November 30, 2018

expert reaction to NHS England plan to pilot very low calorie diets

Reactions to a NHS England plan to trial very low calories diets as part of The Diabetes Prevention Programme (DPP).

Prof Susan Jebb, Professor of Diet and Population Health, University of Oxford, 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.”

Prof Naveed Sattar, Professor of Metabolic Medicine, University of Glasgow, said:

“The direct trial showed around at least a quarter of people with recently diagnosed type 2 diabetes are interested in losing sufficient weight to put their diabetes into remission.  This means low calorie diets could have decent impact to health by helping some people with diabetes lose their ‘diabetes tag’, if even for a short number of years.

“Further follow up of DiRECT continues and will give more data on sustainability of the original weight loss.

“The NHS investment into a large pilot of the DiRECT low calorie concept is timely and evidenced based, therefore.

“Low calorie drinks will become part of the menu of options available to patients to help them lose considerable weight and ongoing work will help us further improve methods to help patients prevent weight regain.  Overall, this is a really positive development.”

“It’s important to note that what NHS England are proposing is technically low calorie rather than very low calorie, as very low would mean less than 800 calories per day (and they are proposing just over 800 calories per day).”

Dr Shareen Forbes, Reader in Diabetes and Endocrinology, University of Edinburgh, said:

“In controlled studies funded by Diabetes UK it has been shown that very low calorie diets, with most importantly appropriate support following these diets, could lead to remission of diabetes.  This is backed up by solid data published by Roy Taylor, Mike Lean and colleagues (Cell Metabolism, 2018).  The studies demonstrate that insulin producing cells of the pancreas could be rebooted once remission had been achieved: this was an important observation which had not been noted previously as it was assumed that beta-cell function once lost probably could not be recovered.

“There are now a number of studies that demonstrate remission of Type 2 diabetes with weight loss.  Such interventions can have significant economic impacts given the levels of type II diabetes now in society.

“These are important clinical studies going forward, and importantly not only is an intervention with the very low calorie diets included but also the necessary support post weight loss.”

Declared interests

Prof Susan Jebb: “Susan Jebb is the chief investigator of the DROPLET trial, funded by the Oxford NIHR CLAHRC and a research grant from the Cambridge Weight Plan to the University of Oxford.”

Prof Naveed Sattar: “Naveed Sattar was part of the steering committee / co-author of the DIRECT trial.”

Dr Shareen Forbes: “I have no COI.”