December 29, 2013
John DiTraglia MD
A few columns ago we relayed the report that intensive life style interventions for overweight and obese patients with type 2 diabetes didn’t prevent death and disability from heart attacks or stroke. (1,2) It also didn’t result in much weight loss. That was bound to incite many letters to the editor. Those appeared in last week’s New England Journal of Medicine.
The first letter said that they could not detect an effect of intensive lifestyle intervention and weight loss because the patients were not risky enough and would have done well anyway. The second letter said that they were already too far gone and so bad off that it was to late to intervene. One letter said that they should have tried the Mediterranean diet. Two letters point out that this report didn’t show that weight loss would not improve mortality, because weight loss surgery that results in big weight loss does improve mortality, but only that intensive lifestyle interventions don’t cause weight loss. To wit: “This trial does not answer the question as to whether lifestyle interventions such as weight loss and exercise improve outcomes in patients with diabetes. They almost certainly do. It simply addresses the question of whether a very intervention-focussed and expensive medically supervised weight-loss program can achieve those outcomes, and it almost certainly cannot.” (3) To which these authors replied that 6% weight loss over 9 to 10 years is real weight loss and that it improved a lot of other things, just not cardiovascular morbidity and mortality.
1. Me. Weight loss doesn’t help type 2 diabetics survive. Portsmouth Daily Times August 4, 2013 2. Wing RR et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013;369:145-54.
3. Eliosoff R, Christou N. et al. N Engl J Med 2013;369:257.