Low Calorie Liquid Diet (LCLD) Pilot

1. Low Calorie Liquid Diet (LCLD) Pilot Gillian Clarke - Clyde Team Lead/Advanced Dietitian October 2013

2. Rationale behind LCLD • Eating less leads to weight loss. • Having the choice at mealtimes/snacks can be very difficult for some to control their intake. • Requires more effort for example weighing out food/counting portions.

3. LCLD Pilot – Aims • To improve adherence to a recommended calorie prescription by removing food choices and replacing food with liquids. • To achieve a 10kg minimum weight loss over a 12 week period. • To measure the effect of liquid diet induced weight loss on patients’ mood/quality of life and eating behaviours. • To support patients with reintroducing food.

4. Why use liquid meal replacements for weight loss? • Evidence shows use of liquid MR as part of a calorie-controlled diet is an effective strategy for long-term maintenance of weight loss as well as the promotion of short-term weight loss compared with a traditional reduced calorie diet. (Ashley et al. 2001)

5. Why use liquid meal replacements for weight loss? • Provides a structured eating pattern. • Easy to follow. • Makes it easier to plan and prepare meals. • Removes food choices – improve accuracy of energy intake. • Patients can often under estimate their calorie intake (Samaras et al, 1999; Mertz et al, 1991). • Can improve nutritional adequacy (vitamins and minerals).

6. Use within GCWMS • Additional intensive treatment option as part of specialist service. • To support patients in following a low calorie diet by removing food choices and being in a liquid form. • To promote motivation to engage with the programme due to good weight losses. • Change in surgery criteria - LCLD may be an ‘alternative’ to surgery for those not eligible.

7. Exclusions • Any patients who had completed phase 1 and whose BMI <30kg/m2. • Patients with diabetes on medications other than Metformin. • No evidence to exclude patients with disordered eating/binge eating. • Upper age limit consideration - <70yrs old for pilot.

8. Recruitment • Patients were recruited from groups having completed at least phase 1 of the programme. • Patients attended an information session on the LCLD pilot. • Written consent obtained from all participants.

9. Pilot Design • Patients energy requirements calculated and they were provided with a 1200 calorie deficit diet. • LCLD plans were 1000/1200/1500 calories. • Plans devised from over the counter meal replacements and a homemade version which patients had to self-purchase. • All plans were nutritionally analysed considering protein, vitamins, minerals and fibre content against recommended amounts for adults.

11. Some individual patient results

12. Patient feedback • “I feel a lot better a lot healthier, lost weight and surprised myself.” • “Big improvements, not tired, feeling good and being very active.” • “Ability to control what I eat, listening to my body to find out if I'm actually hungry.” • “I have more will power than I realised. A lot of my eating is just for the sake of it.”

13. Food reintroduction phase (16 weeks) • Gradually reintroduced one meal at a time, revisiting portion guide as covered in phase 1 of programme. • Continuing on at least a 600 calorie deficit diet. • Aiming to return to a healthy balanced calorie-controlled diet.

14. LCLD Pilot results – Food reintroduction phase

16. Next stage - ongoing • Patients currently in the weight maintenance phase of the programme. • Preliminary results at 1 year post LCLD mean weight loss of 7.7kgs maintained (8/12 patients still in the programme).

17. Evaluation • Range of outcomes being collected including: - weight loss - weight regain - weight maintenance. • Psychologists have developed psychology assessments using QEWP-R, HADS, QOL questionnaires throughout LCLD phase for quantitative results. • Qualitative data will also be gathered.

18. Research • Poster of findings exhibited at European Congress on Obesity, Liverpool (May 2013). • Also exhibited at AHP National Conference, Edinburgh (October 2013).