Comparing the acceptability of total diet replacement and food-based low energy diets for type 2 diabetes remission amongst South Asians: a public and patient involvement activity

Abstract

Background: With type 2 diabetes prevalence rising, low energy diets (total diet replacement and food-based low energy diets) are increasingly used to induce weight loss and achieve diabetes remission. The effectiveness of these diets has been primarily tested in the UK white population but not in the south Asian population at high risk of diabetes. Obtaining the opinion of members of the community on what would constitute a culturally acceptable diet is essential for successful interventions aiming to achieve diabetes remission in south Asians. Methods: We organised two patient and public involvement activities in the North West of England to understand views of people from the south Asian population on whether low energy diets (850 Kcal) in the form of total diet replacement or food-based meals, are acceptable dietary interventions to achieve type 2 diabetes remission. Results: Thirteen people, with either type 2 diabetes or having someone with diabetes in the family attended a virtual or a face-to-face meeting. Low energy total diet replacement in the form of soups and shakes was considered unacceptable, while there was a preference for a culturally tailored low energy food-based diet. Ready-made portion controlled catered meals were suggested as a likely approach to improve adherence. Conclusions: This work provided valuable insights to shape a future study looking at the feasibility of a catered meal low-energy dietary intervention to induce T2D remission in primary care within the south Asian population.

A qualitative study of the perceptions and experiences of participants and healthcare professionals in the DiRECT‐Australia type 2 diabetes remission service

“…One of the major challenges in recruiting participants reported by the HCPs included hesitation towards undertaking total diet replacement for 12 weeks. This resonates with the findings of a prior study where there was low acceptance towards 12‐week total diet replacement for diabetes remission because of reasons such as the requirement of long‐term commitment and perceived need of solid foods to have a fulfilling diet 24 . The hesitation could be amplified especially with the availability of recent medications that can result in significant weight loss but with potential side effects 25 .…”

“…This resonates with the findings of a prior study where there was low acceptance towards 12-week total diet replacement for diabetes remission because of reasons such as the requirement of long-term commitment and perceived need of solid foods to have a fulfilling diet. 24 The hesitation could be amplified especially with the availability of recent medications that can result in significant weight loss but with potential side effects. 25 However, highlighting that sustained remission is achievable through a structured diabetes remission programme, along with presenting supporting evidence from prior studies, 8,9 may help motivate potential participants.…”

South Asian individuals’ experiences on the NHS low-calorie diet programme: a qualitative study in community settings in England

“…However, previous research has looked at perspectives of people of South Asian ethnicity in dietary programmes and found similar results; individuals wanted multilingual support, peer support and help with challenges around social and cultural factors such as family dynamics 41–43. Furthermore, research exploring acceptability of TDR and low energy diets in South Asian populations found participants had a preference for culturally tailored low energy food-based diet and that spices needed to be included to support with their home culture 44…”

Do people with type 2 diabetes find continuous and intermittent low‐energy diets for weight loss and diabetes remission acceptable?

“…Codeveloping and evaluating tailored interventions which are more culturally acceptable may help to ensure LED interventions are accessible and acceptable to specific high-risk populations. 29 At the time of the interviews (week 12 CLED; week 28 ILED) 4 CLED participants (out of 40) and 7 ILED participants (out of 39) had withdrawn from the study. An important and acknowledged further study limitation is that we did not interview participants who dropped out during the intervention stage or who opted not to take part in the study, although two of the participants interviewed (one CLED; one ILED) did subsequently withdraw from the trial after interview and before the end of the full 52-week study period (see Table 2).…”