Weight Loss With Staying Power

I take the liberty to modify the old quip regarding quitting smoking to reflect the likely long-term success of dieting: "Ask anyone who's tried to lose weight and they'll tell you how easy it is- they've done it a million times."  And there is the rub (thank you Wills).  Many people are able to shed the pounds, but over time, they seem to creep back on, and they often bring along a few friends.  And as the weight creeps up, so does the risk of metabolic syndrome, diabetes, high blood pressure, cardiovascular disease, cancer...our international epidemic of obesity is often cited as most likely to break the healthcare bank.  Hope, at last, is here with a study by our Johns Hopkins colleague Lawrence Appel in this week's NEJM, as Rick and I discuss in this week's podcast and which receives top billing in our new weekly YouTube.

Just over 400 participants were recruited to this trial from primary care medical practices in the Baltimore area. They were all obese and had at least one cardiovascular risk factor and were randomized to one of three groups:  one got brief advice on weight loss and maintenance, then was merely followed for two years.  The other two groups were encouraged to lose 5% of their baseline weight within six months, then keep it off for the remaining 1.5 years of the study. One group received advice, support, education, reminders, and tracked their progress via the Internet, email, and telephone contact.  The final group got the electronic contact as well as face-to-face counseling and the opportunity to participate in group support sessions, but was not required to do so.

Each of the intervention groups achieved similar weight loss and ability to keep the weight at bay, demonstrating the efficacy of remote interventions to help people both achieve and maintain weight loss.  Yay!  Finally, a method that's fairly painless and easy for people (at least with a computer and modest skills in using it) get a handle on this effective way to improve health.  And the study also provides physicians, who are often at a loss to provide weight loss interventions, with a way to do so.  As Rick cites in the podcast, only 50% of obese patients queried reported that their physician ever asked them about weight or counseled them that weight loss efforts should be undertaken to improve their health.  Given the relative ease and low demands of this method, that can perhaps be rectified in many primary care practices around the world.

I had the pleasure of interviewing Larry about this study, when he confided, and I most heartily agree, that the best weight loss intervention remains prevention.  So while it's good news that we're finally getting a handle on what works to assist weight loss, never putting those pounds on to begin with is easiest for all concerned.

Other topics this week include giving niacin a miss and a new drug for raising HDL, or 'good' cholesterol, also in NEJM, and the impact of cardiac CT studies on subsequent interventions in JAMA.  Until next week, y'all live well.

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OrthoMolecular November 21, 2011 at 5:43 am

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OrthoMolecular November 21, 2011 at 5:41 am

Everyone who has ever tried to lose weight has hit a plateau at some point. A plateau is that point at which no matter what you do, you cannot seem to lose any more. If you have currently hit a weight loss plateau, there are a number of things that you can do to get going again on your road to successfully reaching your ideal weight.

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