A TV programme isn’t enough to prove a scientific theory – by Emily Burns

Emily BurnsDid you catch the BBC Big Crash Diet Experiment or ITV The Fast Fix: Diabetes programmes about low calorie diets and Type 2 diabetes?

We weren’t involved in the production of either show, and while they can start conversations, they’re not scientifically rigorous and we need to bear that in mind.

With the first-year results of DiRECT trial announced in December, there’s an understandable buzz around what this might mean for people with Type 2 diabetes. Not only are we now talking about remission as a potential option for some people with the condition, a treatment to achieve just this is being tested right now.

Radio, print, TV alike: everyone wants a piece of DiRECT. Or at least the low calorie diet part. DiRECT is so much more than a low calorie diet, but that’s the element many grasp on to. This isn’t a drug still in development, or a piece of equipment not yet available, it’s a programme which involves – in part – low calorie diet supplements that can be bought online.

So when TV programmes ‘testing’ a low calorie diet in people with Type 2 diabetes hail their ‘trials’ a success, there’s just one thing we need to remember:

TV programmes don’t prove scientific theories. Scientific research does.

Yes, we all hope that we’re close to a treatment which can put Type 2 diabetes into remission for as many people as possible. But we’re not there yet. And putting five people in a house and filming their experiences is interesting, but isn’t the level of evidence we need when deciding if a treatment should be made available in the future.

So here are just five boxes the DiRECT trial ticks that TV programmes don’t:

  1. DiRECT involve lots of people. The more people you involve, the more sure you can be about the results. DiRECT involves just over 300 people, and there are much larger trials (involving thousands of people) happening across the world. Four or five people (as is usually the case in a TV programme) isn’t enough.
  2. DiRECT compare people receiving a treatment to people not receiving the treatment. To be sure that what you’re seeing in a group of people is real, you need to compare it to another group of people.
  3. DiRECT takes quite a long time. From months to years, clinical trials are rather long. That’s because you need to follow people, and treatments, for a long time to be sure about the results. For example, DiRECT scientists didn’t classify someone as being in remission until 12 months after the start of the trial.
  4. DiRECT is more than a low calorie diet. DiRECT is testing what’s called a weight management programme: low calorie diet supplements, support from a dietician or nurse to re-introduce healthy food back into the diet, and long-term support to maintain the weight loss. And that’s because it’s keeping the weight off that researchers believe is key to putting Type 2 diabetes into remission for the long term. The team is also interviewing everyone to understand the impact this type of treatment could have on their quality of life.
  5. DiRECT is complex. There are some health risks to a low calorie diet. No one on the trial had Type 2 diabetes for longer than six years or was taking insulin. Everyone had to stop taking blood pressure-lowering medications. The programme didn’t work in just over half of the participants and the likelihood of going into remission was linked to the amount of weight lost, but we don’t yet know the full details of why for either. This stuff doesn’t make great TV, but it’s vitally important.

We also need to bear in mind that this isn’t yet an available treatment option for people with Type 2 diabetes. And that’s because there are questions left to answer – questions that DiRECT and other equally important research is looking at.

Can people who put their Type 2 diabetes into remission keep it there for the long term? What’s the psychological impact of a treatment like this? Are there people for whom an approach like this won’t work? How much might it cost? What about the many people with Type 2 diabetes who aren’t overweight – will we need a similar or different treatment?

And a final message for anyone with Type 2 diabetes who is considering taking part in a low calorie diet: please speak to your healthcare professional first. This type of diet isn’t available in the NHS for Type 2 diabetes, can be dangerous if done while taking medications like insulin or blood pressure-lowering drugs, and definitely isn’t a quick fix.

Here’s some more information about the DiRECT trial and low calorie diets.

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