Non-surgical weight loss programme can combat severe obesity

Groundbreaking research from the University of Glasgow shows clear evidence for a viable clinical programme to address the so-called ‘intervention gap’ in obesity. This refers to the high proportion of people needing and looking for effective weight management who need to lose more weight than is achievable through traditional lifestyle-based programmes, but who don’t want or can’t access bariatric surgery. The NHS Scotland guidelines say obese people with a BMI over 35 or over 30 with medical complications such as type 2 diabetes, sleep apnoea, hypertension, dpression or arthritis - should aim to lose 15kg (33 pounds).

Conventional diet and lifestyle-based options typically only achieve around 5 percent loss. The programme known as Counterweight-Plus is a well-supported intensive dietary programme that includes: Total Diet Replacement (TDR) for 8-12 weeks, followed by food reintroduction, and long-term weight loss maintenance. It is delivered by staff who have had 12 hours training, with ongoing specialist support and access to medical consultant expertise. The TDR provides 825-853 kcal per day from nutrionally complete soups and shakes plus 50ml low fat milk for teas and coffees. The programme was originally developed under funding from the Scottish Government Health Department in collaboration between the University of Glasgow and Robert Gordon University Aberdeen. It was used in the recently-published landmark DiRECT trial, funded by Diabetes UK, which generated 86 percent remissions of type 2 diabetes with weight loss >15kg, and 73 percent with weight loss >10kg.

Lead author Louise McCombie, research associate at the University’s School of Medicine, Dentistry and Nursing said: “Our research is the first published evaluation of a weight management programme involving a phase of Total Diet Replacement outside of a clinical trial. We found great need for a non-surgical intervention like Counterweight-Plus because the patients we looked at had severe and medically complicated obesity, requiring more than conventional ‘lifestyle only’ programmes. Not only that, but access to bariatric surgery is limited in the UK and holds limited appeal for many people”.

Details on Counterweight-Plus are included in the Scottish Government Framework for prevention and management of type 2 diabetes.

Joe FitzPatrick, Scotland’s Minister for Public Health, said: “Two out of three adults in Scotland are overweight or obese, which is the most significant risk factor for developing type 2 diabetes. This research adds to the growing evidence that significant and sustained weight loss can lead to type 2 diabetes going into remission.

“The Counterweight-Plus programme is being considered in our national framework on prevention and early intervention, which we are supporting with £42 million of investment over five years.”