The milk shakes are on the NHS!


Yesterday the British Medial Journal came up with the genius idea that obese people should go on a total diet replacement programme. I'm assuming they mean drink shakes and go on a diet.

Smashing, lets prescribe a very low calorie / starvation diet if we feel you are too fat (you need a BMI over 30), regardless if you have any associated disease or not. 

Traditionally, people who are 'severely overweight' (BMI > 35 or 40) can be prescribed a very low calorie diet (VLCD) to facilitate rapid weight loss, sometimes in preparation for bariatric, or weight loss surgery. The decision to recommend a VLCD is often not taken lightly but when someone has serious coexisting medical conditions, the risk of doing nothing outweighs the risk of adopting a very strict diet. But that may be about to change......

In this recent study that took place in Oxford, 138 people were put on a VLCD for 12 weeks to see if it would enable faster and more significant weight loss than the standard approach, regardless of risk factor profile.

Check this out, it sounds truly delicious........

The day would typically start with a 150 Cal bowl of porridge mix. You can also have a low (145) calorie protein shake, a packet soup (138 Cals) for lunch, maybe another shake or glass of skimmed milk and a snack bar (150 Cals) 

So all food is replaced for 3 lonnnnnnnnnggggg months and they got counselling on the side. Then they were then asked to continue having a shake to replace one meal a day for another 6 months.

The other lucky people received traditional weight loss advice and counselling.

If you haven't read the article here comes the SPOILER ALERT.............

The people on the VLCD lost more weight than the people on the standard weight loss programme. I know, quelle surprise!

I must add that the study was part funded by Cambridge Weight Plan UK (aka The Cambridge Diet).............I'm just going to leave that thought there.

Here are some comments from the BBC news report yesterday: 

1. People on the diets lost three times more weight than those given standard dietary advice by their GP, University of Oxford researchers found.

No shit Sherlock! They were living on 800 Calories!

2. And their risk of developing heart disease and type-2 diabetes reduced.

That's a mighty big assumption about cause and effect here! Considering they didn't even measure activity / exercise, they can't claim the weight loss directly resulted in improvements in health!

They also didn't consider the impact of weight stigma and the associated stress on health outcomes. Discriminating someone because of their weight or size has been shown to account for many of the risk factors linked to having a higher weight.

It makes good sense if someone is to lose weight, they would experience less discrimination and therefore less stress right, but this was ignored.

3. Experts said it would work only if eating habits were changed for good.

So excuse me for stating the obvious, but what does DRINKING shakes and soup every day teach us anything about EATING habits? Confidence is not high with this one.

4. Prof Paul Aveyard, study author, GP and professor of behavioural medicine at the University of Oxford, said losing weight and keeping it off was hard.

It is likely that most of the participants will not be able to keep the weight off. In fact the data shows they had already regained ~⅓ of the weight they lost by the end of the study (at 12 months). Research shows it is also likely they will regain all the weight lost plus more within the next 3-5 years.

This weight cycling (yo yo dieting) has many negative consequences, including an increase in visceral fat - the stuff that sits around your organs. It's THIS fat that can increase the risk of diabetes and heart disease.

5. "It's boring being on a normal diet and people struggle to stick to it for a year," he said. "But these programmes get you when your mental strength is at its highest.

But drinking the same thing every day is NOT boring then? Making the sharing of eating experiences non existent?  Removing so much enjoyment form life? Demoralising the most positive? You may start out motivated and determined but I reckon you'll end up broken.

Please NHS, do NOT adopt this approach to 'combating obesity' It will FAIL! This DROPLET trial simply isn't good enough or long enough to warrant such drastic action.

For any budding nutrition nerds out there, here's the original BMJ paper


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