Lesley's story: how I've helped patients achieve remission as a dietitian

I became a dietitian because I’ve always loved food. My Mum and Nan are amazing cooks and my Dad is a butcher. I was always encouraged to experiment in the kitchen.

When I was filling in my university application form, it was my Mum who suggested I applied for Dietetics (diet and its effects on health).

Nobody in my family has had a diagnosis of diabetes, but professionally, I see patients mainly with type 2 diabetes in my clinic.

I approached DiRECT with the same apprehension and caution as any other dietitian would. This is something which, until then, I would never have recommended to my patients, never mind deliver it. But part of what I really enjoy about dietetics is that our practice is constantly changing as new research is published. So to be involved in a piece of research like this was exciting.

It was all brand new – for me and for the people coming along. There was a mixture of emotions – nerves, excitement, caution, determination. They might be thinking, “How will this be different to things I’ve tried in the past? Will I be able to do this?”

I remember my very first DiRECT patient, who achieved a HbA1c of less than 48mmol/mol, (or less than 6.5%) after 12 weeks, and was in remission at one year. He is still in remission nearly four years later. The impact this has had on his life is incredible.

Anyone who achieves remission after years of taking prescribed medications is amazing. My patient takes no prescriptions for his diabetes or blood pressure, and he is now far more active than he ever was. He’s done so well.

The challenges of DiRECT

The biggest complaint I would hear from people time and time again are the lack of flavours. There are only six. After a few weeks you’re getting a bit fed up. 

For people taking part, there’s also that fear of the unknown about the programme. You would sometimes hear they’ve been told it was just a fad and were being put off taking part. But now that the DiRECT results are published, I hope that that feedback will disappear. 

Reintroducing healthy food is also difficult. Several of the people that I supported raised an anxiety way before it actually started. Handing back control over food intake can be overwhelming.

If anyone is thinking about this sort of plan, the support they get from a practitioner at these stages is really important, we take you through it step by step.

We start to discuss food reintroduction throughout the low-calorie diet stage so you have you loads of time to start planning, and an opportunity to discuss concerns. 

Being told by a family member or friend that they look amazing, or being able to play with their children without getting too out of breath were the kind of things that kept my patients going on a day-to-day basis.

The other thing is that their changes are also benefiting other members of the family. I would hear stories about families eating together more, preparing meals together, the children wanting to be more involved in the food shopping because they’ve seen their parents take more of an interest, that kind of thing.

There was one lady who wanted a particular dress to wear at a wedding which was from a shop that didn’t stock sizes above a size 18. After taking part in DiRECT, she managed to get the dress which was amazing. The main incentive is always achieving remission, but it’s the day-to-day reminders of how fabulously they are doing that give people a nudge to keep going.

Tips for success

In my experience, the people that are most successful at staying in remission are those who are monitoring themselves. So weighing themselves frequently, continuing to monitor their dietary intake using a diary or an app. Sometimes life can take you by surprise and can pull the rug from under you – so holidays, high stress situations or changes in circumstance can all be triggers for changing back into old habits. If you’re not monitoring, it’s easy to fall back.

If you're keeping a track of your food intake or weighing yourself, it’s easier to pick it back up quickly. 

We also talk about social support from the beginning and it’s really nice to hear when people say “I talked this through with my partner or friend, and they got me back on track”.

We always encourage people to get back in touch with us too if they’re struggling and need support, even if it’s just for a chat on the phone. The success of a weight management programme like DiRECT has to be, in part, due to the level of support people received. The total diet replacement is only one piece of the jigsaw – the change in behaviour and habits takes a long time. So get the right support is my biggest advice.

The future of remission

I’ve come full circle from feeling unsure about DiRECT, to an absolute advocate. With the DiRECT results being released, there’s increased demand and interest in remission. People are talking about it far more. I would absolutely support somebody if that’s what they wanted to do. 

I think more research and support is needed to help with maintaining weight loss. But that’s another ongoing learning curve, and will come out eventually with continuing practice.