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Related Experiment Video

Updated: May 31, 2026

'Boden Food Plate': Novel Interactive Web-based Method for the Assessment of Dietary Intake
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Evaluation of the NHS England Low-Calorie Diet implementation pilot: a coproduced mixed-method study.

Louisa J Ells1, Tamara Brown1, Jamie Matu1

  • 1Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK.

Health and Social Care Delivery Research
|August 2, 2025
PubMed
Summary

The National Health Service (NHS) low-calorie diet program effectively supports weight loss and type 2 diabetes management. Improvements in equity, uptake, and delivery are recommended for wider adoption.

Keywords:
BEHAVIOUR CHANGEMIXED METHODSOBESITYOVERWEIGHTREMISSIONSERVICE EVALUATIONTOTAL DIET REPLACEMENTTYPE 2 DIABETES

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Area of Science:

  • Public Health
  • Health Services Research
  • Behavioural Science

Background:

  • The National Health Service (NHS) England piloted a low-calorie diet program using total diet replacement and behavior change support for adults with excess weight and type 2 diabetes.
  • Delivery methods included 1:1, group, or digital formats to improve health outcomes.

Purpose of the Study:

  • To conduct a qualitative and economic evaluation of the NHS low-calorie diet pilot.
  • To understand long-term cost-effectiveness, implementation, equity, and transferability across diverse populations.

Main Methods:

  • A mixed-methods study using a realist-informed approach.
  • Included semistructured interviews (n=67 users, n=55 staff, n=9 providers), focus groups (n=13), and user surveys (n=719).
  • Findings were triangulated with NHS clinical data (n=7540).

Main Results:

  • 55% of users completed the program, averaging 10.3 kg weight loss; 32% achieved type 2 diabetes remission.
  • Barriers included referral inequality and COVID-19; facilitators were cross-stakeholder collaboration.
  • Implementation fidelity varied, with identified needs for person-centered care and improved total diet replacement delivery.

Conclusions:

  • The NHS low-calorie diet program is clinically effective and potentially cost-effective for weight loss and glycemic control in type 2 diabetes.
  • Identified areas for improvement include referral equity, uptake, completion, and delivery fidelity.
  • Recommendations informed national rollout, with ongoing monitoring and long-term follow-up needed.