Soups, Shakes, Weight Loss, and Diabetes Remission
This is an impressive sales push. A diet of soups and shakes offers a brilliant path to weight loss, changing the lives of people with obesity and diabetes. So says the director of the NHS Type 2 Diabetes Path to Remission program, Clare Hambling:
“It’s brilliant that these findings show a large number of those who completed it [the programme] have seen life-changing benefits including major weight loss and type 2 diabetes remission.
“We know obesity is one of the biggest threats to health in the UK and will be one of the biggest and most costly challenges for health systems globally, so seeing such encouraging outcomes from our programme shows that obesity can be tackled head-on, and we’re looking forward to scoping any further expansion to this programme in due course.”
Large Numbers?
While we admire the Hambling’s enthusiasm, we have some questions about her claims of large numbers. This big publicity campaign springs from a new publication of real world outcomes from the NHS program. It appeared in Lancet Diabetes and Endocrinology this week.
Those who take the time to read the paper will find an assessment that is a bit more sober. The 800-calorie diet at the heart of this program is one of extreme deprivation that many people simply cannot tolerate. In their paper, Jonathan Valabhji and colleagues explain:
“Of those who started the programme, 960 (55%) completed it. However, this figure does not take into account those who were referred to the programme and never started TDR. It also does not take into account those who were offered the programme in general practices but declined the referral. The programme and intervention, therefore, are clearly not acceptable to everybody and must be considered as just one treatment pathway in a portfolio of potential options for weight loss, including other dietary strategies, pharmacotherapy, and bariatric surgery.”
So the promise that this program of soups and shakes “can beat type 2 diabetes” is a little overblown. This is a program of such deprivation – nothing but soup, shakes, and bars for 12 weeks – that most people can’t or won’t do it.
High Relapse Rates
On top of the punishing nature of this diet lies the problem of relapse. Long-term data tells us that most of the remissions after one year do not last. Even with extended support, the overwhelming majority – 87% – of people in the DiRECT trial of this program did not maintain a remission after five years.
This program may indeed be helpful for some people. But in no way is this what we call “brilliant” effectiveness. Especially when other treatments offer greater and more durable benefits for most people.
Click here for the new paper by Valabhji et al. For a sampling of the journalistic puffery about it, click here and here.
Guri with Soup, illustration by Theodor Severin Kittelsen / WikiArt
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August 10, 2024
August 10, 2024 at 6:32 pm, John Dixon said:
Managing obesity requires an open mind to looking carefully at all effective therapies. VLEDs (< 800 calorie/ day) are very effective, surprisingly acceptable, and provide many people a valuable tool to assist with managing their weight over many years. These meal replacements can be graded up and down, and combined with other effective as required for chronic disease management.
The major issue relates educating HCP regarding their usage and the support required during the first weeks of care. . Language is also important. Words like extreme and poorly tolerated are emotive and not evidence based.
We need all the effective tools in the tool box to provide optimal individualized care.
It’s easy to put down effective therapies including: VLEDs, Obesity Management Medications and Bariatric-metabolic Surgery.
We all need to be reminded to keep an inquisitive open mind.
August 11, 2024 at 3:05 am, Ted said:
Than you for your thoughtful comments, John.
Yes, VLEDs can be very effective for a few people. But it is worth noting that in the present study, only 13% of the people referred to the program completed it. Only 23% even enrolled in it. These are objective numbers to suggest this approach is not acceptable or tolerable to many people.