Low-energy diet improved eating disorder symptoms in patients with type 2 diabetes

An intensive low-energy diet programme, similar to the NHS Type 2 Diabetes Path to Remission, significantly improved eating disorder symptoms in people with type 2 diabetes and excess weight who were at risk of developing eating disorders, a new clinical trial concludes.

Led by researchers at the University of Oxford, the ARIADNE trial challenges long-standing concerns about the psychological safety of restrictive diets for people at risk of eating disorders who have type 2 diabetes. By restricting calorie intake to 860 kcal per day, participants were able to improve their symptoms of diabetes, with no evidence of their eating disorder symptoms worsening.

The findings, published in The Lancet Psychiatry, suggest that patients with coexisting type 2 diabetes and disordered eating patterns can safely undertake total diet replacement (TDR) intervention, with effective results.

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Previous studies have shown that people with type 2 diabetes have a higher prevalence of eating disorders than the general population. Consequently, there are concerns that restrictive diets as a treatment plan for type 2 diabetes could make an eating disorder worse.

The researchers recruited 56 participants who had type 2 diabetes (diagnosed in the last six years), with obesity or overweight, and a coexisting eating disorder. Half of the cohort received the low-energy TDR programme with behavioural support for six months, followed by a food reintroduction phase and longer-term maintenance advice. The control participants continued their usual diabetes care from their GP. Over the course of a year, all participants were assessed for symptoms of disordered eating, including: restraint eating, eating concerns, shape concerns, and weight concerns.

The participants who took part in the restricted diet programme lost an average of 13.9 kg at six months, compared to 3.7 kg in the usual care group. However, by 12 months, there was no significant difference between the two groups.

The intervention group showed statistically significant improvements in all four symptoms of disordered eating, and these improvements were sustained for the twelve-month study period, even after some weight gain. None of the participants in either group developed a new eating disorder.

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The TDR group also experienced a reduction in symptoms of depression and diabetes-related distress at both six and 12 months, suggesting that the psychological benefits of the TDR programme could extend beyond eating behaviour alone.

Professor Susan Jebb, a co-author on the study from the University of Oxford, said: ‘There’s been understandable caution about using low-energy diets in people with eating disorder symptoms. These results offer clear evidence that with the right support, these patients can benefit safely from these interventions.’

The NHS Path to Remission programme is successfully helping over a quarter of participants achieve diabetes remission at one year. The researchers hope their findings will allow patients with eating disorders to also benefit from the Path to Remission programme.

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Dr Elena Tsompanaki, a registered dietitian who led the study as part of her doctoral research at the University of Oxford, added: ‘I’ve seen first-hand how both eating disorders and type 2 diabetes can impact the quality of people’s lives. Our findings potentially open up important treatment options that many patients might have previously been denied.’