Diet and Exercise Are Important – But Often Insufficient
The stories are heartwarming. A person is vastly overweight and finally decides to do something about it. Through determination, hard work and a newfound discipline, this person loses 25, 50 or even 100 pounds, thereby changing his or her life. Perhaps it is a woman who wants to have a child and is told that bearing a child would be life-threatening if she didn’t lose a significant amount of weight. Perhaps it’s a man who has been ridiculed all his life who decides that he is tired of the verbal abuse. You may have seen these scenarios played out on Dr. Oz or Oprah, or perhaps on the reality show, The Biggest Loser. Seeing the changes in these people’s lives after such a physical transformation can be inspiring.
I am a big supporter of diet and exercise. I once heard a doctor say that if you can somehow put the benefits of exercise in a pill, you’d have a wonder drug. Yet, despite the obvious benefits and the importance of diet and exercise, recent studies suggest that for the majority of the obese population, just diet and exercise won’t be enough.
If you are worried about the obesity epidemic in the US, two recent New England Journal of Medicine articles might further concern you. One is entitled “Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice” (NEJM, 365;21, 1959 – 1968, November 24, 2011) and the other is “A Two-Year Randomized Trial of Obesity Treatment in Primary Care Practice” (same issue, 1969 – 1979). Essentially, these papers are similar in that they look at the effectiveness of different interventions in primary care practices by physicians who were trying to help their obese patients gain better control of their health. On average, the patients in these studies had a body mass index (BMI) of about 35 ( e.g., a height of 5’7” and a weight of 220 pounds) and had at least one cardiovascular risk factor (high blood pressure, plasma glucose, or cholesterol). Both studies had control groups who received usual physician care. In the behavioral intervention study, besides the control group, one group received additional face-to-face counseling and the other group received advice remotely (telephonic or email). In the obesity treatment study, the control group was compared to those who received monthly lifestyle counseling and another group who received enhanced counseling plus meal replacements and weight-loss medications.
The good news is that in both studies, those patients who were getting enhanced treatment, be it extra counseling on behaviors, more frequent sessions with their doctors or physician assistants, or enhanced life-style counseling, all had sustained statistically significant weight-loss after two years. The amount of weight loss wasn’t trivial – it was on the order of 5%. Even if the counseling was done remotely, the results were meaningful. Thus, extra time spent by primary care physicians and their associates can make a difference in helping their patients lose weight.
But the disappointing news is that even with the loss of 5% of body weight, these patients are still obese. For the aforementioned person who loses 5% from their 220 pound frame, their new weight is 209 pounds and their BMI is 34 – still well in the obese range. When you consider that the Center for Disease Control statistics for 2010 show that there are now 12 states where more than 30% of the adult population is obese, the loss of 5% body weight is just a small step to where we must get to in order to improve the nation’s health.
Obesity is a disease and its impact on the future health of the US cannot be trivialized. Lifestyle changes are very important and can’t be minimized. But for millions of Americans, this isn’t nearly enough. Undoubtedly, the future for obesity treatment will necessitate a three-pronged effort that includes diet/exercise, life-style changes and new drugs. For the latter, both the FDA and the pharmaceutical industry need to work together to help find safe and effective treatments to enhance a physician’s armamentarium to deal with this problem.