RE: Lifestyle changes better than drugs
I'm sorry that this went first to just Debbi, but the mail went to me and brin-l, and my reply to user just went to her, not brin-l. Debbi convinced me that this study found a long term weight loss. From studies I'm familiar with, weight loss is usually short term...the average weight change 5+ years after various diets have been tried is positive; yet this study has found that there was an overwhelming number of people who kept at least a third of the weight off. So, I looked around, and there were few free references to long term weight loss that were not advertisements. I didn't feel like buying papers; so I just found a couple of free references. http://grants.nih.gov/grants/guide/pa-files/pa-04-092.html http://tinyurl.com/yds2l83 The first is a grant announcement from the NIH for studies looking into why people don't keep off weight. The second states with a footnote that I'd have to pay to refer to how weight loss is rarely maintained. Then I got creative, and found other studies with long term follow ups, which also showed about a third of the weight staying off. Why the contradiction? Then it hit mestudies usually _pay_ participants. Someone who is paid to stay in a study, and gets support for weight loss during that entire time is a unique individual. Thus, they are far more likely to maintain weight gain than folks who do not have this type of backing. Thus, we have a reason for the inconsistency, and why most folks don't keep weight off after they diet. I think there is little argument that losing weight is the first option for pre-diabetics, people with high cholesterol etc. But, in the real world, physicians tell people they need to change their lifestyle and most don't. That's why I see a strong correlation between abstinence before marriage and fidelity in marriage (include gay marriages if you will) as the best form of AIDS prevention and lifestyle changes as the best means of improving health. Both, if practiced, have shown tremendous results. Condoms, for example, only decrease the chances of pregnancy and getting AIDS, they don't prevent either. Given the fact that most folks are promiscuous, and education doesn't prevent it, talking about safer sex in schools makes sense. Just like it makes sense for a physician to tell a patient to try diet and exercise at the first signs of weight related problems and then go to meds at the next visit when the weight is either unchanged or increased. Dan M. ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
Lifestyle changes better than drugs
At least in diabetes prevention: http://diabetes.webmd.com/news/20091028/diet-beats-drugs-for-diabetes-prevention?ecd=wnl_day_103109 -- Lifestyle changes resulting in long-term weight loss of just a few pounds proved to be roughly twice as effective as drug treatment for preventing type 2 diabetes in an ongoing government-sponsored trial. Researchers followed almost 3,000 high-risk patients for a decade in one of the largest and longest studies aimed at preventing diabetes ever conducted in the U.S. Roughly a third of the participants were initially asked to eat a low-fat diet and engage in at least 30 minutes of moderate activity a minimum of five times a week, with the goal of losing 7% of their body weight within a year. Another third were put on the diabetes drug metformin; the remaining patients initially received no intervention. 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... ...Three years into the trial, Knowler and colleagues reported that diabetes incidence was reduced by a whopping 58% in the lifestyle intervention group and 31% in the metformin group, compared to people who received no intervention. This dramatic difference led the researchers to offer lifestyle intervention, in the form of group counseling and support sessions, to all three groups for the rest of the study. The 10-year follow up analysis, which appears Thursday in TheLancet, shows that: *Compared to the non-intervention group, patients in the intensive lifestyle intervention group and metformin group, respectively, were 34% and 18% less likely to develop diabetes over 10 years. *Lifestyle intervention was found to delay the onset of diabetes by four years. Drug treatment delayed diabetes by two years. *The benefits of intensive lifestyle intervention were particularly strong in the elderly. Those aged 60 and older in the diet and exercise group lowered their rate of developing diabetes by half over 10 years... 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! (Not that meds aren't often necessary and life-saving; I just don't like to hear them always put ahead of nutrition and exercise etc.) Debbi Ate My Oatmeal This Morning Maru ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
RE: Lifestyle changes better than drugs
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! (Not that meds aren't often necessary and life-saving; I just don't like to hear them always put ahead of nutrition and exercise etc.) I'd be curious to see if the lifestyle and weight loss group continued to include follow ups of all the failures. You know of course, that weight loss programs that do not involve surgery have about a 3% sucess rate after 2 yearsso my guess is that these folks are simply ignored in the study. Oherwise, they will have come up with unprecedented techniques for weight loss sucess...orders of magnitude better than any program previous to this. That's why my wife's physician strongly reccomended this surgery for her. After 5 years, she's 120 lbs lighter, and now has two new knees and can be active. She's within about 10 lbs of her absolue minimum weight, which is better than average. Dan M. VFP Just say no to food. myhosting.com - Premium Microsoft® Windows® and Linux web and application hosting - http://link.myhosting.com/myhosting ___ http://mccmedia.com/mailman/listinfo/brin-l_mccmedia.com
RE: Lifestyle changes better than drugs
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
