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Low-energy Total Diet Replacement (TDR) programmes, comprise of two essential components:

A period of low-energy total diet replacement:

You’ll be asked to replace all your foods with a number of formula products such as soups shakes and bars which, if used as directed will provide between 800–1200kcal/day and supply all the nutrients you need. As a result this total diet replacement phase can be followed for periods of up to 12 weeks.

A programme of behavioural support:

You will meet with a specially trained counsellor (individually or in groups) who will offer you tailored support, encouragement, motivation, goal setting, problem solving to assist your weight loss journey and help you develop techniques and skills to maintain the weight you lose when you are back eating conventional foods again.

Low energy TDR programmes are suitable for most people who have more than a few kilogrammes to lose, and have remained overweight despite making health changes to their diet and lifestyle. A TDR programme might be an option for you if you fall in the pink zone on the figure below:

However, TDR programmes are not suitable for everybody, and others, who suffer from certain conditions or take certain classes of medications may require their GP to review and adjust their medications before they begin the programme.

A TDR programme is NOT suitable for you if you are:

  • Aged <18 years.
  • Have a BMI >20 kg/m2
  • Alcoholic.
  • Taking anti-obesity medication.
  • Having cancer treatment.
  • Experienced a heart attack or stroke in the past three months.
  • Taking monoamine oxidase inhibitor (MAOI) medication.
  • Pregnant, breastfeeding or have given birth in the past 3 months.
  • A substance misuser.

In some instances, although you may not suitable for the low-energy TDR programme, you may be able to do a modified version. If any of the following apply you should contact individual providers for more information. On your suitability:

  • Your BMI >40kg/m2.
  • You have diabetes insipidus.
  • Your suffer from gout.
  • You have psoriasis treated with tablet or injection.
  • You have rheumatoid arthritis treated with medication.
  • You have angina.
  • You have arrythmia.
  • Take fertility medication.
  • You have type 1 diabetes, or type 2 diabetes controlled by insulin.
  • You have epilepsy.
  • You have a heart conditions.
  • You have kidney disease/failure.
  • You have liver disease/failure.
  • You suffer from pophyria.
  • You have a history of eating disorders.

If you are healthy and don’t take any medications you do not need the permission of your GP to undertake a TDR programme. However, in some circumstances, such as if you take medications for type 2 diabetes or hypertension, you will need your GP to adjust your medications before you commence the programme:

  • You have type 2 diabetes, controlled by diet or oral medications.
  • You have been diagnosed with hypertension and take medication to control your blood pressure.
  • You take lithium.
  • You take diuretics (water tablets).
  • You take blood thinning medication like warfarin.

Currently TDR programmes are not available on referral from the NHS. So if you’re interested in undertaking a low-energy TDR programme you will have to pay for it yourself. Providers of low-energy TDR programmes in the UK:

Please contact your chosen provider for more information on what’s involved, costs, availability of these programmes in your area as well as information on whether you are eligible and advice on whether they recommend informing your GP.

In general if you are healthy, and don’t take any medications, no you won’t need your GP’s permission to go on a TDR programme. However, in certain circumstances, such as if you have certain health conditions or if you take some classes of medication you may need to notify your GP of your intentions to undertake a TDR weight loss programme, and they will need to agree to monitor your condition and/or make adjustments to the medications that you take. In some instances it might be your providers’ policy to notify your GP, even if you do not need their agreement to make medication adjustments.

This is so that a note can be placed on your medical record, so if you do have any health issues you can be treated appropriately by the person you see.

In the DROPLET study side effects were closely monitored. Although mild side effects were more common in the patients assigned to the low-energy TDR programme than those assigned to the usual care programme, the incidence of more severe side effects (those rated moderate or above) was roughly the same in both groups.

Side effects more common in those assigned to the TDR programme:

  • Bad breath.
  • Abdominal pain.
  • Hair loss.
  • Dry skin.
  • Tiredness/fatigue.
  • Constipation.
  • Dizziness.
  • Gallstones.

This information was developed with support from the National Institute for Health Research's Oxford Biomedical Research Centre and the Collaboration for Leadership in Applied Health Research and Care Oxford. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.