Obesity Survey

Fizzwizz · Feb 22, 2009

ally5555 said:
we need more dietitians and fizz is making very sweeping statements about their outcomes..

Come now, I wouldn't call the 10 or so references to mata analyses, systematic reviews, and Randomised Controlled trials that I have posted "sweeping statements".

Thirsty · Feb 22, 2009

ally5555 said:
fergus - u are sceptic !

we need more dietitians and fizz is making very sweeping statements about their outcomes. I am not having 100% success but I would say from my own audit that 70% of pts lose wt and i have an ever increasing no that are keeping it off. We need more dietitians at ground level - not in hospitals as that is the worst place to promote a healthy lifestyle.

Ally, do your patients manage to maintain their weight loss long term? I think that's the point Fizz is trying to make.

Fizzwizz · Feb 22, 2009

This is again from my review of the literature

A Cochrane review in 1997 illustrated that bariatric surgery was an effective intervention for obesity, demonstrating good results in evidence(13). In contrast to the bleak long term results obtained by dietary and pharmacotherapy treatments bariatric surgery has been shown to result in excess weight loss of over 61% in a meta-analysis(14) which was sustainable at 10 – 15 year follow up. The ‘Swedish Obese Subjects’ study compared surgical, pharmacological, and lifestyle alteration therapy, demonstrating a tenfold increase in the success of surgical intervention compared to non surgical after 10 years(15-17).

More importantly this success can be shown in the reduction of obesity related mortality, and morbidity. Sjöström et al(18) demonstrated in 2007 that surgery decreased the overall mortality of obese patients, with a hazard ratio compared to the control group and adjusted for age, sex, and risk factors, of 0.71 (p=0.001). An earlier study by Pories et al(19) in 1995 also demonstrated the impact of bariatric surgery upon type II diabetes stating “No other therapy has produced such durable and complete control of diabetes mellitus.” This study also demonstrated bariatric surgery to correct or alleviated other co-morbidities of obesity, including hypertension, sleep apnoea, cardiopulmonary failure, arthritis, and infertility stating “Gastric bypass is now established as an effective and safe therapy for morbid obesity and its associated morbidities.“

13. Glenny AM, O'Meara S, Melville A, Sheldon TA, Wilson C. The treatment and prevention of obesity: a systematic review of the literature. Int J Obes Relat Metab Disord 1997;21(9):715-37.
14. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292(14):1724-37.
15. Torgerson JS, Sjostrom L. The Swedish Obese Subjects (SOS) study--rationale and results. Int J Obes Relat Metab Disord 2001;25 Suppl 1:S2-4.
16. Sjostrom CD, Peltonen M, Wedel H, Sjostrom L. Differentiated long-term effects of intentional weight loss on diabetes and hypertension. Hypertension 2000;36(1):20-5.
17. Silecchia G, Perrotta N, Boru C, Pecchia A, Rizzello M, Greco F, et al. Role of a minimally invasive approach in the management of laparoscopic adjustable gastric banding postoperative complications. Arch Surg 2004;139(11):1225-30.
18. Sjostrom L, Narbro K, Sjostrom CD, Karason K, Larsson B, Wedel H, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007;357(8):741-52.
19. Pories WJ, Swanson MS, MacDonald KG, Long SB, Morris PG, Brown BM, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 1995;222(3):339-50; discussion 350-2.

fergus · Feb 22, 2009

we need more dietitians

Well, it's a long shot, Ally :shock:
Tell you what, if you throw the 'Eat well plate' against the wall so that it shatters into unrecognisable pieces, then introduce the 'Abattoir of good health'. Or the 'Heart healthy Butterchurn', then we can talk. :wink:

fergus

sugarless sue · Feb 22, 2009

Obviously,Fizz,if you remove most of someone's stomach so that they can never again eat normally they will lose weight and probably that weight will stay off because they cannot eat normally.It is not rocket science therefore to predict that they will not have put that weight back on in ten years,although apparently so do manage to do just that.Are these hapless souls going to be vetted before hand to make sure that they will adhere to the diet after their surgery.

Fizzwizz · Feb 22, 2009

This is from the National Institute of Clinical Excellence's own audit of Bariatric surgery.

Expert clinical opinion
The consensus of the topic-specific advisory group was that:

Of the total population with a BMI of 35 kg/m2 or more with comorbidities, and those with a BMI of 40 kg/m2 or more, 90% to 95% are unlikely to achieve or maintain clinically beneficial weight loss through non-surgical means.
On the basis of current clinical opinion and published research it is anticipated that there would be an annual increase of severe obesity of 5% in the English population, and that the rate of increase would be the same in each BMI group.
Of the total population with a BMI of 35 kg/m2 or more with comorbidities, and those with a BMI of 40 kg/m2 or more, around 50% to 70% could be considered eligible for bariatric surgery. This is based on the proportion undertaking multicomponent specialist non-invasive weight management programmes including diet and exercise advice, and those making contact with health services.
Of those eligible for bariatric surgery, between 30% and 50% would take up surgery if offered it.
Of those eligible and willing to receive bariatric surgery, it would be possible to treat around 1.6% (around 4800 patients) per year, given appropriate future investment and optimal service capacity.
Rates of surgery should be expressed as a benchmark that may be achieved annually after a number of years – for example, 5 years – given the expected current unmet need in the population.

Thirsty · Feb 22, 2009

Also, is it possible that what remains of the stomach after surgery is capable of expanding in size over time? I don't know, but strongly suspect that this is the case when the procedure hasn't been successful.

sugarless sue · Feb 22, 2009

Yes Thirsty the stomach can expand,but probably not to what it was originally but still expand enough to accommodate excessive food.

ally5555 · Feb 23, 2009

keeping people motivated is also underfunded - I have pts who come back now and then and that seems to work. Some keep going by email or even txt. It has to suit the individuals.

In fact there are quite a number of long term wt loss projects going on across the UK. In wales we have just roled out the MEND project for kids. That has been very successful in England - go and check out the web site . Mend and other similar projects are based on behaviour change and addresses the reasons people over eat.
Dietitians are a bit shy about promoting alot of the work that is going on across the UK. They certainly do not publish enough of it but money and time is a restriction.

So Fergus if you do not like the food plate what would you advice - I use the plate to explain food groups. Not everyone understands the concept of protein ,carbs etc - so it is a useful too in practice.

I would welcome your suggestions.

Fizzwizz · Feb 23, 2009

ally5555 said:
we need more dietitians and fizz is making very sweeping statements about their outcomes. I am not having 100% success but I would say from my own audit that 70% of pts lose wt and i have an ever increasing no that are keeping it off. We need more dietitians at ground level - not in hospitals as that is the worst place to promote a healthy lifestyle.

I don't dismiss the fact that 70% of your patients are losing weight due to your intevention. But this is not sustainable over the long term. This is the important concept that people aren't getting. Many interventions cause short term weight loss, but when the research is done it's shown that in the long term it goes back on again so dietary and lifestyle advise is not working. This doesn't mean that short term weight loss isn't of benefit.

So when plans are formulated to combat nationwide obesity, the role of the dietician is limited and won't have an impact on the overall problem of obesity. The misconception that dietary advice can impact obesity is causing us to look in the wrong place for an effective treatment. More dieticians will definitely improve the nation's health, but it won't help obesity in the long term.

catherinecherub · Feb 23, 2009

Hi Fizz,
I also think that self help groups have a part to play. A little bit of competition works wonders and people feel at ease because they are not being judged, everyone is in the same boat.
I think lifestyle has a part to play but our lifestyles now are part of progress. No labour saving devices, no cars, no televisions, walking everywhere or cycling. That is how previous generations coped and it meant that exercise was incorporated into day to day living. They also didn't have access to fast foods or the range of goodies that we have today. Walk through any supermarket and most things come in at least ten variations and the ceral aisles just amaze me. I also notice that some young mothers ask their children what they want mum to buy. Kids are going to pick the product that appeals with regard to the advertising strategy. No kid wants a boring box containing the product. The best advertised are the ones they ask for. Advertising has a lot to answer for.
There is no quick fix and surgical intervention may seem the answer but is it? If it was offered to all obese people then that would certainly bring the shopping bill down but how would the food industry fight back? The diet industry would also be in chaos. Profit before people is the mantra of these groups.
Regards, Catherine.

Trinkwasser · Feb 23, 2009

sugarless sue said:
My incentive ,Fizzwizz is to lower my blood sugars,for the first time in fifty years I am successfully losing weight and keeping it off.For the second time I have found a successful way to lose weight but this time the incentive to keep the weight down will win out.

Seen this?

OK it's not truly a scientific survey, but interesting nonetheless

http://diabetesupdate.blogspot.com/2009 ... sults.html

see previous post for the actual results

Trinkwasser · Feb 23, 2009

saz1 said:
Metabolic problems, insulin or leptin resistance etc don't frequently just begin, surely they are often side effects of long term weight problem or a nutritionally deficient diet like the common "yellow food diet". :?:

The metabolic problems are there all along and are probably an adaptive response to famine. They only get triggered in the presence of high levels of food and they get triggered worse in the presence of high levels of carbs.

Some research suggests around 30% of the population has "diabetic genes". The government are working on the basis that all of these people WILL become diabetic. What changed between when this didn't happen and now? The Heart Healthy Diet (see also increases in other cardiovascular disease)

Trinkwasser · Feb 23, 2009

Fizzwizz said:
The misconception that dietary advice can impact obesity is causing us to look in the wrong place for an effective treatment. More dieticians will definitely improve the nation's health, but it won't help obesity in the long term.

Yes but they are mostly recommending the WRONG diet so obviously there is going to be no long term change. It's just like telling diabetics to eat more starch and less fat then blaming them when they get worse. Wait a minute, it's EXACTLY like telling diabetics to eat more starch and less fat.

fergus · Feb 23, 2009

More people suffer health problem from not having the surgery than having it!

On that basis, as even more people appear to lose weight quickly, effectively, and often permanently by eating a diet which eliminates sugars and refined carbohydrates, and suffer no ill effects in the process, we ought to be looking for the solution there?

I may have said it before, but if we spend our resources treating the symptoms and not the cause, then the battle is lost. If the success rate of weight-loss strategies is only 5%, and yet poor diet is responsible for the problem in the first place, it strongly suggests that the majority of those weight-loss diets are ill conceived. And yes, the vast majority appear to be low calorie, low fat diets don't they?

All the best,

fergus

ally5555 · Feb 23, 2009

well Fergus - most low carbers are following a low calorie diet - alot less than I would prescribe - of course you are the exception! My snap shot analysis also showed that - except for you and Graham. maybe there is a difference between women and men?

Have you ever looked at the BBC diet trials - the low carb - atkins dieters were also following a low calorie diet and there was quite a drop out rate. That was based on analysis of food diaries. Are you actually saying then that no one drops out of low carbing - one look at bernsteins site would not concur that.

Most people need some kind of support in the BBC project which compared the fashionable type diets at the end it was the support from a slimming club that alot turned to. I think that support from peers and professionals is the way forward for a lot of people.

fergus · Feb 23, 2009

First of all, most of the diets you analysed were from people actively trying to lose weight. If they were low in calories, that's hardly surprising. My own experience taught me that low calorie wasn't essential to lose weight, but it certainly won't do any harm. Maybe we should ask why those people perhaps weren't deliberately restricting calories, but their lack of hunger made them eat less independently? Low-calorie diets typically make for hungry dieters don't they? There seems to be unanimity amongst those on low carb or low GI diets that they feel a remarkable absence of hunger.

No-one should be too surprised if the attrition rate for low carb diets is higher than it might be when the powerful consensus of health professionals and the food industry actively discourages them. We have to continually defy the sceptics and get no support from the NHS at all. Yet the attrition rate for low fat diets is higher, despite the relentless drive to promote them.

Must dash, the stilton is calling me.

fergus

ally5555 · Feb 23, 2009

fergus - do you ever listen .

some of the low carbers are not trying to lose wt but are still restricting calories because it is difficult to eat alot of fat for many people.

You didnt ans about the plate - I would love to see your version!

fergus · Feb 23, 2009

I'm quite a good listener, Ally, but I find it helps enormously when what I'm listening to makes sense.

Please let's not end up with yet another futile argument. This has been a really interesting and civilsed thread up until now.

fergus

ally5555 · Feb 23, 2009

yes it has but make statements about healthy eating / food plates but no ideas what to replace it with - I am just interested !

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