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Primary and secondary outcome measures: This paper reports retention and adherence to the programme, weight loss, changes in mental well-being, quality of life (QoL), weight loss self-efficacy, physical activity and fidelity of delivery of the programme.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      37 women (79%) completed the whole programme. Completers and those who withdrew, respectively, had a mean (SD) age of 41.4 years (5.7) vs 38.1 (5.8) and baseline body mass index of 36.2 (4.9) kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      vs 40.0 (7.9) kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      and 76% vs 90% had children 18 or younger living at home. Median (IQR) weight was reduced at all time points; \u221210.8 kg (\u221213.8, \u22127.2) at 3 months, \u221211.5 kg (\u221215, \u22127.6) at 6 months, \u221211.0 kg (\u221216.4, \u22127.8) at 9 months and \u22128.4 kg (\u221213.9, \u22123.7) at 12 months. Across the 12-month programme, the median (IQR) contacts with the study dietitians per participant was 28 (25, 33) and median contact hours were 7.6 (6.6, 10.6). 68% received psychological support. QOL improved; OWL-QOL (Obesity and Weight Loss)\u221217 (\u221224.8, \u22127.8) and EQ5D 1 (0, 2), with reductions in binge eating scores \u22124 (\u22126.5, \u22120.8) but no changes in mental health or physical activity scales.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>TDR could be a weight loss programme for women at increased risk of breast and endometrial cancers related to obesity. Future controlled trials with extended follow-up are required before recommending routine implementation of TDR in high-risk clinics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" xlink:href=\"ISRCTN15358157\">ISRCTN15358157<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-119498","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:00:48Z","timestamp":1790614848000},"page":"e119498","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Adherence and weight loss with a total diet replacement programme for increased cancer risk associated with obesity: a UK cohort study"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"isrctn15358157","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4110-8926","authenticated-orcid":false,"given":"Helen","family":"Clarke","sequence":"first","affiliation":[{"name":"Department of Gynaecological Oncology, St. Mary\u2019s Hospital, Manchester University NHS Foundation Trust, Manchester, UK"},{"name":"Division of Cancer Sciences, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8919-9493","authenticated-orcid":false,"given":"Cheryl","family":"Lombardelli","sequence":"additional","affiliation":[{"name":"The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Barrett","sequence":"additional","affiliation":[{"name":"Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1698-5014","authenticated-orcid":false,"given":"Julie","family":"Wisely","sequence":"additional","affiliation":[{"name":"Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharine","family":"Sellers","sequence":"additional","affiliation":[{"name":"The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basil","family":"Issa","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes, Manchester University NHS Foundation Trust, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Howell","sequence":"additional","affiliation":[{"name":"Division of Cancer Sciences, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma J","family":"Davidson","sequence":"additional","affiliation":[{"name":"Department of Gynaecological Oncology, St. Mary\u2019s Hospital, Manchester University NHS Foundation Trust, Manchester, UK"},{"name":"Division of Cancer Sciences, The University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sacha","family":"Howell","sequence":"additional","affiliation":[{"name":"Division of Cancer Sciences, The University of Manchester, Manchester, UK"},{"name":"The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9761-3089","authenticated-orcid":false,"given":"Michelle","family":"Harvie","sequence":"additional","affiliation":[{"name":"Division of Cancer Sciences, The University of Manchester, Manchester, UK"},{"name":"The Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust, Manchester, UK"},{"name":"Manchester Academic Health Science Centre, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"2026092810001944000_16.9.e119498.1","doi-asserted-by":"crossref","DOI":"10.1093\/jncics\/pkz054","article-title":"Intentional Weight Loss and Obesity-Related Cancer Risk","volume":"3","author":"Luo","year":"2019","journal-title":"JNCI Cancer Spectr"},{"key":"2026092810001944000_16.9.e119498.2","doi-asserted-by":"crossref","unstructured":"Fabian CJ , Kimler BF , Donnelly JE , et al . 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