Participants in a total diet replacement (TDR) program showed significant improvements in eating disorder symptoms, with effects lasting six months after the program ended, despite some weight regain. This addresses a gap identified by the National Institute for Health and Care Excellence (NICE) regarding the psychological impact of restrictive diets.
Dr. Elena Tsompanaki, a registered dietitian and lead author from the University of Oxford's Nuffield Department of Primary Care Health Sciences, stated: "As a dietitian, I've seen first-hand how both eating disorders and type 2 diabetes can impact the quality of people's lives. Our findings challenge the assumption that weight loss programmes worsen eating disorder symptoms in vulnerable people, potentially opening up important treatment options that many patients might have previously been denied."
The study involved 56 participants with type 2 diabetes diagnosed within the last six years who were overweight or obese and had existing eating disorder symptoms. Half underwent a low-energy TDR program with behavioral support for six months, while the control group received standard diabetes care from their GP. The study assessed restraint eating, eating concerns, shape concerns, and weight concerns.
Key findings included significant improvement in eating disorder symptoms in the TDR group compared to usual care at six months (-0.8 points EDE-Q difference), persisting at twelve months (-0.7 points). Depression and diabetes distress symptoms also reduced significantly in the TDR group at both time points compared to usual care. The TDR group lost more weight at six months (-13.9kg vs -3.7kg), but this difference was not statistically significant at twelve months. No new cases of eating disorders were suspected among participants.
Professor Susan Jebb, OBE, co-author and Professor of Diet and Population Health at Oxford's Nuffield Department of Primary Care Health Sciences commented: "The NHS Path to Remission programme is already showing promising results, with 27% of participants achieving diabetes remission at one year. Our new findings provide reassurance that these programmes can be safely offered to patients with symptoms of eating disorders."
Concerns about the safety of weight loss programs like NHS Path to Remission for those at high risk of eating disorders are addressed by these findings.
Dr. Dimitrios Koutoukidis, senior author also based at Oxford's Nuffield Department noted: "This study provides crucial reassurance that this type of intervention does not appear to harm, and may even benefit people with type 2 diabetes already experiencing eating disorder symptoms."
Dr. Tsompanaki concluded: "Low-energy total diet replacement programmes can be a very effective option for those who wish to give them a go to manage their diabetes."
Limitations include small sample size and participant demographics. The team continues follow-up studies on long-term changes in participants' eating disorder symptoms.
The study titled ‘An intensive weight loss programme with behavioural support for people with type 2 diabetes at risk of eating disorders: the ARIADNE non-inferiority randomised controlled trial’ is published in The Lancet Psychiatry.