improve patient care based on evidence from very recent clinical trials conducted in the UK.

“Most doctors believe that type 2 diabetes is an incurable disease that must be managed and it is rare for doctors to offer people a realistic prospect that they can reverse the disease. But the evidence is now strong enough that routine practice should change; treatment to reverse diabetes should become the first treatment option for many.

“We used to believe these treatments were only suitable for highly selected, highly motivated people supervised in specialist clinics. However, both the DROPLET and DiRECT trials show that unselected people in primary care lose an average of over 10kg at one year, and nearly half of everyone with newly diagnosed diabetes will be in remission after 1 year following treatment with a very low calorie diet plus behavioural support. Crucially, these results were achieved either with the support of GPs and nurses in primary care, or by referring patients to a provider in the community.

“These programmes lead to rapid weight loss and many people assume that they will lead to rapid weight gain, but the recent trials show this is not the case.  While most people who lose weight regain weight, we have good evidence that the rate of weight gain after more rapid weight loss is the same as after a ‘slow and steady’ approach to weight loss.  We also know that the risks from being overweight relate to how long a person carries the extra weight. The US diabetes prevention trial show us that even temporary weight loss reduces the risk of developing diabetes for at least 15 years.”

The NHS also plans to scale up the Diabetes Prevention Programme, which sees people at risk of developing Type 2 diabetes given help to lose weight and become more active, will double in size to treat around 200,000 people a year.

NHS Chief Executive, Simon Stevens said: “The NHS is now going to be ramping up practical action to support hundreds of thousands people avoid obesity-induced heart attacks, strokes, cancers and Type 2 diabetes. The NHS Long Term Plan is going to give people the power and the support to take control of their own lifestyles - so that they can help themselves while also helping the NHS.

“Because what’s good for our waistlines is also good for our wallets, given the huge costs to all of us as taxpayers from these largely preventable illnesses. However this isn’t a battle that the NHS can win on its own. The NHS pound will go further if the food industry also takes action to cut junk calories and added sugar and salt from processed food, TV suppers and fast food takeaways.”

Read more:

Find out more about the DROPLET study

Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET): pragmatic randomised controlled trial.
Nerys M Astbury, Paul Aveyard, Alecia Nickless, Kathryn Hood, Kate Corfield, Rebecca Lowe, Susan A Jebb.
BMJ 2018;362:k3760

Total diet replacement programmes – support for patients
Information is available on the University of Oxford website which aims to provide an overview of what total diet replacement programmes are, who they might be suitable for, potential side effects and where people can go if they’re interested in giving this type of programme a try.

Total diet replacement programmes – support for health professionals
Fact sheets on total diet replacement programmes are available for health professionals on the University of Oxford website and include an introduction to the interventions, FAQs and a medication adjustment guide. 

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