This qualitative systematic review explored how entrustment is understood, experienced and enacted within pre-registration practice-based learning (PBL) across international healthcare education, with a specific focus on implications for the UK dietetic profession. Fifteen qualitative and mixed methods studies were synthesised using thematic synthesis, identifying how entrustment shapes learner participation, supervision, and capability development. The review found that entrustment functions as a 'credible developmental space' that enables learners to engage in authentic workplace activities with supported autonomy, while also revealing how workplace pressures and local contextual factors influence entrustment decisions. Feedback emerged as the central mechanism through which learners make sense of supervision levels, understand expectations, and professionally develop; without high quality dialogic feedback, entrustment risks becoming a procedural rather than educational process. Entrustment was shown to be inherently relational and co-constructed, shaped by trust, supervisor familiarity, contextual constraints, perceived risk, and the quality of supervisory relationships. These findings challenge overly technical or checklist based interpretations of entrustment and highlight the need for assessment approaches that prioritise narrative feedback, shared sensemaking and contextual awareness. For UK dietetics, an entrustment informed approach offers a defensible, capability-aligned way to structure PBL across diverse settings, particularly as the profession implements a national common assessment tool. A proportionate, light touch approach, using a small number of meaningful EPA aligned tasks supported by succinct narrative feedback, may enhance developmental value without increasing burdens on practice educators. Entrustment has the potential to strengthen fairness, consistency, and capability development in dietetic PBL when implemented in a relational, context sensitive manner. These insights have relevance globally, providing a conceptual foundation for international dietetics and wider health professions to strengthen supervision and assessment in diverse PBL contexts.

BACKGROUND:Local authorities (local government) in England is responsible for promoting a healthy food environment. The food environment includes any opportunity to obtain food which includes physical and virtual environments. However, currently both local and national policy only regulates around restricting types of food available in the physical food environment Over the past decade there has been a substantial rise in the virtual food outlets where customers can only order food online using an app. This creates challenges for promoting a healthy food environment if policy on regulates the physical but not virtual environment. To support public health policy making this research explored prevalence of online only delivery kitchens in four Northern areas in England and if current data collection methods for monitoring the food environment can capture these outlets. METHODS:Data was collected using automated searches on food delivery websites for four areas in the North of England. Data from the Food Standards Agency (FSA) and Google were used for business registration details, location and validation. Prevalence of outlets adjusted by population size, premise type, Positive Predicted Value for comparing accuracy with the FSA data and Sensitivity were estimated. RESULTS:Newcastle had 118 online only delivery food outlets or 15 per 100,000 people, Gateshead had 116 outlets or 59 per 100,000 people, Middlesbrough had 36 outlets or 9 per 100,000 people, and Lancaster had 107 outlets or 26 per 100,000 people. Approximately 40% were operating from existing business sites. PPV was 100% in all areas. Sensitivity was 15.9% in Newcastle upon Tyne, 17.4% in Gateshead,, 9.1% in Middlesborough, and 26.2% in Lancaster. CONCLUSIONS:Current policy tools that manage the built environment do not consider the virtual food environment. This may limit their ability to promote a healthy food environment.

While food taxes are proposed to promote healthier dietary choices and mitigate diet-related diseases, addressing rising UK obesity requires navigating a highly complex web of causal mechanisms. Economic evaluations of these interventions often lack a documented understanding of this systemic complexity. To bridge this gap, this study aims to comprehensively map the system by identifying the specific components affected, the causal pathways (mechanisms), and the individual and system-level factors (context) influencing the ultimate impact of food taxes. A diagrammatic representation of the conceptual model was developed through an iterative process. We first undertook a synthesis of reviews of food taxes and a rapid review of economic evaluations of food and drink taxes. The research team synthesised these results to describe mechanisms and outcomes for inclusion in the conceptual model. Secondly, the conceptual model was validated and revised according to feedback from 14 stakeholders across academia, policy, and third sector organisations. Our final conceptual model illustrates system components which were grouped into eight sub-systems including policy infrastructure, industry behaviour, consumer behaviour, household expenditure, nutrition outcomes, health outcomes, environmental outcomes, and macroeconomic outcomes. Food taxes will influence consumption through price changes impacting purchases of taxed food and other purchases resulting in changes to consumption. Industry may modify the effects by absorbing the tax burden, marketing and product development and reformulation. We identify health, macroeconomic and environmental outcomes linked to food, and explore complex feedback loops linking health and macroeconomic performance to household finances further modifying food purchasing. We identify individual and contextual factors that modify these mechanisms. When studying the impacts of food and drinks taxes, researchers should consider the mechanisms by which individuals and industry can modify the effects of food taxes, and the extent to which these actions can be anticipated. System-wide factors can be documented so that the modelled evidence can be interpreted considering these factors even if they are not explicitly modelled. The conceptual model v3.0 remains dynamic and can be updated as evidence and perspectives on the food tax policy system develop over time.

Tackling food insecurity and food waste are two interrelated and complex policy challenges. Innovations in food retail termed 'social supermarkets' (SSMs) could provide a solution, utilising surplus produce from mainstream food retailers, which are then traded at reduced prices. This scoping review aimed to synthesise the peer-reviewed research literature concerning the application of SSM models internationally, with a particular focus on how they influence food insecurity and reduce food waste. Free-text keywords and index terms were combined with Boolean operators for comprehensive searches of MEDLINE, Embase, Cochrane, Web of Science, CINAHL, PsycINFO and Google Scholar. Fourteen studies were included after duplication removal, sifting and results from citation searches were added. SSMs were primarily used by low-income, food-insecure households, although some clients do not fall under these categories, instead choosing to shop at SSMs to prevent further societal food waste from unused surplus. Attitudes towards SSMs were predominantly positive (especially in comparison to food banks), largely due to the implementation of the choice model, where clients are treated as 'customers' rather than 'recipients' of food. Although SSMs play an important role in providing food assistance to the food insecure and preventing surplus food from supermarket retailers becoming food waste, they do not address the deeper underlying causes of food insecurity and food waste, namely: income inequality and the on-going creation of surplus food throughout the food supply chain. Policies are needed which address these issues directly, unlike SSMs, which paradoxically rely on these increasingly dysfunctional systems to continue trading.

Background Local Government in England is responsible for promoting a healthy food environment. Online only food outlets create challenges to achieving this goal. This research explored prevalence of online only delivery kitchens in four Northern areas in England and if current data collection methods for monitoring the food environment can capture these outlets. Methods Data was collected using automated searches on food delivery websites for four areas in the North of England. Data from the Food Standards Agency (FSA) and Google were used for business registration details, location and validation. Prevalence of outlets adjusted by population size, premise type, Positive Predicted Value for comparing accuracy with the FSA data and Sensitivity were estimated. Results Newcastle had 118 online only delivery food outlets or 15 per 100,000 people, 116 outlets or 59 per 100,000 people in Gateshead, 36 outlets or 9 per 100,000 people in Middlesbrough, and 107 outlets or 26 per 100,000 people in Lancaster. Approximately 40% were operating from existing business sites. PPV was 100% in all areas. Sensitivity was 17.4% in Gateshead, 26.2% in Lancaster, 9.1% in Middlesborough, and 15.9% in Newcastle upon Tyne. Conclusions Policy tools available to manage the food environment may need to be re-designed.

Background There is strong evidence that advertising commodities which harm human and/or planetary health increases their consumption and exacerbates health inequalities. Yet there has been little evaluation of local government policies that restrict such advertising. We aimed to assess what policy restrictions local authorities in England place on advertising harmful commodities and explore local authority characteristics associated with these restrictions. Methods We systematically searched for advertising policy documents pertaining to local authorities in England and extracted key information, including restrictions placed on advertising harmful commodities. We used logistic regression to explore local authority characteristics associated with having these restrictions. Results Only a third (N = 113; 33.9%) of local authorities in England were found to have advertising policies by June 2025. Most policies included restrictions on advertising tobacco products (86.7%), alcohol (72.6%), gambling (76.1%) and/or high-interest loans (66.4%). A minority included advertising restrictions for unhealthy foods (41.6%), e-cigarettes (26.6%), high-carbon commodities (15.0%), unregulated health products (9.7%), formula milk (5.6%), weight loss products (7.1%) and cosmetic surgery (4.4%). In the unadjusted analyses, larger, more population-dense local authorities and those with younger populations and greater income inequality and deprivation were more likely to have restrictions on advertising a range of harmful commodities, particularly unhealthy foods. After adjusting for covariates, population size remained strongly associated with having advertising restrictions for tobacco products, gambling, alcohol, unhealthy foods and high-interest loans. Conversely, greater ethnic diversity was associated with a lower likelihood of having restrictions on advertising e-cigarettes, high-interest loans and unhealthy foods. Conclusions A third of English local authorities have adopted advertising restriction policies to date, which vary widely in the harmful commodity advertising restrictions they include. Future research should explore how to support policy adoption among local authorities less likely to introduce these policies, and help to inform evidence-based best-practice guidelines for greater policy consistency.

Analysis of media coverage of food tax debates is limited, with most focusing on taxation of sugar sweetened beverages (SSBs). This study explored UK media coverage of food tax debates, extending beyond SSBs to other food products. We investigated trends in print and online news media coverage and how the UK media presented anti- and pro-tax arguments. A mixed-methods content analysis of eight UK news publishers between 2017 and 2023 was undertaken. Articles (n = 369) were coded to identify publishers, food product types, and tax types. Coverage was mapped by date, by food product, and by publisher. The article sample was refined to exclude coverage related to the UK Soft Drinks Industry Levy, and remaining articles were analysed for argument types and uses around other food tax debates such as meat, sugar and salt. The results showed that the media respond to triggering events and reproduce arguments from key stakeholders such as industry, policymakers, and prominent researchers. Similar arguments were consistently used across all publishers, regardless of food product. Pro-tax arguments tended to reinforce the evidence for negative health impacts while anti-tax arguments questioned the need for and efficacy of intervention. This can be understood as a 'media playbook' of food tax arguments. To the best of our knowledge, this is the first study to examine media coverage of food taxes across food products. It develops work exploring the media's impact on food tax debates and informs food policymakers about the acceptability of food taxes and recommended strategies for media engagement.

BACKGROUND:Inclusive, community-based research is increasingly important for aligning academic work with real-world needs. This paper describes the challenges and successes of a research collaboration between academic, health service, and voluntary sector partners, working together to address nutrition and food waste for individuals with severe mental illness. METHODS:This reflective article reports a primary study evaluation of the process of a co-produced project aimed at developing a nutritious ready meal from surplus food to be distributed through Eco Shops, involving individuals with severe mental illness (SMI). A collaborative partnership was formed between a University, an NHS Foundation Trust, and a Voluntary Sector Organisation in the North-East of England. Data for this process evaluation were collected through a team questionnaire evaluating all aspects of the collaboration, including ethics, governance, and communication practices. RESULTS:While the overall project achieved positive outcomes, the collaborative research process included substantial challenges in ethical and governance alignment, collaborative working practices, and communication across diverse organisational cultures. CONCLUSION:This study highlights the need for flexible governance, clear communication protocols, and effective workload management in cross-sector collaborations. Insights emphasise adapting project frameworks to support interdisciplinary, community-focused research for successful, sustainable partnerships.

INTRODUCTION:There are several known risks relating to poor nutrition during pregnancy, including the development of complications and poor birth outcomes. While food insecurity is associated with poorer nutrition, data on the prevalence and severity of food insecurity in pregnancy in the UK is lacking. This study aims to explore the prevalence, experiences and health impact of food insecurity in pregnancy in England to develop strategic recommendations for intervention strategies. METHODS AND ANALYSIS:Food, Pregnancy & Me is an observational, multi-method study. Questionnaires exploring diet quality, food security, mental health, and other health behaviours will be distributed to all women and pregnant people in their third trimester in two NHS Trusts in England (North East and West Midlands). Returned questionnaires (n=605) will be linked to routine maternal and birth outcome data and pseudo-anonymised. We will estimate the prevalence of food insecurity in pregnancy in these locations, associations with diet quality, maternal mental health, and pregnancy outcomes (e.g., pre-term birth, pre-eclampsia, gestational diabetes). Qualitative interviews (n=40) with participants identified as having experienced food insecurity will explore their lived experience, support received, and recommendations for additional support needs. Through a series of co-production workshops with local and national system shapers and experts by lived experience, we will use the data gathered to produce strategic recommendations for intervention with pregnant women and people facing food insecurity. We will then explore the potential costs and benefits of implementing the proposed recommendations. ETHICS AND DISSEMINATION:Ethical approval was obtained from Newcastle and North Tyneside 1 NHS Research Ethics Committee (24/NE/0027). Findings will be disseminated to key national and local system shapers and policy makers, advocacy groups, and the public through reports, presentations, the media and open access publications. STUDY REGISTRATION NUMBER:ISRCTN16655955.

Food insecurity is a growing concern worldwide, particularly in the United Kingdom. Despite this, community-based interventions to address food insecurity remain an under-researched area. Existing food insecurity reviews have focused on international evidence, limiting investigations to foodbank use and/or interventions targeted towards children. This scoping review aimed to understand the evidence on available community-based interventions for adults experiencing food insecurity in the United Kingdom and the suggested elements for a feasible, acceptable intervention. A comprehensive electronic search was completed up to January 2024. All study designs were considered. A descriptive analytical approach was used to summarise intervention data. Narrative synthesis explored the data further, using the Food Ladders model as a framework. This review identified a very limited scope and quantity of evidence on community food insecurity interventions for UK adults, with 21 included studies. Over half of interventions (52.4%, n  = 11) relied on volunteers, and a high proportion used donated or surplus food. The nutritional quality of emergency food provision was poor, and it was unclear whether providers could adequately cater for special dietary requirements, cultural and/or religious needs. There were very few studies (19.0%, n  = 4) assessing the feasibility or acceptability of interventions or their impact on food insecurity. Further research is required into the feasibility, acceptability and effectiveness of community food insecurity interventions for adults in the United Kingdom.

BACKGROUND:Sales and consumption of energy drinks (EDs) continue to rise, especially amongst young people, yet the reason remains unclear. In 2018, a campaign by Jamie Oliver resulted in a voluntary sales ban to under 16-year-olds. Also in 2018, the Department of Health and Social Care ran a consultation to end the sales of EDs to under 16 s in England. In the Kings Speech (July 2024), the incoming Labour Government promised to restrict the sale of energy drinks to children. The aim of this mixed method study is to understand children and young people's perceptions of EDs in North East England UK, post the 2018 voluntary ban and to analyse consumption patterns via focus groups and a survey. METHODS:Fifty students from Years 5 and 6 (n = 38 aged 9-11 years) and Year 9 (n = 12, aged 13-14 years) were involved in eight semi-structured focus groups exploring perceptions of EDs; and twenty-two Year nine students (aged 13-14 years) were involved in a survey measuring consumption of EDs and reasons for use. RESULTS:This study presents a complex picture of children perceptions of EDs and the emergence of a new popular hydration drink, defined as those marketed as replenishing electrolytes, having low(er) sugar, and improving functional wellness. The survey reported that 81.8% consume EDs. More males consumed EDs in comparison to females and most consumed EDs 2-4 days a week. Qualitative analysis showed factors influencing consumption included marketing, brand association, taste, influence of friends and family, cost and easy access. CONCLUSION:Children and young people had a strong understanding around the use of branding and marketing as a powerful tool to encourage purchasing behaviours.

Specialist adult weight management (AWM) services (tier 3) provide multidisciplinary support for people with obesity to manage their weight. Many people with severe mental illness (SMI)/learning disability also have obesity. This study explored the opinions of specialist AWM dietitians in the North-East and North Cumbria (NENC) region regarding their skills, knowledge, and services for supporting people with obesity and SMI/learning disability. Dietitians ( n  = 9) were purposively selected and interviewed using Microsoft Teams in July 2023. The data was thematically analysed. Dietetic pre-registration training on SMI/learning disability was inconsistent. Dietitians' confidence in supporting people with SMI/learning disability was wide-ranging. Six themes were identified: training, resources, service provision, networking & external influences, assessment and compassion & self-efficacy. Specialist AWM dietitians in the NENC region are compassionate and want to provide a quality service for people with obesity and SMI/learning disability. However, they sometimes feel they fail these service users through a lack of training and resources. Training, accessible resources, and collaboration with mental health dietitians may improve AWM dietitians' confidence and skills when supporting people with SMI/learning disability and may reduce stigma. The British Dietetic Association (BDA) may wish to ensure training on SMI and learning disability is available for all dietitians, along with resource sharing. Additionally, limited staffing and waiting lists may impact the provision of reasonable adjustments required for people with additional needs. Alternative pathways for people with obesity and additional requirements may be of benefit. More comprehensively completed referrals and additional funding may facilitate this.

Food insecurity is a well-established obesity driver. Less is known about food insecurity during pregnancy. This review (PROSPERO:CRD42022311669) aimed to explore associations between food insecurity, maternal obesity, gestational weight gain (GWG), and nutrition. Searches included seven databases, gray literature, references, citations, and contacting authors. Observational studies reporting data from January 1st, 2008 to 21 November 2023 in high-income countries were included. Duplicate screening, data extraction, and quality assessments were performed. Random effects meta-analysis estimated odds ratios (OR), mean difference (MD), and 95% confidence intervals (CI). Narrative synthesis was conducted when data could not be pooled. Database searches identified 22,272 results; 20 studies were included (n = 19 North America, n = 1 Europe; n = 32,803 women). Food insecurity significantly increased obesity (OR 1.53 95%CI 1.39, 1.66), but not underweight (OR 1.12 95%CI 0.89, 1.34) or overweight (OR 1.18 95%CI 0.90, 1.46). Food insecurity significantly reduced GWG (MD -0.42 kg 95%CI -0.62, -0.22) and increased inadequate GWG (OR 1.16 95%CI 1.05, 1.28), but not excessive GWG (OR 1.04 95%CI 0.96, 1.13). Diet outcomes were inconsistent, with some evidence of reduced vitamin E and diet quality and increased red/processed meat consumption. Further studies outside of North America are needed to inform practice and policy to support maternal health.

Background Food taxes have been proposed to encourage people to choose healthier foods and reduce diet-related disease. Rising obesity in the UK has been explained through various causal mechanisms and systems. Economic evaluation of obesity interventions would benefit from a documented understanding of system complexity. We aimed to describe the parts of the system affected (components), the causal pathways through which the effects work (mechanisms), and the individual and system-level factors that impact on food tax impacts (context).Methods We developed the conceptual model through an iterative process to develop the diagrammatic representation of the conceptual model. We first undertook a synthesis of reviews of food taxes and a rapid review of economic evaluations of food and drink taxes. The research team synthesised these results to describe mechanisms and outcomes for inclusion in the conceptual model. Secondly, the conceptual model was validated and revised according to feedback from 14 stakeholders across academia, policy, and third sector organisations.Results Our final conceptual model illustrates system components which were grouped into eight sub-systems including policy infrastructure, industry behaviour, consumer behaviour, household expenditure, nutrition outcomes, health outcomes, environmental outcomes, and macroeconomic outcomes. Food taxes will influence consumption through price changes impacting purchases of taxed food and other purchases resulting in changes to consumption. Industry may modify the effects by absorbing the tax burden, marketing and product development and reformulation. We identify health, macroeconomic and environmental outcomes linked to food, and explore complex feedback loops linking health and macroeconomic performance to household finances further modifying food purchasing. We identify individual and contextual factors that modify these mechanisms.Conclusions When developing a health economic individual simulation model of the impact food taxes, researchers should consider the mechanisms by which individuals and industry can modify the effects of food taxes, and the extent to which these actions can be anticipated. System-wide factors can be documented so that the modelled evidence can be interpreted considering these factors even if they are not explicitly modelled. The conceptual model v3.0 remains dynamic and can be updated as evidence and perspectives on the food tax policy system develop over time.

AIM:This study aimed to explore food insecurity prevalence and experiences of adults with severe mental illness living in Northern England. METHODS:This mixed-methods cross-sectional study took place between March and October 2022. Participants were adults with self-reported severe mental illness living in Northern England. The survey included demographic, health, and financial questions. Food insecurity was measured using the US Department of Agriculture Adult Food Security measure. Quantitative data were analysed using descriptive statistics and binary logistic regression; and qualitative data using content analysis. RESULTS:In total, 135 participants completed the survey, with a mean age of 44.7 years (SD: 14.1, range: 18-75 years). Participants were predominantly male (53.3%), white (88%) and from Yorkshire (50.4%). The food insecurity prevalence was 50.4% (n = 68). There was statistical significance in food insecurity status by region (p = 0.001); impacts of severe mental illness on activities of daily living (p = 0.02); and the Covid pandemic on food access (p < 0.001). The North West had the highest prevalence of food insecurity (73.3%); followed by the Humber and North East regions (66.7%); and Yorkshire (33.8%). In multivariable binary logistic regression, severe mental illness' impact on daily living was the only predictive variable for food insecurity (odds ratio = 4.618, 95% confidence interval: 1.071-19.924, p = 0.04). CONCLUSION:The prevalence of food insecurity in this study is higher than is reported in similar studies (41%). Mental health practitioners should routinely assess and monitor food insecurity in people living with severe mental illness. Further research should focus on food insecurity interventions in this population.

BACKGROUND:Maternal nutrition is crucial for health in pregnancy and across the generations. Experiencing food insecurity during pregnancy is a driver of inequalities in maternal diet with potential maternal and infant health consequences. This systematic review explored associations between food insecurity in pregnancy and maternal and infant health outcomes. METHODS AND FINDINGS:Searches included 8 databases (MEDLINE, Embase, Scopus, Web of Science, PsychInfo, ASSIA, SSPC in ProQuest, and CINAHL), grey literature, forwards and backwards citation chaining, and contacting authors. Studies in high-income countries (HICs) reporting data on food insecurity in pregnancy and maternal or infant health, from January 1, 2008 to November 21, 2023 were included. Screening, data extraction, and quality assessment were carried out independently in duplicate. Random effects meta-analysis was performed when data were suitable for pooling, otherwise narrative synthesis was conducted. The protocol was registered on PROSPERO (CRD42022311669), reported with PRISMA checklist (S1 File). Searches identified 24,223 results and 25 studies (n = 93,871 women) were included: 23 from North America and 2 from Europe. Meta-analysis showed that food insecurity was associated with high stress level (OR 4.07, 95% CI [1.22, 13.55], I2 96.40%), mood disorder (OR 2.53, 95% CI [1.46, 4.39], I2 55.62%), gestational diabetes (OR 1.64, 95% CI [1.37, 1.95], I2 0.00%), but not cesarean delivery (OR 1.42, 95% CI [0.78, 2.60], I2 56.35%), birth weight (MD -58.26 g, 95% CI [-128.02, 11.50], I2 38.41%), small-for-gestational-age (OR 1.20, 95%, CI [0.88, 1.63], I2 44.66%), large-for-gestational-age (OR 0.88, 95% CI [0.70, 1.12] I2 11.93%), preterm delivery (OR 1.18, 95% CI [0.98, 1.42], I2 0.00%), or neonatal intensive care (OR 2.01, 95% CI [0.85, 4.78], I2 70.48%). Narrative synthesis showed food insecurity was significantly associated with dental problems, depression, anxiety, and maternal serum concentration of perfluoro-octane sulfonate. There were no significant associations with other organohalogen chemicals, assisted delivery, postpartum haemorrhage, hospital admissions, length of stay, congenital anomalies, or neonatal morbidity. Mixed associations were reported for preeclampsia, hypertension, and community/resilience measures. CONCLUSIONS:Maternal food insecurity is associated with some adverse pregnancy outcomes, particularly mental health and gestational diabetes. Most included studies were conducted in North America, primarily the United States of America, highlighting a research gap across other contexts. Further research in other HICs is needed to understand these associations within varied contexts, such as those without embedded interventions in place, to help inform policy and care requirements.

Out-of-home eating (takeaway, take-out and fast-foods) is associated with intakes of higher energy and fat, and lower intakes of micronutrients, and is associated with excess weight gain. In 2017, a unique opportunity arose to measure the association between the opening of a new multi-national fast-food restaurant (McDonald's) and consumption of fast-food on young people aged 11-16. This study uses a repeated cross-sectional design to explore group level change over time with respect to out-of-home eating behaviours of young people. Two secondary schools in Redcar and Cleveland agreed to participate and facilitated the completion of a questionnaire on their pupils eating behaviours at three timepoints a) prior to the new restaurant opening, b) three months post-opening and c) nine months post opening. Reported frequency of visits to McDonald's showed a statistically significant increase in visits between 3 and 9 months of the restaurant opening. This research asks and explores the question of whether the introduction of a new multi-national fast-food restaurant influences eating habits of young people attending schools near the new outlet.

This qualitative research sought to identify factors influencing patient choice of, and patient-related internal and external enablers and barriers to engagement with, type 2 diabetes (T2D) remission strategies offered by the Remission in diabetes (REMI.D) project. Patients had a choice of three diets: Total Diet Replacement (TDR)-Formula Food Products, TDR-Food, and Healthy lifestyle approach; and three activity pathways: Everyday life, General Practitioner referral, and Social hub. Semi-structured interviews were recorded and transcribed. Thematic analysis used the Framework Method and NVivo 12 to assist with generation and organisation of codes, inductive and deductive (Theoretical Domains Framework). The REMI.D project was a place-based approach (place in this case being defined as two local authorities with significant rates of deprivation) situated in the North East of England. Twenty patients out of a possible 65 patients took part. Areas of interest included: patient choice, patient intention, patient adherence, patient non-adherence, and patient stigma. Addition of a more moderate dietary strategy (not dissimilar to the diet in the Healthier You NHS Diabetes Prevention Programme) to the existing NHS England T2D Path to Remission programme may enable more patients to achieve remission or delayed progression with deprescribing of diabetes medications. Embedding a tailored physical activity path within or as a bolt-on to the NHS programme requires consideration. Limited resources should be targeted towards patients who identify with more barriers or fewer opportunities for health behaviour modification. Further research on use of virtual programmes in deprived areas is warranted.