A fresh start with high hopes: a qualitative evaluation of experiences of the Total Diet Replacement phase of the NHS Low Calorie Diet Programme pilot

Authors

  • Catherine Homer Sport and Physical Activity Research Centre, Sheffield Hallam University, Olympic Legacy Park, Sheffield
  • Karina Kinsella Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds
  • Kevin James Drew Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds
  • Jordan Marwood Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds
  • Tamara Brown Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds
  • Simon Rowlands Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds
  • Duncan Radley Obesity Institute, School of Sport, Leeds Beckett University, Headingley Campus, Leeds
  • Charlotte Freeman Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds
  • Abimbola Ojo Re:Mission Patient and Public Involvement Group, Obesity Institute, School of Health, Leeds Beckett University, Leeds
  • Jennifer Teke Re:Mission Patient and Public Involvement Group, Obesity Institute, School of Health, Leeds Beckett University, Leeds
  • Ken Clare Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds
  • Chirag Bakhai Larkside Practice, Churchfield Medical Centre, Luton, Bedfordshire
  • Louisa Ells Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds

DOI:

https://doi.org/10.15277/bjd.2024.435

Keywords:

type 2 diabetes, obesity, Low Calorie Diet, qualitative, longitudinal, Re:Mission study

Abstract

Background: The National Health Service (NHS) Low Calorie Diet (LCD) programme in England aims to support people with type 2 diabetes (T2DM) to lose weight, improve glycaemic parameters and potentially achieve diabetes remission. The programme pilot launched in 2020 using three different delivery models: one-to-one, group and digital via an App. Service users begin the programme with 12 weeks of Total Diet Replacement (TDR). This study aims to understand the experience of this TDR phase from the service user perspective.

Methods: This was a co-produced qualitative longitudinal and cross-sectional study, underpinned by a realist informed approach using semi-structured interviews and photovoice techniques. Service users (n=45) from the NHS LCD programme were recruited across the three delivery models and 21 pilot sites in England. Data were analysed using a thematic approach.

Results: Participant demographics were representative of the overall LCD pilot population sample and included experiences from a mix of delivery models and providers. Three themes were presented chronologically. 1) life pre-LCD: the LCD programme was viewed as an opportunity to reset eating behaviours and improve quality of life; 2) experience of TDR: flexibility in allowing supplementary non-starchy vegetables and adapting the flavour and texture of TDR products supported adherence; 3) looking ahead to food reintroduction: at the end of the TDR phase, weight and glycaemia had reduced, while subjective energy levels and mobility improved. Some participants were concerned about progressing to the food reintroduction phase and the possibility of weight regain. Conclusions: The paper reports insight from the TDR phase of the LCD programme. The co-production of this work has resulted in several recommendations for policy and practice which have informed the national roll out of the programme.

References

Homer C, Kinsella K, Marwood J, et al. The Re:Mission study: Evaluating the NHS Low Calorie Diet pilot - an overview of service user data collection. Br J Diabetes 2024;24:ONLINE AHEAD OF PUBLICATION. https://doi.org/10.15277/bjd.2024.433

Lean MEJ, Leslie WS, Barnes AC, et al. Durability of a primary care- led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster- randomised trial. Lancet Diabetes Endocrinol 2019;7(5):344-55. https://doi.org/10.1016/S2213-8587(19)30068-3

Astbury NM, Aveyard P, Nickless A, et al. Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET): pragmatic randomised controlled trial. BMJ 2018;362:k3760. https://doi.org/10.1136/bmj.k3760

England N. NHS Low Calorie Diet Programme – face to face [one to one/group] delivery model - Service Specification. 2019.

Clare K, Ojo A, Teke J, et al. ‘Valued and listened to’: the collective experience of patient and public involvement in a national evaluation. Perspectives in Public Health 2022;142(4):199-201. https://doi.org/10.1177/17579139221103184

Braun V, Clarke V, Weate P. Using thematic analysis in sport and exercise research. Routledge handbook of qualitative research in sport and exercise 2016; pp191-205.

Homer CV, Tod AM, Thompson AR, Allmark P, Goyder E. Expectations and patients’ experiences of obesity prior to bariatric surgery: a qualitative study. BMJ Open 2016;6(2):e009389. https://doi.org/10.1136/bmjopen-2015-009389

Thomas DM, Martin CK, Redman LM, et al. Effect of dietary adherence on the body weight plateau: a mathematical model incorporating intermittent compliance with energy intake prescription. American Journal Clin Nutr 2014;100(3):787-95. https://doi.org/10.3945/ajcn.113.079822

Silva MN, Vieira PN, Coutinho SR, et al. Using self-determination theory to promote physical activity and weight control: a randomized controlled trial in women. Journal Behavior Med 2010;33:110-22. https://doi.org/10.1007/s10865-009-0239-y

Rehackova L, Rodrigues AM, Thom G, et al. Participant experiences in the Diabetes REmission Clinical Trial (DiRECT). Diabetic Medicine 2022;39(1):e14689. https://doi.org/10.1111/dme.14689

Hall KD, Kahan S. Maintenance of lost weight and long-term management of obesity. Medical Clinics of North America 2018;102(1):183-97. https://doi.org/10.1016/j.mcna.2017.08.012

Carroll P, Mygind V, Anderson J, Khot F, Simpson J. Patient reported outcome measures in weight management service evaluation. Journal Human Nutrition Dietetics 2011;24(4):381-2. https://doi.org/10.1111/j.1365-277X.2011.01177_9.x

Griffiths C, Ells L, Gilthorpe M, Clare K, Coggins A. A complex systems approach to obesity: a transdisciplinary framework for action. 2022. https://doi.org/10.1177/17579139231180761

Nguyen-Trung K, Saeri AK, Zhao K, Boulet M, Kaufman S. A brief introduction to a Socio-Ecological COM-B (SeCOM-B): a behaviour change framework response to wicked problems. 2023. https://doi.org/10.31219/osf.io/4x6wa

Ells LJ, Ashton M, Li R, et al. Can we deliver person-centred obesity care across the globe? Current Obesity Reports 2022;11(4):350-5. https://doi.org/10.1007/s13679-022-00489-7

Chen Y, Li Z, Yang Q, et al. The effect of peer support on individuals with overweight and obesity: a meta-analysis. Iranian Journal Public Health 2021;50(12):2439. https://doi.org/10.18502/ijph.v50.12.7926

Ufholz K. Peer support groups for weight loss. Current Cardiovascular Risk Reports 2020;14:1-11. https://doi.org/10.1007/s12170-020-00654-4

Marwood J, Radley D, Evans TS, et al. Cross-sectional analysis of emotional and binge eating in UK adults enrolled on the NHS Low- Calorie Diet Pilot for Type 2 Diabetes (under review); 2023.

Elran-Barak R, Sztainer M, Goldschmidt AB, et al. Dietary restriction behaviors and binge eating in anorexia nervosa, bulimia nervosa and binge eating disorder: trans-diagnostic examination of the restraint model. Eating Behaviors 2015;18:192-6. https://doi.org/10.1016/j.eatbeh.2015.05.012

Dhir P, Maynard M, Drew KJ, Homer CV, Bakhai C, Ells LJ. South Asian individuals’ experiences on the NHS low-calorie diet programme: a qualitative study in community settings in England. BMJ Open 2023;13(12):e079939. https://doi.org/10.1136/bmjopen-2023-079939

Jones S, Brown TJ, Watson P, et al. Commercial provider staff experiences of the NHS low calorie diet programme pilot: a qualitative exploration of key barriers and facilitators. BMC Health Services Research 2024;24(1):53. https://doi.org/10.1186/s12913-023-10501-y

Downloads

Published

2024-06-29

Issue

Section

Original Research

Most read articles by the same author(s)