Total Diet Replacement Programmes

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 changes to their diet and lifestyle. A TDR programme might be an option for you if you fall in the orange or red 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 <30 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/m^2.
• 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 to tell your GP that you're planning to undertake a TDR programme. However, in some circumstances, such as if you have certain health conditions or if you take certain classes of medication you may need to notify your GP of your intentions to undertake a TDR weight loss programme. Your GP will need to agree to monitor your condition and/or make adjustments to the medications you take.

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 generally available on referral from the NHS. So if you’re interested in undertaking a low-energy TDR programme you will usually have to pay for it yourself.

Providers of low-energy TDR programmes in the UK:

Cambridge Weight Plan UK Ltd	LighterLife	Counterweight Plus Programme	Optifast Weight Loss Programme

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.

Most people do not experience side effects whilst undertaking TDR, but a few people report:

• Bad breath.
• Abdominal pain.
• Diarrhoea.
• Headache.
• Hair loss.
• Dry skin.
• Mood changes.
• Feeling cold.
• Tiredness/fatigue.
• Constipation.
• Dizziness.

Most of these side effects do not pose a risk to your health. However, if you experience prolonged side effects which do not subside when you begin to eat normal food again, you should seek medical advice.diarrhoea

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.