NHS should prescribe crash diet replacing meals with shakes and nutrition bars to tackle obesity, scientists say

Partnership with commercial weight loss firms should be extended nationwide to allow GPs to prescribe, scientists add

Eating shakes, soups and meal replacement bars for three meals a day helped obese patients lose nearly four times as much weight as those told to eat healthily and cut calories, a study has found.

Oxford University researchers have reported “total meal replacement” diets, which restrict participants to just 810 calories per day for eight weeks, safely enabled more patients to lose more weight – and keep it off for a year with diet support.

The survey results fly in the face of long standing criticism of “crash dieting”, amid fears it can lead to a yo-yo effect where people lose weight but immediately put it back on.

Less radical meal replacement schemes are run by groups such as the recently-rebranded WW and total replacement programmes are not usually funded by the NHS.

However the Oxford University report’s authors argue there is ample evidence such regimes can help combat a growing obesity crisis which is costing the health service billions of pounds to treat complications such as type 2 diabetes

“In the past we have worried that a short period of rapid weight loss may lead to rapid weight regain,” said Professor Susan Jebb, a diet and population health expert at the university’s Nuffield Department of Primary Care Health Sciences.

“But this study shows that nine months after the intensive weight loss phase, people have lost more than three times as much weight as people following a conventional weight loss programme.”

The study, published in the British Medical Journal on Thursday, involved 278 patients from Oxfordshire GP practices who were invited to take part when their medical record showed they had a body mass index of more than 30 – the threshold for “obesity”.

For the first two months of the programme, participants were given meal replacements, developed to provide their daily nutrients, along with 750ml of skimmed milk, 2.25l of water and a fibre supplement.

Conventional food was gradually reintroduced throughout the third month and for the following three months, patients were told to continue replacing one daily meal with shakes, soups or bars.

There was dietary counselling throughout to help patients stick to the programme, and to adopt a healthier diet over the 12-month scheme as meal replacements were phased out.

After 12 months, the participants had lost an average 10.7kg. That compared to an average weight loss of 3.5kg for those who received their GP’s standard weight loss programme, including advice and support from a nurse and written information.

Three times as many patients – 45 per cent – saw their weight decrease by at least 10 per cent on the meal replacement programme.

The authors write, in the BMJ, that 38 per cent of participants continued to be part of the meal replacement scheme, paying for products and receiving support, even though it was only funded for six months. That compared to 5 per cent of the group given GP support.

Professor Paul Aveyard, a co-author of the paper, said: “This study shows that GP referral to a total diet replacement programme in the community is an effective intervention which GPs can confidently recommend, knowing that it leads to sustainable weight loss and lowers the risk of heart disease and diabetes.”

As the scheme involved a meal replacement package and counselling by a private group, in this case Cambridge Weight Loss Plan, the authors say there is potential for a “rapid roll-out at scale across the NHS and [it] could help reduce the pressure on GPs in treating obesity-related disease”.

Independent experts said it was striking virtually all participants stayed on the programme for the entire 12 months, and suggested sticking with meal replacement is not too arduous.

However, they added, meal replacement alone is not a solution to maintaining healthy weight.

“Many people reading this will ask themselves whether they should try one of these diets,” Dr Katarina Kos, a lecturer in diabetes and obesity from the University of Exeter Medical School said.

“My answer is a clear ‘not on your own’, especially if it is understood as ‘a standalone diet’, as the evidence given here clearly shows the diet alone is much less effective than the diet combined with behavioural support.

“Of course losing weight is good if you are overweight, but a large body of research indicates that the only way it will work is if using the programme as a means to future change, as a stepping stone to change eating habits for good.”