Could the NHS-backed 800-calorie ‘soup and shake’ diet work for you?

Today’s crash diets are a far cry from the nutritionally poor single-food ones – such as cabbage soup and grapefruit. The NHS year-long programme consists of total diet replacement with nutritionally balanced shakes, soups, porridges and bars for three months, after which participants reintroduce ‘real’ food. Online one-to-ones, group sessions and digital support are essential ingredients to keep people on track.  

The pilot, which is due to continue until at least next April, was inspired by the revolutionary Diabetes Remission Clinical Trial (DiRECT), which in 2018 revealed that an 800-calorie-a-day ‘crash diet’ along the same lines sent Type 2 diabetes packing, scuppering the idea that the condition was lifelong. New findings from a three-year extension of the trial, funded by Diabetes UK, show that almost a quarter (23%) of participants who were in remission at two years in the original trial remained so five years later. 

“People lose lots of weight quickly, which motivates them to keep going,” says Dr Duncan Radley, reader in obesity at Leeds Beckett University, part of a team evaluating the NHS programme.

To be eligible you must be under 65 with a BMI of over 27 (White ethnicities) or over 25 (Black, Asian and other ethnicities) and have been diagnosed with Type 2 diabetes in the last six years. 

“Because of its high protein content, participants don’t feel hungry,” says Dr Radley. 

“Once past initial hiccups, such as headaches and constipation, most find it easy to fit into their lives. People say they feel full, have more energy and are less tired. Their blood sugar readings improve and they can reduce their medication.”

There’s no doubt that finding effective ways to lose weight is an urgent matter; three quarters of people aged 45-70 are overweight or obese. A report from Diabetes UK earlier this year revealed that 4.3 million people are living with diabetes and more than 2.4 million are at high risk of developing it.

Obesity (a BMI of 30+) also increases the risk of heart disease, asthma, high cholesterol, osteoarthritis, high blood pressure, sleep apnoea, and some cancers. 

“Maintaining a healthy weight in later life can help mitigate these risks as well as reduce the need for medications, such as blood pressure lowering drugs,” says nutrition scientist Dr Nerys Astbury of Oxford University, a senior researcher on another soups and shakes trial called DROPLET (Doctor Referral of Overweight People to Low Energy Treatment).

Participants were overweight but didn’t have diabetes and lost an average of 10.7kg – three times  as much as those who followed conventional dietary advice from the GP. “Losing weight is tough mentally, meaning that it can be hard to sustain a diet long enough to reap the health benefits,” she says. “Crash dieting can be easier than conventional portion control, especially if you have a lot to use.”

One reason experts previously favoured a slower approach was the belief that the quicker you shed the kilos the quicker you put them on again. Not so, says Astbury, citing an Australian study which found that, over two years, people who had lost weight fast were no more likely to pile it back than those who lost it more slowly.  A follow-up of the DROPLET trial also discovered that the benefits of steep initial weight loss lasted at least three years, even with some weight gain. 

What about the charge that these ‘meals’ aren’t real food and don’t teach people how to eat healthily? Actually, it can be a relief to have a breather from planning and cooking, and gives you a chance to reshape eating habits, says Roy Taylor, professor of medicine and metabolism, at the University of Newcastle, who led DiRECT. “In fact, the quality of many participants’ diets improves because they are no longer eating high-calorie, highly-processed foods,” he says. 

But isn’t it better to have a bit more flesh on our bones as we get older? It’s true the picture becomes muddier over the age of 65. The NHS soups and shakes programme has a cut-off at this point, mainly, suggests Radley, because the data isn’t yet there to support it, not because it doesn’t work.

However, experts say that the clear association between BMI and the risk of dying is less marked at older ages. A 2014 meta-analysis hinted that there was a sweet spot for older people at around a BMI of 27-27.9 when the risk of death is lowest. 

That said, experts say if you’re prone to putting on weight, the occasional ‘crash diet’ could be a positive move, as long as it’s nutritionally balanced. If total diet replacement feels a step too far there are real food options. GP Dr Clare Bailey, wife of TV’s Dr Michael Mosley, has recently written The Fast 800 Keto Recipe Book (£10, Amazon), which claims you can shed a stone in 21 days. 

“The benefits of being slim are so overwhelming that if you need to go on a low-calorie diet every so often it shouldn’t be seen as a failure,” says Astbury. “The right diet for you is the one you can stick to.”

To see if you’re eligible visit NHS Type 2 Diabetes Path to Remission Programme or ask your GP or diabetes treatment team at your next appointment.