“Trying to make healthy choices”: the challenges of the food reintroduction phase of the NHS Low Calorie Diet Programme pilot for type 2 diabetes

Authors

  • Catherine Homer Sport and Physical Activity Research Centre, Sheffield Hallam University
  • Karina Kinsella Obesity Institute and School of Health, Leeds Beckett University, Leeds
  • Tamara Brown Obesity Institute and School of Health, Leeds Beckett University, Leeds
  • Jordan Marwood Obesity Institute and School of Health, Leeds Beckett University, Leeds
  • Kevin Drew Obesity Institute and School of Health, Leeds Beckett University, Leeds
  • Duncan Radley Obesity Institute and School of Sport, Leeds Beckett University, Leeds
  • Charlotte Freeman Obesity Institute and School of Health, Leeds Beckett University, Leeds
  • Abimbola Ojo Obesity Institute and School of Health, Leeds Beckett University, Leeds
  • Jennifer Teke Obesity Institute and School of Health, Leeds Beckett University, Leeds
  • Ken Clare Obesity Institute and School of Health, Leeds Beckett University, Leeds
  • Chirag Bakhai Larkside Practice, Churchfield Medical Centre, Luton, Bedfordshire
  • Louisa Ells Obesity Institute and School of Health, Leeds Beckett University, Leeds

DOI:

https://doi.org/10.15277/bjd.2024.436

Keywords:

food reintroduction, type 2 diabetes, obesity, Low Calorie Diet, qualitative, longitudinal, Re:

Abstract

Background: The food reintroduction phase of the NHS Low Calorie Diet (LCD) programme aims to support service users to reintroduce food gradually back into their diet. Understanding experiences of food reintroduction from a broad and diverse range of service users is critical in helping to improve service delivery and commissioning and equity in care.

Methods: This was a co-produced qualitative study underpinned by a realist informed approach, using interviews and photovoice techniques. Service users (n=43) of the NHS LCD Programme were recruited from three delivery models across 21 pilot sites in England. Data were analysed using a thematic approach.

Results: The food introduction phase required control and planning that challenged the behaviours of participants. Around a third of participants continued use of Total Diet Replacement products, or considered doing so, for convenience and to maintain calorie control. The coach–service user relationship was important to understanding of session content and translation into behaviour change. Physical activity increased during this phase, which contributed to positive health outcomes.

Conclusions: The paper reports insights from the food reintroduction phase of the LCD programme. Key messages include the need for increased frequency of support and the need for tailored and culturally representative education.

References

Homer C, Kinsella K, Drew KJ, et al. 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. Br J Diabetes 2024;24:ONLINE AHEAD OF PUBLICATION. https://doi.org/10.15277/bjd.2024.435

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

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

Drew KJ, Homer C, Radley D, Bakhai C, Ells L. A qualitative study of the experiences of individuals who did not complete the NHS Low Calorie Diet Programme Pilot. Br J Diabetes 2024;24:ONLINE AHEAD OF PUBLICATION. https://doi.org/10.15277/bjd.2024.434

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.

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

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

Elfhag K, Rössner S. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obesity Reviews 2005;6(1):67-85. https://doi.org/10.1111/j.1467-789X.2005.00170.X

Byrne S, Cooper Z, Fairburn C. Weight maintenance and relapse in obesity: a qualitative study. Internat Journal Obesity Relat Metab Disord 2003;27(8):955-62. https://doi.org/10.1038/sj.ijo.0902305

Cunningham C, Johnson S, Cowell B, et al. Menu plans in a diabetes self-management weight loss program. Journal Nutrition Education Behav 2006;38(4):264-6. https://doi.org/10.1016/j.jneb.2006.01.013

Faruqi N, Spooner C, Joshi C, et al. Primary health care-level interventions targeting health literacy and their effect on weight loss: a systematic review. BMC Obesity 2015;2(1):1-16. https://doi.org/10.1186/s40608-015-0035-7

Dhir P, Maynard M, Drew KJ, Homer C, Bakhai C, Ells L. 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. https://pubmed.ncbi.nlm.nih.gov/38154908/

Muñoz Obino KF, Aguiar Pereira C, Caron-Lienert RS. Coaching and barriers to weight loss: an integrative review. Diabetes Metabolic Syndrome Obesity 2017;10:1-11. https://doi.org/10.2147/DMSO. S113874

Marwood J, Kinsella K, Homer C, et al. Is the NHS low-calorie diet programme delivered as planned? An observational study examining adherence of intervention delivery to service specification. Clinical Obesity 2024;e12652. https://doi.org/10.1111/cob.12652

Kruger J, Blanck HM, Gillespie C. Dietary and physical activity behaviors among adults successful at weight loss maintenance. Internat Journal Behavioral Nutrition Physical Activity 2006;3(1):1-10 https://doi.org/10.1186/1479-5868-3-17

Catenacci VA, Wyatt HR. The role of physical activity in producing and maintaining weight loss. Nature Clinical Practice Endocrinol Metab 2007;3(7):518-29. https://doi.org/10.1038/ncpendmet0554

Swift DL, Johannsen NM, Lavie CJ, Earnest CP, Church TS. The role of exercise and physical activity in weight loss and maintenance. Progress Cardiovascular Dis 2014;56(4):441-7. https://doi.org/10.1016/j.pcad.2013.09.012

Posadzki P, Pieper D, Bajpai R, et al. Exercise/physical activity and health outcomes: an overview of Cochrane systematic reviews. BMC Public Health 2020;20:1-12. https://doi.org/10.1186/s12889-020- 09855-3

Biddle SJ, Fox K, Boutcher S. Physical activity and psychological well-being: Routledge; 2003.

Lidegaard L, Schwennesen N, Willaing I, Færch K. Barriers to and motivators for physical activity among people with type 2 diabetes: patients' perspectives. Diabetic Medicine 2016;33(12):1677-85. https://doi.org/10.1111/dme.13167

Bantham A, Ross SET, Sebastião E, Hall G. Overcoming barriers to physical activity in underserved populations. Progress Cardiovasc Dis 2021;64:64-71. https://doi.org/10.1016/j.pcad.2020.11.002

Rutter H, Cavill N, Bauman A, Bull F. Systems approaches to global and national physical activity plans. Bulletin World Health Organization 2019;97(2):162. https://doi.org/10.2471/BLT.18.220533

Downloads

Published

2024-04-16

Issue

Online First: Qualitative learning from an evaluation of the NHS Low Calorie Diet Programme

Section

Original Research

License

Copyright (c) 2024 British Journal of Diabetes

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Publish & Transfer of Copyright Agreement
For the mutual benefit and protection of the Author and the Journal Owner/Publisher it is necessary that the Author provides formal written Consent to Publish and Transfer of Copyright before publication of the Work.

Most read articles by the same author(s)