An intensive weight loss program didn’t worsen eating disorder symptoms — in fact, it helped reduce them. That’s the key takeaway from a new University of Oxford study that challenges assumptions about how restrictive diets affect people with type 2 diabetes who are at risk of disordered eating.
The 12-month randomized trial involved 56 adults with type 2 diabetes and symptoms of eating disorders. Half followed a low-energy total diet replacement (TDR) plan, similar to the NHS Path to Remission program, a structured UK initiative that uses meal replacement shakes and behavioral support to help people with type 2 diabetes lose weight and potentially achieve remission. The others received usual care from their primary providers.
Those in the TDR group showed significantly greater improvements in eating disorder symptoms, including reduced concerns about weight, shape and eating, compared to the control group — and those benefits persisted even six months after the program ended.
“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,” said lead author Dr. Elena Tsompanaki, a registered dietitian and doctoral researcher at Oxford.
Participants in the TDR group also experienced greater weight loss and reduced symptoms of depression and diabetes-related distress, without any new cases of eating disorders developing.
“This type of intervention does not appear to harm, and may even benefit, people with type 2 diabetes already experiencing eating disorder symptoms,” said senior author Dr. Dimitrios Koutoukidis.
Researchers say the study, published in The Lancet Psychiatry, offers reassurance for clinicians hesitant to offer structured dietary programs to people with disordered eating risk, as long as behavioral support is included. Longer-term follow-up is underway.
This study was funded by the Novo Nordisk UK Research Foundation, with additional support from the National Institute for Health and Care Research (NIHR), including the NIHR Oxford Biomedical Research Centre and NIHR Applied Research Collaboration Oxford and Thames Valley. Medichecks provided HbA1c testing kits. The funders had no role in the design, data collection, analysis, interpretation or writing of the study.