This week’s Journal of the American Medical Association (JAMA) has the reports of 2 studies and an editorial about the treatment of obesity. Do we need more studies about diet and exercise for the treatment of obesity published in prestigious medical journals?
The first one (1) conducted by 9 PhD’s at the University of Pittsburgh and the University of North Carolina at Chapel Hill, was designed to see if we could spend less time and money on trying to make people diet and exercise by starting with quick and easy and then only increase the face time with the coaches if they didn’t lose weight. This strategy, called “stepped care (STEP),” was compared to group-based intervention sessions on a fixed schedule, called “standard behavioral weight loss intervention (SBWI).” They divided 363 overweight and obese adults into these 2 approaches and found that at the end of 6 months there were better results in the SBWI group than in the STEP group, 10.4% weight loss vs 8.2%, but that by 18 months the difference was not significant, 8% vs 7% weight loss respectively. And the average cost difference, $1357 for the SBWI and $785 for the STEP means that STEP is better. Even better than that would be “just do it” like they say in the Nike commercial. Why should it take $785 or $1357 to make people diet and exercise? All that for about 10% weight loss that you’re going to put back on over time even with continued “intervention.”
In an editorial in this issue of JAMA, Dr. George Bray, a doyen in the field of obesity, comments that, “This trial thus shows that the novel approach of spending more time and effort on patients who need it most may be more economical than implementing a standard protocol for all participants regardless of their response.” but that “..the findings do not answer the question of how to achieve weight loss in a manner that will be appealing enough to the participants to result in long-term, sustained weight loss.” (2) So weight loss is hard but maintaining weight loss is even harder.
For a possible answer to the even more important question of weight loss maintenance is the second study report in this issue of JAMA. (3) For my examination of that report, which you may have heard about because it has gotten a lot of press, you’ll have to wait until next week. I’m hungry and tired.
1. Jakicic JM et al. Effect of a stepped-care intervention approach on weight loss in adults. JAMA 2012;307:2617-26.
2. Bray G A. Diet and exercise for weight loss. JAMA 2012;307:2641-2.
3. Ebbeling CB et al. Effects of dietary composition on energy expenditure during weight-loss maintenance. JAMA