{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:30:30Z","timestamp":1790659830482,"version":"4.1.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2021,7,23]],"date-time":"2021-07-23T00:00:00Z","timestamp":1626998400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,23]],"date-time":"2021-07-23T00:00:00Z","timestamp":1626998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Obes"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objectives<\/jats:title>\n                <jats:p>To test the long-term effectiveness of a total diet replacement programme (TDR) for routine treatment of obesity in a primary care setting.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This study was a pragmatic, two-arm, parallel-group, open-label, individually randomised controlled trial in adults with obesity. The outcomes were change in weight and biomarkers of diabetes and cardiovascular disease risk from baseline to 3 years, analysed as intention-to-treat with mixed effects models.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Interventions<\/jats:title>\n                <jats:p>The intervention was TDR for 8 weeks, followed by food-reintroduction over 4 weeks. Behavioural support was provided weekly for 8 weeks, bi-weekly for the next 4 weeks, then monthly for 3 months after which no further support was provided. The usual care (UC) group received dietary advice and behavioural support from a practice nurse for up to 3 months.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Outcome measures were collected from 179 (66%) participants. Compared with baseline, at 3 years the TDR group lost \u22126.2\u2009kg (SD 9.1) and usual care \u22122.7\u2009kg (SD 7.7); adjusted mean difference \u22123.3\u2009kg (95% CI: \u22125.2, \u22121.5), <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001. Regain from programme end (6 months) to 3 years was greater in TDR group +8.9\u2009kg (SD 9.4) than UC\u2009+\u20091.2, (SD 9.1); adjusted mean difference +6.9\u2009kg (95% CI 4.2, 9.5) <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001. At 3 years TDR led to greater reductions than UC in diastolic blood pressure (mean difference \u22123.3\u2009mmHg (95% CI:\u22126.2; \u22120.4) <jats:italic>P<\/jats:italic>\u2009=\u20090.024), and systolic blood pressure (mean differences \u22123.7\u2009mmHg (95% CI: \u22127.4; 0.1) <jats:italic>P<\/jats:italic>\u2009=\u20090.057). There was no evidence of differences between groups in the change from baseline to 3 years HbA<jats:sub>1c<\/jats:sub> (\u22121.9\u2009mmol\/mol (95% CI: \u22120.7; 4.5; <jats:italic>P<\/jats:italic>\u2009=\u20090.15), LDL cholesterol concentrations (0.2\u2009mmol\/L (95% CI \u22120.3, 0.7) <jats:italic>P<\/jats:italic>\u2009=\u20090.39), cardiovascular risk score (QRISK2) (\u22120.37 (95% CI \u22120.96; 0.22); <jats:italic>P<\/jats:italic>\u2009=\u20090.22).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Treatment of people with obesity with a TDR programme compared with support from a practice nurse leads to greater weight loss which persists to at least 3 years, but there was only evidence of sustained improvements in BP and not in other aspects of cardiometabolic risk.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1038\/s41366-021-00915-1","type":"journal-article","created":{"date-parts":[[2021,7,23]],"date-time":"2021-07-23T09:03:23Z","timestamp":1627031003000},"page":"2432-2438","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Extended follow-up of a short total diet replacement programme: results of the Doctor Referral of Overweight People to Low Energy total diet replacement Treatment (DROPLET) randomised controlled trial at 3 years"],"prefix":"10.1038","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9301-7458","authenticated-orcid":false,"given":"Nerys M.","family":"Astbury","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhiannon M.","family":"Edwards","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fitsum","family":"Ghebretinsea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milensu","family":"Shanyinde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill","family":"Mollison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1802-4217","authenticated-orcid":false,"given":"Paul","family":"Aveyard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan A.","family":"Jebb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,7,23]]},"reference":[{"key":"915_CR1","doi-asserted-by":"publisher","first-page":"k3760","DOI":"10.1136\/bmj.k3760","volume":"362","author":"NM Astbury","year":"2018","unstructured":"Astbury NM, Aveyard P, Nickless A, Hood K, Corfield K, Lowe R, et al. 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SAJ and NMA are investigators on a trial which digital weight loss interventions have been provided by Slimming World and Rosemary Conley to the participants of the trial free of charge. PA did half a day\u2019s consultancy for Weight Watchers and spoke at a symposium funded by Novo Nordisk. SAJ attended a 1-day meeting on digital health interventions, organised by Oviva UK Ltd, in which expenses were paid to the University of Oxford. None of these activities have led to personal payments. SAJ and PA are members of NHS England advisory boards relating to weight-loss interventions for the prevention and treatment of type 2 diabetes and obesity. RE, FG, MS and JM have no competing interests to declare.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}