This will not be welcome news for all of us who resolved to eat less and move more this year, but still secretly hoped that maybe medicine would step in. Maybe some novel treatment would reach maturity just as our willpower waned — a drug, a device, some new twist on surgery.
Sigh. The journal JAMA Internal Medicine is just out with an up-to-date analysis of options for treating obesity, accompanied by editor Fiona Clement’s vivid personal account of her own struggles with weight. The conclusion she draws from the latest data: “After much thought and brutal honesty with myself, I would not pursue any of the interventions; the risks outweigh the benefit,” she writes. “I’m off to the gym.”
I spoke with Dr. Clement, an assistant professor in the Department of Community Health Science at the University of Calgary, about her take on the data and her decision to discuss her own obesity — and even reveal her Body Mass Index — in print. “This is by far the bravest thing I’ve ever written, and perhaps ever done,” she says.
“After much thought and brutal honesty with myself, I would not pursue any of the interventions; the risks outweigh the benefit.”
But first, a distillation of the data from lead author Dr. Dan Ollendorf, chief scientific officer at the Institute for Clinical and Economic Review in Boston. The review is actually geared for doctors, but here’s his summary for the general public:
• Surgery: “The evidence is pretty consistent that these procedures do lead to significant weight loss in the short-term, up to about two years of follow-up. The challenge with the evidence available is that after two years, it’s a a bit of a black box. It’s unknown what actually happens. There’s some suggestion that in a pretty significant number of situations, patients actually regain weight. In cases where other conditions related to obesity, like diabetes, have improved or resolved as a result of surgery, that can be reversed in some individuals. And so that is the really big unknown with surgery: What are the longer term outcomes for patients?”
• New drugs: “The bottom line is that this is sort of more of the same. A number of drugs have been used — some FDA-approved and labeled for weight loss, others used off-label for weight loss. The new drugs result in relatively modest reductions in weight, really not very different from the existing medications that have been available for decades. They are very high cost and in some cases have the potential for really significant side effects. So there really is mixed evidence, and the benefit, if any, that appears to be available with the current evidence is pretty modest.”
• Devices: “This is kind of a heart-wrenching situation because surgery is a major step for people. Most of the advanced surgical programs in the U.S. have been able to reduce their complication rates, but this is still a risky surgery, and there are some major complications that can occur. And given that medications have produced only modest weight reductions, there’s been a lot of interest in trying to produce something that may be less invasive than surgery but more effective than medication. Continue reading