Tuesday, November 12, 2019

New Systematic Review Concludes No One Will Ever Successfully Maintain Their Lost Weight. Or Does It?

From the Journal I Can't Believe This Ever Got Published (ok, in this case from Obesity Reviews) comes The challenge of keeping it off, a descriptive systematic review of high-quality, follow-up studies of obesity treatments.

The paper apparently is meant to be a counterpoint to other systematic reviews of long term weight loss where,
"conclusions are generally positive and give the impression that weight loss interventions work and that weight loss can be maintained"
Well we can't have that now can we?

It appears these authors sure couldn't because here are the criteria they used in selecting papers for their systematic review that concluded long term weight loss is impossible:
  1. Studies must have follow up periods of at least 3 years
  2. Patients must not have had any continued interventions during the follow up period
  3. Medications approved for weight management aren't allowed
So what they ended up with were 8 studies of varied protocols being administered temporarily for a chronic medical condition where half provided what by definition were only temporary interventions (3 with very low energy diets, and one with hospital provided food). But guess what, chronic medical conditions require ongoing treatment, and what happens when you actually provide it? Well you get studies that would spoil the impossible narrative as noted by the authors of this paper,
"several of the non-included studies report a majority of participants achieving satisfactory weight loss and little regain, especially among studies with continued interventions during the follow-up period."
Imagine that! Appropriately treating a chronic medical condition with continued interventions works!

And this notwithstanding the fact that many (most? all?) of those studies that provided ongoing interventions likely did not include the appropriate prescription of medications to either help with losses or to prevent regain (just as we would with any other chronic condition) because weight loss medications are almost always excluded from use in weight loss diet studies. Which is odd by the way. Consider hypertension for instance. Sure some people might be able to resolve theirs by way of such things as lower sodium diets, increased exercise, and weight loss, but there's zero doubt that patients with hypertension will receive regular ongoing follow up visits with their physicians, and where appropriate, will be prescribed medications to help. Why? Because that's how chronic condition are managed! Which is why we'll never see a systematic review of hypertension treatments demonstrating that brief lifestyle counselling and the explicit exclusion of medications didn't lead to lower blood pressure 3 years later.

Leaving me to wonder, why publish a paper with the literal conclusion,
"that the majority of high-quality follow-up treatment studies of individuals with obesity are not successful in maintaining weight loss over time"
when really all your systematic review (of just 8 papers all with different dietary/lifestyle interventions) has proven is that delimited, lifestyle counselling doesn't miraculously cure a chronic medical problem, and where you admit in your paper that the appropriate provision of ongoing care might well in fact lead to sustained treatment benefits?

But I don't really need to wonder. Because the only reason that this paper was conceived and published is because of weight bias, whereby obesity has different rules applied to it, in this case, the notion that unlike so many other chronic medical conditions that are impacted strongly by lifestyle changes (eg. hypertension, type 2 diabetes, GERD, heart disease, COPD, gout, osteoarthritis, osteoporosis, kidney stones, and many more) people believe that for obesity some brief counselling should be enough to do the job, because that in turn plays into the trope of obesity being a disease of willpower and a deficiency of personal responsibility.

(Thanks to Dr. Andrew Dickson for sending my way)

Thanks to your generosity I'm over 2/3s of the way to my $3,000 Movember fundraising goal. While I'll never monetize this blog, this is my annual fundraiser and if you find value here, consider a donation! Remember, every dollar counts, it's tax deductible, and you can give anonymously! To donate, simply click here

Saturday, November 09, 2019

Saturday Stories: Mary Cain, Fatal Powerpoint, And Echo Chambers

Mary Cain, in the New York Times, tells her story of the intersection of abuse and elite sport.

Jamie, in McDreeamie Musings, on the Powerpoint slide that killed 7 people.

C Thi Nguyen, in Aeon, on the dangers of echo chambers

And if you haven't had a chance to donate yet to my lipterpillar, and you find some value or enjoyment from this blog, please consider and remember, every dollar counts. So far this year the generosity of friends and family have helped to raise $1,640. Movember is a tax deductible charity and you can give anonymously if you'd prefer. And of course, as I've mentioned, Movember funds multiple men's health initiatives including mental health, suicide, body image, eating disorders, substance use disorders, & testicular cancer. To donate, simply click here

Wednesday, November 06, 2019

"Severe" Energy Restriction Better For Weight Loss Than "Moderate" Energy Restriction?

Well according to this new RCT it is - in it they found that patients randomly assigned to 4 months of severe energy restriction (65-75% restriction of energy by way of total meal replacement/all liquid diet) followed by 8 months of moderate energy restriction (25-35%), at 12 months, lost significantly more weight than those assigned from the get go to the same degree of moderate energy restriction.

Hurrah?

So first off it's not remotely surprising that putting two groups on the exact same diet (25-35% energy restriction) but starting one group off with 4 months of extreme energy restriction sees those who had the extreme jump start lose more in total.

Secondly, it would appear that the extreme folks have a weight gain trajectory that may well erase the differences over time.

And thirdly, this got me thinking. Behavioural weight loss programs, because they don't involve products (unless medications are being tested, and here they were not), have outcomes that are likely significantly dependent on both material, and perhaps more importantly, on the service providers. Consequently I do wonder about the ability of any of these sorts of studies to be applicable to other offices or programs. Meaning here at least, it would appear the extreme folks did better, and the moderate folks dropped out more often (perhaps consequent to slower than desired initial losses), but would the same necessarily be true at a different site, with the same restrictions but with different service providers, collateral materials, attention and support?

I'd venture those things matter a great deal more than is generally ever mentioned in the medical literature.

And a Movember update! If you enjoy these posts (or even if you don't but you hate read them for something to rage about thereby adding some extra meaning or identity to your life) would love your tax deductible donation to my lipterpillar's growth (and remember, you can give anonymously too). And though I have a family history of prostate cancer (hi Dad!) I think it's important to note that beyond prostate cancer Movember funds multiple men's health initiatives including mental health, suicide, body image, eating disorders, substance use disorders, and testicular cancer. And while I will never charge a penny or host an advertisement on this site, I will, on an annual basis, ask for your donation to this cause. To donate, simply click here

Tuesday, November 05, 2019

Just Because Your Cafeteria Has A Salad Bar Does Not Make It Healthy

A few months ago I visited the Ottawa Hospital's Civic campus and decided to have a peek over at the cafeteria.

It won an award you see, an "Award of Recognition" to be exact, which according to the plaque was for,
"significant achievement in creating a supportive, healthy, nutrition environment across hospital retail food settings"
A supportive and health nutrition environment you say?

Um, about that:


Sigh

Saturday, November 02, 2019

Saturday Stories: Bad Nutrition Advice, Nell Scovell, And The Memo Method Of Fitness

Shauna Harrison, herself both a fitness instruction and a Ph.D. in public health, in Self, is begging you to stop taking nutrition advice from your fitness instructors.

Nell Scovell, in Vanity Fair, with an amazing piece of writing about her pre-#MeToo era interactions with David Letterman, and what it was like to sit down with him a decade later to discuss it.

Lindsay Crouse, Nayeema Raza, Taige Jensen and Max Cantor, in the New York Times, with just a lovely video on Guillermo PiƱeda Morales, a.k.a. Memo, and his fitness methodology.

Lastly, I've had many people write to me over the years about their enjoyment of Saturday Stories in particular. If that's you, and if it moves you, today is #Movember 2nd! and your donations  are my ෴'s fertilizer! You give, I grow. And beyond prostate cancer Movember funds multiple men's health initiatives including mental health, suicide, body image, eating disorders, substance use disorders, & testicular cancer. To donate, simply click here

Photo by Pete Souza - Cropped from https://www.flickr.com/photos/whitehouse/3994558942, Public Domain, Link