(Press-News.org) An intensive low-energy diet programme, similar to the NHS Type 2 Diabetes Path to Remission, significantly improved eating disorder symptoms in people with type 2 diabetes and excess weight who were at risk of developing eating disorders, according to a University of Oxford study published today in The Lancet Psychiatry.
Participants enrolled in a total diet replacement (TDR) programme experienced significant improvements in eating disorder symptoms which persisted six months after the programme finished when participants had regained some weight. This directly addresses a research gap highlighted by recent National Institute for Health and Care Excellence (NICE) guidance on the use of ‘Low-energy and very-low-energy diets for adults’ in Overweight and obesity management, which noted a lack of evidence on the psychological impact of restrictive diets.
"As a dietitian, I've seen first-hand how both eating disorders and type 2 diabetes can impact the quality of people's lives," said lead author Dr Elena Tsompanaki, a registered dietitian who led the study as part of her doctoral research at the Nuffield Department of Primary Care Health Sciences, University of Oxford. "Our findings challenge the assumption that weight loss programmes worsen eating disorder symptoms in vulnerable people, potentially opening up important treatment options that many patients might have previously been denied."
The researchers recruited 56 participants with type 2 diabetes (diagnosed within the last six years), overweight or obesity, and existing eating disorder symptoms identified via a validated questionnaire (called Eating Disorders Examination Questionnaire or EDE-Q). Half were assigned to receive a low-energy (~860 kcal/day) TDR programme with behavioural support for six months – similar to the NHS Path to Remission programme- while the control group received usual diabetes care from their GP. It assessed four types of symptoms: restraint eating, eating concerns, shape concerns, and weight concerns.
Key findings:
Eating disorder symptoms significantly improved in the TDR group compared to usual care at 6 months (-0.8 points EDE-Q difference) and this benefit persisted at 12 months (-0.7 points).
The TDR group also saw significant reductions in depression and diabetes distress symptoms at 6 and 12 months compared to usual care.
The TDR group lost more weight at 6 months (-13.9kg vs -3.7kg), but the difference between groups was no longer statistically significant at 12 months.
Crucially, no participants were suspected of developing a new eating disorder.
Professor Susan Jebb, OBE, study author and Professor of Diet and Population Health at the Nuffield Department of Primary Care Health Sciences, who was also involved in evaluating the NHS Path to Remission programme, commented: "The NHS Path to Remission programme is already showing promising results, with 27% of participants achieving diabetes remission at one year. Our new findings provide reassurance that these programmes can be safely offered to patients with symptoms of eating disorders, providing an opportunity for them to benefit from these effective treatments."
The findings are important as there have been concerns that weight loss programmes, like the NHS Path to Remission, might not be safe or appropriate for people at high risk of eating disorders who might otherwise benefit from weight loss.
Dr Dimitrios Koutoukidis, senior author also based at the Nuffield Department of Primary Care Health Sciences, added: "This study provides crucial reassurance that this type of intervention does not appear to harm, and may even benefit, people with type 2 diabetes already experiencing eating disorder symptoms. It suggests that receiving structured support to lose weight may improve not only the physical health of this vulnerable group but also aspects of their mental health too.
"Low-energy total diet replacement programmes can be a very effective option for those who wish to give them a go to manage their diabetes," Dr Tsompanaki concluded. "I hope these results help patients and healthcare professionals feel more confident in navigating the discussion around these treatment options."
Limitations include the small sample size and participant demographics (see Notes). The team, who worked with patient advisors throughout the study, are continuing to follow-up participants to explore how their eating disorder symptoms change in the longer term.
Notes to Editors
Publication: ‘An intensive weight loss programme with behavioural support for people with type 2 diabetes at risk of eating disorders: the ARIADNE non-inferiority randomised controlled trial’ The Lancet Psychiatry
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(25)00126-9/fulltext (after embargo lifted at 00:01 BST Wednesday 11 June 2025)
Media contact: Communications Team, Nuffield Department of Primary Care Health Sciences, University of Oxford. Email: communications@phc.ox.ac.uk
Funding: This trial was funded by the Novo Nordisk UK Research Foundation (Doctoral Fellowship to ET). Further support from NIHR Advanced Fellowship (DK), NIHR Oxford Biomedical Research Centre (SJ, PA, DK), NIHR Applied Research Collaboration Oxford and Thames Valley (SJ). Medichecks donated HbA1c kits (used to diagnose diabetes, diabetes risk, or monitor blood sugar levels). The funders had no role in study design, data collection, data analysis, data interpretation, or writing of the study. Views are authors' own.
Limitations: Limitations noted by the authors include online recruitment; a modest skew towards more affluent, White ethnic background participants vs UK diabetes population; self-reported weight; small sample size (n=56), relatively short-term follow-ups.
Patient and Public Involvement:
Eight public members advised on study design, materials, and delivery.
The NHS Path to Remission programme is offered to people within the first 6 years of diagnosis of type 2 diabetes. It uses a similar total diet replacement programme and early evaluation has shown 27% of people with available data achieved remission at 1 year. https://pubmed.ncbi.nlm.nih.gov/39116897/
About the University of Oxford
Oxford University has been placed number 1 in the Times Higher Education World University Rankings for the ninth year running, and number 3 in the QS World Rankings 2025. At the heart of this success are the twin-pillars of our ground-breaking research and innovation and our distinctive educational offer.
Oxford is world-famous for research and teaching excellence and home to some of the most talented people from across the globe. Our work helps the lives of millions, solving real-world problems through a huge network of partnerships and collaborations. The breadth and interdisciplinary nature of our research alongside our personalised approach to teaching sparks imaginative and inventive insights and solutions.
Oxford University’s Medical Sciences Division is one of the largest biomedical research centres in Europe, with over 2,500 people involved in research and more than 2,800 students. The University is rated the best in the world for medicine and life sciences, and it is home to the UK’s top-ranked medical school. It has one of the largest clinical trial portfolios in the UK and great expertise in taking discoveries from the lab into the clinic. Partnerships with the local NHS Trusts enable patients to benefit from close links between medical research and healthcare delivery.
Within the division, the Nuffield Department of Primary Care Health Sciences is the largest centre for academic primary care in the UK, and leads world-class research and training to rethink the way healthcare is delivered in general practice and other primary care settings. The department’s main research focus is on the prevention, early diagnosis and management of common illness, bringing together academics from many different backgrounds to work together to produce benefits for the NHS, for populations and for patients. www.phc.ox.ac.uk
END
Intensive weight loss programme improves eating disorder symptoms in people with Type 2 Diabetes at risk of eating disorders, Oxford study finds
2025-06-10
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