Participant Experiences of the NHS Low Calorie Diet Programme Pilot: A Cross-Sectional Survey Evaluation

Abstract

Background The NHS Low Calorie Diet (LCD) Programme was introduced to support remission of type 2 diabetes through total diet replacement combined with behavioural support. Understanding participant experience is essential to optimise service delivery, engagement, and long-term outcomes as the programme expands nationally.

Aims To evaluate participant experiences across all stages of the NHS LCD pilot and identify factors influencing satisfaction, engagement, and perceived support across delivery models and providers.

Method Anonymous online surveys were administered at baseline, 12-, 18-, and 52-weeks between September 2021 and April 2023. Surveys captured quantitative Likert-scale responses and qualitative free-text feedback regarding referral processes, programme delivery, support, and improvement needs. Responses were analysed cross-sectionally and compared by sociodemographic characteristics, delivery model, and provider.

Results A total of 719 participants completed the baseline survey, with decreasing responses across follow-up time points. Most participants reported positive experiences of referral, provider contact, and coaching relationships, highlighting the importance of supportive practitioner interactions. Participants valued weight loss outcomes, improved health markers, and structured guidance during the total diet replacement phase. Challenges included limited information at referral, delays starting the programme, variability in product acceptability, and reduced perceived support within digital delivery models. During food reintroduction and maintenance phases, participants reported increased confidence in healthy eating but also anxiety about weight regain and a desire for greater practical guidance and ongoing contact. Peer support and enhanced communication were frequently suggested improvements.

Conclusion Participant experience within the NHS LCD pilot was largely positive but varied by delivery model and provider. Findings emphasise the importance of person-centred communication, consistent professional support, and enhanced guidance during transition phases. Strengthening referral knowledge, expanding peer and personalised support, and refining digital delivery approaches may improve engagement and outcomes within NHS weight management and diabetes remission services.