Efficacy and acceptability of very low energy diets in overweight and obese people with Type 2 diabetes mellitus: a systematic review with meta‐analyses
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Aims: To explore the efficacy and acceptability of very low energy diets in overweight or obese adults with Type 2 diabetes. Methods: Controlled trials and qualitative studies of individuals with Type 2 diabetes that compared very low energy diets with standard care, minimal interventions, other weight loss interventions, less intensive very low energy diet interventions and very low energy diets with additional components were eligible for inclusion. Meta‐analyses of changes in weight, blood glucose levels and attrition rates were performed. Acceptability of very low energy diets was assessed by attrition rates, number and severity of side effects, and by qualitative evaluations of the interventions. Results: Four randomized, five non‐randomized controlled trials and no qualitative studies (21 references, 9 studies, 346 participants) were identified. Meta‐analyses showed that very low energy diets induced greater weight losses than minimal interventions, standard care or low energy diets at 3 and 6 months. No conclusive evidence for differences in outcomes between very low energy diets and Roux‐en‐Y gastric bypass surgery was found. Greater differences in energy prescription between intervention and comparator arms were associated with greater differences in weight loss and fasting blood glucose levels at 3 months. Attrition rates did not differ between the very low energy diets and the comparator arms at any measurement point. Conclusions: Very low energy diets are effective in substantial weight loss among people with Type 2 diabetes. Levels of adherence to very low energy diets in controlled studies appear to be high, although details about behaviour support provided are usually poorly described.
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High adherence to VLEDs (up to 6 months), judged from rapid early weight loss and dietary assessment, led to better long-term results.
“High adherence to VLEDs (up to 6 months), judged from rapid early weight loss and dietary assessment, led to better long-term results [43].”
Only seven meta-analyses were assessed as high quality.
“Only seven meta-analyses (LCDs, n = 5 [37–40, 41]; liquid meal replacement, n = 1 [42]; very low energy diet (VLED), n = 1 [43]) were assessed as high quality.”
VLEDs achieved greater weight loss at 6 months (−5.7 kg; 95% CI −11.1, −0.4) compared with an energy-restricted diet.
“One high-quality meta-analysis [43] of two RCTs reported that VLEDs (1.7–2.1 MJ/day for 8–12 weeks) achieved greater weight loss at 3 months (−6.6 kg; 95% CI −9.5, −3.7; I2 = 58%, p = 0.12) and at 6 months (−5.7 kg; 95% CI −11.1, −0.4; I2 = 58%, p = 0.12), compared with an energy-restricted diet (4.2–6.3 MJ/day).”
VLEDs (1.7-2.1 MJ/day for 8-12 weeks) achieved greater weight loss at 3 months (−6.6 kg; 95% CI −9.5, −3.7) compared with an energy-restricted diet (4.2-6.3 MJ/day).
“One high-quality meta-analysis [43] of two RCTs reported that VLEDs (1.7–2.1 MJ/day for 8–12 weeks) achieved greater weight loss at 3 months (−6.6 kg; 95% CI −9.5, −3.7; I2 = 58%, p = 0.12) and at 6 months (−5.7 kg; 95% CI −11.1, −0.4; I2 = 58%, p = 0.12), compared with an energy-restricted diet (4.2–6.3 MJ/day).”
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- Authors
- Rehackova, L., Arnott, B., Araujo‐Soares, V., Adamson, A. A., Taylor, R., & Sniehotta, F. F.
- Affiliations
- Newcastle University (GB)
- Institute of Health and Society Newcastle University Newcastle upon Tyne UK
- Corresponding author
- Sniehotta, F. F.
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2015-12-12
- Volume
- 33
- Issue
- 5
- Pages
- 580-591
- ISSN
- 0742-3071 (ISSN-L)
- 1464-5491
- OpenAlex
- W1905573047
- Cited by
- 60
- References
- 55
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 13 · 2023: 6 · 2022: 3 · 2021: 10 · 2020: 5 · 2019: 4 · 2018: 6 · 2017: 6 · 2016: 2
- FWCI
- 0.57
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Diabetic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- Newcastle University
- British Heart Foundation
- Cancer Research UK
- Economic and Social Research Council
- Medical Research Council
- National Institute for Health Research
- Topics
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Keywords
- very low calorie diet, type 2 diabetes, obesity, overweight, weight loss, Roux-en-Y gastric bypass, fasting blood glucose, attrition rates, dietary adherence, adverse effects, behavioral support
- MeSH terms
- Energy Intake, Combined Modality Therapy, Diabetes Mellitus, Type 2, Diet, Diabetic, Diet, Reducing, Humans, Hyperglycemia, Hypoglycemia, Hypoglycemic Agents, Middle Aged, Obesity, Patient Acceptance of Health Care, Patient Compliance, Patient Dropouts, Weight Loss, Randomized Controlled Trials as Topic, Overweight, Non-Randomized Controlled Trials as Topic
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