This is the third installment of a review of an article published in the New England Journal of Medicine on January 31, 2013 (NEJM 2013 368:446) titled “Myths, Presumptions and Facts About Obesity”. This week we will look at what the authors felt were scientifically proven facts about obesity. These nine facts have implications for public health, health care policy or clinical care. They are as follows:
1) Although genetic factors play a large role, heritability is not destiny; studies show that moderate environmental changes can promote as much as weight loss as the most efficacious pharmacologic agents available. Diet and exercise can trump genetic background!
2) Reduced caloric intake diets very effectively reduce weight, but long term compliance and efficacy are not impressive. Strategies such as eating more fruit or regular breakfasts will only work if total daily caloric intake is reduced
3) Regardless of body weight or weight loss, increased exercise increases health. So exercise itself is the primary goal; weight loss is a great side effect.
4) Physical activity in a sufficient dose aids in long term weight maintenance The key is SUFFICIENT exercise-at least 30 minutes 5 times weekly of aerobic work.
5) Continuation of interventions that lead to weight loss promotes maintenance of lower weight Weight control is a lifelong process, requiring a commitment to long term interventions
6) For overweight children, programs that involve the parents are more effective than stand alone measures Since obesity runs in families, both because of genetic and environment causes, it is best managed as a family health challenge.
7) Provisions of meals and meal replacement products promote weight loss Predictable and structured caloric delivery is more successful than non-specific attempts to eat less.
8) Some pharmaceutical agents can help patients achieve and maintain weight loss-as long as the agents continue to be used. An important discussion with your primary care physician.
9) In appropriate patients, bariatric surgery results in long term weight loss and reduction in the rates of diabetes and mortality. As above, this is an important discussion to have with your primary care physician.
In sum the three columns have reviewed one group’s analysis of the available scientific data base. However, medicine is an art and not a science. Certain things we know. Exercise is good. BMIs of 30 or above are of concern; one between 25 and 30 is a warning sign. Coexisting diabetes, hypertension or other conditions need to be factored in to your overall health prescription.
If there are things that make sense to you, or other thoughts you have on the meaning and management of your weight, a discussion with your primary care physician is of value.