Frequently Asked Questions (FAQs)

Behavioural toolkit: has been designed by our multidisciplinary team including the dietitians, trainee health psychologist with a specialist consulted during the development. 

Exercise content: physical exercise specialists in collaboration with our dietetics team to ensure appropriateness. 

Cultural toolkit: external dietetic professionals who work with individuals from multiple cultures in collaboration with our dietetic team to ensure the right mix of experience and programme application.

1. Safety: as service users are on a significant calorie deficit the adverse effects of alcohol are heightened

2. Energy contribution: Alcohol carries 7kcal/g, being more calorie dense than both protein and carbohydrates but slightly lower than fat. This will reduce the calorie deficit.

This guidance should however be considered with regards to your patient. For some patients it may be more realistic to reduce alcohol intake overtime. Therefore you may need to delay starting A Total Diet Replacement

If you prefer alternatives, Fybogel (ispaghula husk) , usually flavoured, is a common over-the-counter option. Some participants also consider ground flaxseed, but as it contains calories and fats, we recommend discussing it with your coach before use.

You can also enhance your fibre intake by adding a small portion (around 30g) of low-calorie vegetables like cucumber, carrots, or broccoli. These provide extra fibre with minimal impact on your calorie intake and can help with satiety and bowel regularity.

- Planning meals ahead to ensure healthier foods are at hand at the right times.

- Reducing portion sizes (but not of vegetables).

- Three regular, balanced meals a day.

- Meals at planned times during the day and try to only include snacks when physically hungry.

- Follow the Eatwell guide when building meals.

- Being mindful of high-fat and high-sugar foods - limit sweet, fatty and salty snacks.

To support patients with these key principles, particularly the portion sizes, and to respond to feedback from patients, Counterweight has provided more than one way to plan a meal to offer flexibility. Both low carbohydrate and low fat diets have been shown to be effective for weight loss and improving blood sugar control in people with type 2 diabetes. When we increase protein intake to support muscle and satiety, it naturally means reducing either carbs or fat.

The higher fibre element has been maintained from Fruit and Veg intake and recommending high fibre carbohydrates, along with a shift towards higher protein due to positive impact on feelings of fullness. The dietary approach that people can stick to until they can meet their weight and health goals, and afford, is the most important consideration over macro nutrient content which is why there are two options. People can toggle between meal plans. The plate models are a starting point and practitioners can help patients alter the different food groups to suit their likes, preferences and cultural requirements. Non meat based proteins are encouraged such as beans, pulses, eggs as part of the recommendations for the population to have an affordable and sustainable eating pattern. 

For more information, please see the following paper "Is There an Optimal Diet for Weight Management and Metabolic Health?": https://pubmed.ncbi.nlm.nih.gov/28214525/

Low carb diets (30–45% of total intake) are safe and effective over the short term (up to one year), though more research is needed on long-term effects. Low fat diets (20–30% of total intake) are also evidence-based for weight loss.

In the programme, you can choose a low carb or low fat meal depending on your preferences. Some people alternate between the two, while others find one approach suits them best

If an individual gains more than 2kg in the TDR or FR stage, you should explore what barriers they have to following the plan and work with them to put solutions in place.