Table 2.

Intervention characteristics in DiRECT.

Counterweight Plus Program	Weeks 0 to 12: total diet replacement (TDR)
	Weeks 13 to 18: food re-introduction (FR)
	Weeks 19 to 104: weight maintenance (WM)
Delivery of intervention	The intervention was delivered to each patient individually, at their usual primary care center, by either a practice nurse or a local dietitian (if one was available). These practitioners received two days of training, and subsequent on-job mentoring from experienced specialist dietitians.
Handling of medications	As a key feature of the intervention, participants were asked to stop all oral hypoglycemic agents, antihypertensive and diuretic drugs upon commencement of TDR. This served two functions: first, as a safety measure to avoid potential hypoglycemia and postural hypotension associated with weight loss, and secondly as a strong incentive to adhere to the intervention. These medications were reintroduced (as per study protocol based on national clinical guidelines) if blood glucose or blood pressure rose above treatment thresholds.
TDR Phase (Weeks 0 to 12)	The TDR phase consisted of a micronutrient replete 825–853 kcal/d liquid formula diet (soups and shakes) provided by Cambridge Weight Plan (which owned Counterweight Ltd at that time) to replace usual foods, with ample fluids (2.25 L/day), for 12 weeks
FR Phase (Weeks 13 to 19)	The FR phase involved a stepped transition to a food-based WM diet.
WM Phase (Weeks 19 to 104)	During the WM phase, participants were advised to follow a food-based diet based on the “Eatwell” guidelines (15) with an individually tailored energy prescription (to support weight stabilization and prevent weight regain) with the option of using one sachet of formula diet per day. The macronutrient content of the maintenance diet was not formally prescribed, but the Eatwell guidelines target a reduction in total and long-chain saturated fatty acids, with approximately 50% of energy from carbohydrate.
‘Rescue plan’	Recognizing the potential for weight regain, the program included a firm commitment to provide relapse management. Correcting even small weight regains can be difficult, so participants were offered a further period of partial or full TDR if they regained >2 kg (partial TDR) or 4 kg (full TDR)