> From: dsummersmi...@comcast.net <dsummersmi...@comcast.net> <Me> > >OK, so I'm still harping on lifestyle as preferable over drugs in > treating and preventing chronic illnesses -- nice to have my > opinion backed up so decisively!
> I'd be curious to see if the lifestyle and weight loss > group continued to include follow ups of all the failures. From the WebMD article (cited last post): "...Many of the people in the lifestyle intervention group met the weight loss goal, losing an average of 15 pounds during the first year of the study. While they regained, on average, 10 of those pounds during the next seven years, the lifestyle intervention group continued to have the lowest rates of diabetes..." If you're defining 'failure' as regain of weight, they still benefitted WRT diabetes prevention/delay of onset. This is from the Lancet abstract: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61457-4/abstract "...All active DPP participants were eligible for continued follow-up. 2766 of 3150 (88%) enrolled for a median additional follow-up of 5·7 years (IQR 5·5—5·8). 910 participants were from the lifestyle, 924 from the metformin, and 932 were from the original placebo groups. On the basis of the benefits from the intensive lifestyle intervention in the DPP, all three groups were offered group-implemented lifestyle intervention. Metformin treatment was continued in the original metformin group (850 mg twice daily as tolerated), with participants unmasked to assignment, and the original lifestyle intervention group was offered additional lifestyle support..." I think 88% continuance of original participants is pretty good. "...During the 10·0-year (IQR 9·0—10·5) follow-up since randomisation to DPP, the original lifestyle group lost, then partly regained weight. The modest weight loss with metformin was maintained..." - and yet their diabetes rate was still lower than the metformin subset. Commentary from another journal: http://www.medicalnewstoday.com/articles/169082.php "...The authors explain: "In this study, onset of diabetes was delayed by about 4 years by lifestyle intervention and 2 years by metformin compared with placebo." They write in conclusion: "Our results have shown that a reduction in diabetes cumulative incidence by either lifestyle intervention or metformin therapy persists for at least 10 years. Further follow-up will provide crucial data for long-term clinical outcomes, including mortality... The long-term reductions in bodyweight and diabetes are encouraging, but further quantification of long-term outcomes is crucial to establish the benefits of diabetes prevention..." > You know of course, that weight > loss programs that do not involve surgery have about a 3% > sucess rate after 2 years.... What made this study noteworthy to me was that *in spite of* regaining much of the weight lost, delay of diabetes onset still was better than the drug (or of course no intervention at all). Also, surgery results for extreme obesity are much better than mild or overweight (further confusion with use of BMI vs. 'ideal weight,' follow-up years, and changes in surgical techniques (some studies are based on out-moded procedures). This 2006 Mayo article was one of the better ones I found: http://www.mayoclinicproceedings.com/content/81/10_Suppl/S46.full "... Few randomized, controlled prospective trials have compared bariatric surgery to nonsurgical weight-loss treatments, and the quality of current outcome data is suboptimal. However, the available evidence suggests that bariatric surgery, and particularly gastric bypass, is the most effective weight-loss treatment for people with extreme (class III) obesity. In addition to reduced energy intake and to a lesser extent malabsorption, numerous other potential mechanisms related to bariatric surgery may play a role in promoting weight loss and improving comorbidities. After bariatric surgery, clinical improvement or resolution has been reported in 64% to 100% of patients with diabetes mellitus, 62% to 69% of patients with hypertension, 85% of patients with obstructive sleep apnea, 60% to 100% of patients with dyslipidemia, and up to 90% of patients with nonalcoholic fatty liver disease. A wide range of other weight-related conditions also appear to improve, and limited data suggest that overall mortality may decrease in patients undergoing bariatric surgery. Although not conclusive, evidence from available studies indicates that bariatric surgery is cost-effective. Further research with improved methodology is needed to define the mechanisms of action of bariatric surgery; to document its effect on long-term weight loss, comorbid conditions, and overall mortality; and to determine its cost-effectiveness... "With the exception of 2 studies published more than 20 years ago and 2 studies published in 2002 and 2006, no other prospective randomized controlled trials have compared bariatric surgery with nonsurgical approaches. The first 2 trials compared either jejunoileal bypass or horizontal gastroplasty (surgical procedures no longer performed) to medical treatment. The study by Mingrone et al compared outcomes in a diet group with those in a group undergoing a biliopancreatic diversion (BPD) procedure. After 1 year, men and women in the diet group lost an average of 6.2% and 5.8% of initial body weight, respectively, compared with an average loss of 34.3% and 28%, respectively, in the BPD group. In the study by O'Brien et al, 80 adults with mild to moderate obesity (body mass index [calculated as weight in kilograms divided by the square of height in meters], 30-35 kg/m2) were randomized to an intensive medical program vs placement of a laparoscopic adjustable gastric band (LAGB). At 2 years, mean weight loss in the medical and surgical groups was 5.5% and 21.6%, respectively..." > ...That's why my wife's physician strongly reccomended this > surgery for her... I have myself recommended surgery for a few select patients -- but the study I originally cited was about lifestyle changes vs. drug or nothing, and outcome was in delay/prevention of disease, not only weight loss. Debbi Experiencing Massive Carb-craving With Shorter Days Maru :P _______________________________________________ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
