{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T11:21:38Z","timestamp":1783682498225,"version":"3.55.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,4,16]],"date-time":"2020-04-16T00:00:00Z","timestamp":1586995200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,4,16]],"date-time":"2020-04-16T00:00:00Z","timestamp":1586995200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013373","name":"NIHR Oxford Biomedical Research Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013373","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["Applied Research & Care (Oxford)"],"award-info":[{"award-number":["Applied Research & Care (Oxford)"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Cambridge Weight Plan Uk Ltd"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Trials have shown total diet replacement (TDR) programmes are safe and effective for weight loss in primary care. However, it is not clear whether participant characteristics affect uptake, attendance, or effectiveness of the programme.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>We used data from 272 trial participants who were invited to participate in a clinical weight loss trial via a letter from their GP. We used a Cochran-Mantel-Haenszel analysis to assess whether accepting an invitation to participate in the trial differed by gender, age, BMI, social deprivation, and the presence of a diagnosis of type 2 diabetes or hypertension. We used mixed generalised linear modelling to examine whether participants\u2019 age, gender, or social deprivation based on area of residence were associated with weight change at 12\u2009months.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Men were less likely to enrol than women (RR 0.59 [95% CI 0.47, 0.74]), and people from the middle and highest BMI tertile were more likely to enrol than those from the lowest tertile (RR 2.88 [95% CI 1.97, 4.22] and RR 4.38 [95% CI 3.05, 6.07], respectively). Patients from practices located in most deprived and intermediate deprived tertiles were more likely to enrol compared with those in the least deprived tertile (RR 1.84 [95% CI 1.81, 2.59] and RR 1.68 [95% CI 1.18, 2.85], respectively). There was no evidence that age or a pre-existing diagnosis of type 2 diabetes (RR 1.10 [95% CI 0.81, 1.50]) or hypertension (RR 0.81 [95% CI 0.62, 1.04]) affected enrolment. In the TDR group, 13% of participants were low engagers, 8% engaged with the weight loss phase only, and 79% engaged in both weight loss and weight maintenance phases of the programme. Those who engaged in the entire programme lost most weight. Subgroup analyses suggested that older participants and those with a higher baseline BMI lost more weight at 1\u2009year than their comparators.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Despite some heterogeneity in the uptake and outcomes of the programme, if the results of this trial are replicated in routine practice, there is no evidence that TDR weight loss programmes would increase inequity.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Trial registration<\/jats:title>\n<jats:p>The DROPLET trial was prospectively registered on ISRCTN registry (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/doi.org\/10.1186\/ISRCTN75092026\">ISRCTN75092026<\/jats:ext-link>).<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12916-020-01547-4","type":"journal-article","created":{"date-parts":[[2020,4,16]],"date-time":"2020-04-16T02:02:49Z","timestamp":1587002569000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Heterogeneity in the uptake, attendance, and outcomes in a clinical trial of a total diet replacement weight loss programme"],"prefix":"10.1186","volume":"18","author":[{"given":"Nerys M.","family":"Astbury","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Tudor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"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":[[2020,4,16]]},"reference":[{"issue":"607","key":"1547_CR1","doi-asserted-by":"publisher","first-page":"e115","DOI":"10.3399\/bjgp13X663073","volume":"63","author":"M Lean","year":"2013","unstructured":"Lean M, Brosnahan N, McLoone P, McCombie L, Higgs AB, Ross H, et al. Feasibility and indicative results from a 12-month low-energy liquid diet treatment and maintenance programme for severe obesity. Br J Gen Pract. 2013;63(607):e115\u201324.","journal-title":"Br J Gen Pract"},{"key":"1547_CR2","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. Doctor referral of overweight people to low energy total diet replacement treatment (DROPLET): pragmatic randomised controlled trial. BMJ. 2018;362:k3760.","journal-title":"BMJ."},{"key":"1547_CR3","unstructured":"National Institute for Health and Clinical Excellence (NICE). Obesity: identification, assesment and management London; 2014."},{"issue":"6","key":"1547_CR4","doi-asserted-by":"publisher","first-page":"1234","DOI":"10.1038\/oby.2011.140","volume":"20","author":"SL Pagoto","year":"2012","unstructured":"Pagoto SL, Schneider KL, Oleski JL, Luciani JM, Bodenlos JS, Whited MC. Male inclusion in randomized controlled trials of lifestyle weight loss interventions. Obesity (Silver Spring). 2012;20(6):1234\u20139.","journal-title":"Obesity (Silver Spring)"},{"issue":"645","key":"1547_CR5","doi-asserted-by":"publisher","first-page":"e258","DOI":"10.3399\/bjgp16X684337","volume":"66","author":"AL Ahern","year":"2016","unstructured":"Ahern AL, Aveyard P, Boyland EJ, Halford JC, Jebb SA, Team W. inequalities in the uptake of weight management interventions in a pragmatic trial: an observational study in primary care. Br J Gen Pract. 2016;66(645):e258\u201363.","journal-title":"Br J Gen Pract"},{"issue":"10085","key":"1547_CR6","doi-asserted-by":"publisher","first-page":"2214","DOI":"10.1016\/S0140-6736(17)30647-5","volume":"389","author":"AL Ahern","year":"2017","unstructured":"Ahern AL, Wheeler GM, Aveyard P, Boyland EJ, Halford JCG, Mander AP, et al. Extended and standard duration weight loss referrals for adults in primary care (WRAP): a pragmatic randomised controlled trial. Lancet. 2017;389(10085):2214\u201325.","journal-title":"Lancet"},{"issue":"9801","key":"1547_CR7","doi-asserted-by":"publisher","first-page":"1485","DOI":"10.1016\/S0140-6736(11)61344-5","volume":"378","author":"SA Jebb","year":"2011","unstructured":"Jebb SA, Ahern AL, Olson AD, Aston LM, Holzapfel C, Stoll J, et al. Primary care referral to a commercial provider for weight loss treatment versus standard care: a randomised controlled trial. Lancet. 2011;378(9801):1485\u201392.","journal-title":"Lancet."},{"issue":"2","key":"1547_CR8","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1159\/000327249","volume":"4","author":"RJ Stubbs","year":"2011","unstructured":"Stubbs RJ, Pallister C, Whybrow S, Avery A, Lavin J. Weight outcomes audit for 34,271 adults referred to a primary care\/commercial weight management partnership scheme. Obes Facts. 2011;4(2):113\u201320.","journal-title":"Obes Facts"},{"key":"1547_CR9","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1186\/1471-2458-11-434","volume":"11","author":"AL Ahern","year":"2011","unstructured":"Ahern AL, Olson AD, Aston LM, Jebb SA. Weight watchers on prescription: an observational study of weight change among adults referred to weight watchers by the NHS. BMC Public Health. 2011;11:434.","journal-title":"BMC Public Health"},{"issue":"3","key":"1547_CR10","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1002\/oby.22407","volume":"27","author":"S Kent","year":"2019","unstructured":"Kent S, Aveyard P, Astbury N, Mihaylova B, Jebb SA. Is doctor referral to a low-energy total diet replacement program cost-effective for the routine treatment of obesity? Obesity (Silver Spring). 2019;27(3):391\u20138.","journal-title":"Obesity (Silver Spring)"},{"issue":"8","key":"1547_CR11","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016709","volume":"7","author":"SA Jebb","year":"2017","unstructured":"Jebb SA, Astbury NM, Tearne S, Nickless A, Aveyard P. Doctor referral of overweight people to a low-energy treatment (DROPLET) in primary care using total diet replacement products: a protocol for a randomised controlled trial. BMJ Open. 2017;7(8):e016709.","journal-title":"BMJ Open"},{"key":"1547_CR12","volume-title":"So you want to lose weight... for good","author":"British Heart Foundation","year":"2005","unstructured":"British Heart Foundation. So you want to lose weight... for good. London: BHF Publications; 2005."},{"key":"1547_CR13","unstructured":"Department for Communities and Local Government. The English indicies of Deprivation 2015 [Available from: https:\/\/www.gov.uk\/government\/statistics\/english-indices-of-deprivation-2015. Accessed 6 Nov 2019."},{"key":"1547_CR14","unstructured":"Department for Communities and Local Government. The English Indices of Deprivation 2015 Statistical Release 2015."},{"key":"1547_CR15","unstructured":"Office for National Statistics. 2011 Census analysis: Ethnicity and religion of the non-UK born population in England and Wales: 2011. 2015."},{"issue":"3","key":"1547_CR16","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1007\/s00125-017-4503-0","volume":"61","author":"R Taylor","year":"2018","unstructured":"Taylor R, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, et al. Clinical and metabolic features of the randomised controlled diabetes remission clinical trial (DiRECT) cohort. Diabetologia. 2018;61(3):589\u201398.","journal-title":"Diabetologia."},{"issue":"9669","key":"1547_CR17","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1016\/S0140-6736(09)60318-4","volume":"373","author":"GL Whitlock","year":"2009","unstructured":"Prospective Studies Collaboration, Whitlock GL, Sherliker S, Clarke P, Emberson R, Halsey J, Qizilbash J, Collins N, Peto R. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373(9669):1083\u201396.","journal-title":"Lancet."},{"issue":"5","key":"1547_CR18","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1080\/07315724.2003.10719316","volume":"22","author":"JW Anderson","year":"2003","unstructured":"Anderson JW, Kendall CW, Jenkins DJ. Importance of weight management in type 2 diabetes: review with meta-analysis of clinical studies. J Am Coll Nutr. 2003;22(5):331\u20139.","journal-title":"J Am Coll Nutr"},{"key":"1547_CR19","volume-title":"Social Inequalities and Public Health: Policy Press Scholarship Online","author":"M White","year":"2009","unstructured":"White M, Adams J, Heywood P. How and why do interventions that increase health overall widen inequalities within populations? In: Babones S, editor. Social Inequalities and Public Health: Policy Press Scholarship Online; 2009."},{"key":"1547_CR20","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1186\/1471-2458-14-444","volume":"14","author":"C Relton","year":"2014","unstructured":"Relton C, Li J, Strong M, Holdsworth M, Cooper R, Green M, et al. Deprivation, clubs and drugs: results of a UK regional population-based cross-sectional study of weight management strategies. BMC Public Health. 2014;14:444.","journal-title":"BMC Public Health"}],"container-title":["BMC Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12916-020-01547-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12916-020-01547-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12916-020-01547-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,16]],"date-time":"2021-04-16T01:17:21Z","timestamp":1618535841000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedicine.biomedcentral.com\/articles\/10.1186\/s12916-020-01547-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,16]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1547"],"URL":"https:\/\/doi.org\/10.1186\/s12916-020-01547-4","relation":{},"ISSN":["1741-7015"],"issn-type":[{"value":"1741-7015","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,16]]},"assertion":[{"value":"6 November 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 March 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 April 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The DROPLET study was conducted in accordance with the guidelines set out in the Declaration of Helsinki, and the study was reviewed and approved by NHS HRA Research Ethics Committee South Central Oxford B (ref: 15\/SC\/0337). Informed consent was obtained from all participants before they were enrolled on to the trial.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Susan A Jebb is an External Board Member. PA has done half a day\u2019s consultancy for Weight Watchers. He has also given a talk at an academic conference on weight management in a seminar supported by Novo Nordisk. Both led to payments to his institution but not to him personally. SAJ spoke at a meeting on digital health hosted by Oviva for which expenses and an honorarium were paid to the University of Oxford. The other authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"86"}}