The Diabetes Remission Clinical Trial (DiRECT) demonstrated that substantial weight loss and remission from type 2 diabetes can be achieved with low-energy total diet replacement and behavioural support. However, the acceptability of the DiRECT intervention in diverse populations with strong cultural emphases on food and shared eating remains unclear. We conducted a qualitative study nested within a pilot randomised controlled trial of DiRECT in one M & amacr;ori (the Indigenous people of New Zealand) primary care provider in Aotearoa New Zealand. Participants with type 2 diabetes or prediabetes, obesity, and a desire to lose weight were randomised to either dietitian-supported usual care or the dietitian-supported DiRECT intervention for twelve months. The DiRECT intervention included three months of total diet replacement, then food reintroduction and supported weight loss maintenance. At three and twelve months, semi-structured interviews explored the acceptability of DiRECT and participants' experiences of each intervention. Interview transcripts from 25 participants (aged 48 +/- 10 years, 76% female, 78% M & amacr;ori or Pacific) at three months and 15 participants at twelve months were analysed. Participants viewed their pre-enrolment selves as unhealthy people with poor eating habits and desired professional weight loss support. For DiRECT participants, the total diet replacement phase was challenging but well-received, due to rapid improvements in weight and health. Food reintroduction and weight loss maintenance each presented unique challenges requiring effective strategies and adaptability. All participants considered individualised and empathetic dietetic support crucial to success. Sociocultural factors influencing success were experienced in both interventions: family and social networks provided support and motivation; however, eating-related norms were identified as challenges. The DiRECT intervention was considered an acceptable approach to weight loss in participants with type 2 diabetes or prediabetes with strong cultural emphases on food and shared eating. Our findings highlight the importance of individualised and culturally relevant behavioural support for effective weight loss and weight loss maintenance.
- 9926548451501891
- 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
- Kate CampbellMeredith PeddieNatalie AshtonKim Ma'ia'iTakiwai Russell-CampJim MannJustine CampAndrew N. Reynolds
- Medicine (DSM); Edgar Diabetes and Obesity Research Centre; Human Nutrition; Healthier Lives - He Oranga Hauora National Science Challenge
- Nutrients, Vol.16(12), 1853
- MDPI
- 13/06/2024
- Ministry of Social Development, New Zealand; Healthier Lives National Science Challenge (11601116); Pūtahi Manawa Healthy Hearts Aotearoa Centre of Research Excellence grant (3724480); University of Otago Doctoral Scholarship; Heart Foundation of New Zealand; Healthier Lives National Science Challenge
- Copyright © The Author(s) 2024. This work was first published in Nutrients (MDPI). This is an open access article is distributed under the terms of the Creative Commons Attribution 4.0 License (http://www.creativecommons.org/licenses/by/4.0/) which permits unrestricted use, reproduction and distribution of the work in any medium provided the original work is properly attributed to the creator(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
- English
- Journal article