Te Kāika DiRECT

Tā mātou e tūhura ana

What we are investigating

Take | Issue

Obesity is one of the main risk factors for type 2 diabetes, heart disease and certain cancers. Aotearoa New Zealand has amongst the highest rates of obesity in the world, so we need more options for helping people who want to lose weight.

There is international evidence that a new dietitian-supported intervention, known as the DiRECT protocol, of total meal replacement, followed by a weight-loss maintenance phase, is effective for long-term weight loss. Additional benefits can include remission of type 2 diabetes and a reduction in the risk of related conditions such as heart disease, chronic kidney disease, retinopathy, nephropathy and lower limb amputation.

However, the feasibility or acceptability of this intervention had not yet been considered in Aotearoa New Zealand.

Whāinga | Aim

The purpose of this study was to consider the feasibility and acceptability of using the DiRECT protocol in Aotearoa New Zealand.

Huarahi i whāia | Approach

This study undertook a randomised controlled study of 40 participants with obesity, and either prediabetes or type 2 diabetes, who were looking to lose weight. It was conducted within Te Kāika, a primary care provider in Dunedin.

Participants were randomised to either one year of gold-standard usual care (dietetic counselling, grocery vouchers to afford healthy foods, and free gym membership) or to the DiRECT intervention, a three-month programme of rapid weight loss via total meal replacement, followed by nine-months of weight loss maintenance support.

The trial measured both quantitative outcomes (such as body weight, lipids and blood glucose control) and qualitative outcomes (such as the experiences of study participants, whānau and the primary care provider).

Funding acknowledgement

This project also receives funding from:

The Ministry of Social Development and Pūtahi Manawa | Healthy Hearts for Aotearoa New Zealand.

Outcomes and Impact

NGA PUTANGA ME TE PĀNGA

Outcome | Putanga

The findings of this feasibility study indicated that the DiRECT intervention was effective for and acceptable to study participants.

After three months, participants in both groups had lost weight, but the DiRECT group lost over 6kg more on average than those in the usual care group. DiRECT participants also improved their blood sugar control and had lower blood pressure levels and medication use than the usual care group. By 12 months, the difference in weight loss had reduced to 3.8kg, but this was due to the usual care group continuing to lose weight rather than weight gain in the DiRECT group.

Alongside monitoring clinical health markers, a qualitative study was undertaken to understand participant experiences. One of the major themes that emerged was the invaluable support of the dietitian in helping people in both arms of the study to make changes towards a healthier lifestyle. As well as working with individual study participants, the dietitian worked with their whānau and extended family, which created an additional layer of support.

Next Steps | Te ara kei mua

A multi-centre trial of the DiRECT intervention would be a useful next step prior to rolling it out nationwide (as has been done in the UK).

Video

Research presentation: A DiRECT approach to weight loss in Aotearoa

Healthier Lives Kōrero Tahi 2024: equity and beyond (13-14 February 2024)

Knowledge exchange

Whakawhiti Mōhiotanga

Academic Publications | Puka Rangahau

Experiences and Acceptability of a Weight Loss Intervention for Diabetes (Diabetes Remission Clinical Trial—DiRECT) in Aotearoa New Zealand: A Qualitative Study within a Pilot Randomised Controlled Trial. Campbell K., Peddie M., Ashton N., Ma’ia’i K., Russell-Camp T., Mann J., Camp J., Reynolds A.N. (2024) Nutrients.

Video | kōnae whakaata

Healthier Lives Kōrero Tahi 2024: equity and beyond (13-14 February 2024)
- - - - A DiRECT approach to weight loss in Aotearoa (22 min)
Professor Mike Lean - presentation at Edgar Diabetes and Obesity Research 20th anniversary event (November 2023) (39 min)
Doctor Kim Ma'ia'i - presentation at Edgar Diabetes and Obesity Research 20th anniversary event (November 2023) (10 min)