Medscape
Yoni Freedhoff, MD
Gerry Gajadharsingh writes:
“I took the decision, a number of years ago, to extend the standard length of the Metabolic Balance individual nutritional program that we offer patients here at The Health Equation, from 3 to 6 months. As a recent article below from Medscape suggests there are many “diets” that will help people lose weight over a short period of time. The challenge is to help people adopt a healthier eating pattern over the long term, which is why our program last for six months. However, even when people know what they need to eat and when they need to eat, sometimes life gets in the way and people can go off track. Being healthy is sometimes hard work!
The article below, also refers to some of the more modern drugs that are now being used for obesity, including Semaglutide. At the moment it is used for helping manage type 11 diabetes and is currently off label for weight management/obesity, but this is in the process of being changed, by NICE.
Semaglutide, a GLP 1 (glucagon like peptide) injection is a type 11 diabetic drug used off label for weight loss, it slows down digestion and helps reduce cravings. It increases insulin production from the pancreas and reduces the release of glucose from the liver. A weekly injection pen costs in the UK approximately £150 for 4 doses, i.e., for 1 month.
It was the trial, “Once weekly Semaglutide in adults with overweight or obesity” published in the New England Journal of Medicine, in March 2021, which helped to get this drug on the map, The study was carried out over 68 weeks, so this would cost approximately 68/4 *£150, £2,550. They monitored the progress of 1961 adults with a BMI of over 30 (or over 27 with the weight-related condition) for 68 weeks. Half took a placebo, an inactive drug that is believed to be the weight-loss drug, and the other half took Semaglutide.
They found that those who took the Semaglutide had a 14.9% loss in body weight (average weight loss 15.3kg) when combined with a healthy diet and exercise, compared to those who took the placebo and lost 2.4% of their body weight.
There are many listed side effects, some of them serious which may put some people off, in addition to the expense. Also, the study used a dose of 2.4mg, higher than the commonly prescribed doses commercially.
And when you stop it, guess what, you gain weight again. Elevated insulin tends to be pro inflammatory, activating a cascade of other inflammatory cytokines. I can’t help but think this will eventually prove to be a problem. Let’s see what happens with emerging data over the next few years. In the meantime, you now have a choice of an expensive drug or a comprehensive Metabolic Balance program including comprehensive blood tests, where my guess is that an individualised Metabolic Balance program will give people a better long-term outcome, assuming people are motivated enough to really change their diet.”
https://www.thehealthequation.co.uk/metabolic-balance-nutritional-programmes/
Is there a diet or weight-loss program out there that doesn’t work for those who stick with it during its first 12 weeks?
Truly, the world’s most backwards, upside-down, anti-science, nonsensical diets work over the short haul, fuelled by the fact that short-term suffering for weight loss is a skillset that humanity has assiduously cultivated for at least the past 100 years. We’re really good at it!
It’s the keeping the weight off, though, that’s the hitch. Which leads me to the question, why are medical journals, even preeminent nonpredatory ones, publishing 12-week weight-loss program studies as if they have value? And does anyone truly imagine that after over 100 years of trying, there’ll be a short-term diet or program that’ll have the durable, reproducible results that no other short-term diet or program ever has? Why are we still pretending that there’s a magic bullet out there?
Take this study published by Obesity just last month, “Pragmatic implementation of a fully automated online obesity treatment in primary care”. It details a 12-week online, automated, weight-loss program that led completers to lose the roughly 5% of weight that many diets and programs see lost over their first 12 weeks. By its description, aside from its automated provision, the program sounds like pretty much the same boilerplate weight management advice and recommendations that haven’t been shown to lead large numbers of people to sustain long-term weight loss.
Participants were provided with weekly lessons which no doubt in some manner told them that high-calorie foods had high numbers of calories and should be minimized, along with other weight-loss secrets. Users were to upload weekly self-monitored weight, energy intake, and exercise minutes and were told to use a food diary. Their goal was losing 10% of their body weight by consuming 1200-1500 calories if they weighed less than 250 lb (113 kg) and 1500-1800 calories if they weighed more than 250 lb, while also telling them to aim for 200 minutes per week of moderate- to vigorous-intensity physical activity.
What was found was wholly unsurprising. Perhaps speaking to the tremendous and wide-ranging degrees of privilege that are required to prioritise intentional behaviour change in the name of health, 79% of those who were given a prescription for the program either didn’t start it or stopped it before the end of the first week.
Of those who actually started the program and completed more than 1 week, despite having been selected as appropriate and interested participants by their physicians, only 20% watched all of the automated programs’ video lessons while only 32% actually bothered to submit all 12 weeks of weight data. Of course, the authors found that those who watched the greatest number of videos and submitted the most self-reported weights lost more weight and ascribed that loss to the program. What the authors did not entertain was the possibility that those who weren’t losing weight, or who were gaining, might simply be less inclined to continue with a program that wasn’t leading them to their desired outcomes or to want to submit their lack of loss or gains.
Short-term weight-loss studies help no one and when, as in this case, the outcomes aren’t even mediocre, and the completion and engagement rates are terrible, the study is still presented as significant and important. This bolsters the harmful stereotype that weight management is achievable by way of simple messages and generic goals. It suggests that it’s individuals who fail programs by not trying hard enough and that those who do, or who want it the most, will succeed. It may also lead patients and clinicians to second-guess the use of antiobesity medications, the current generation of which lead to far greater weight loss and reproducibility than any behavioural program or diet ever has.
The good news here at least is that the small percentage of participants who made it through this program’s 12 weeks are being randomly assigned to differing 9-month maintenance programs which at least will then lead to a 1-year analysis on the completers.
Why this study was published now, rather than pushed until the 1-year data were available, speaks to the pervasiveness of the toxic weight-biased notion that simple education will overcome the physiology forged over millions of years of extreme dietary insecurity.
Our food environment, which is a veritable floodplain of hyperpalatable foods, and the social determinants of health that make intentional behaviour change in the name of health an unattainable luxury for a huge swath of the population.
Yoni Freedhoff, MD, is an associate professor of family medicine at the University of Ottawa and medical director of the Bariatric Medical Institute, a nonsurgical weight management centre. He is one of Canada’s most outspoken obesity experts and the author of The Diet Fix: Why Diets Fail and How to Make Yours Work.