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Episode 42: Obesity – what’s the big deal? – Part II

In episode 42, we continue to take a bite out of the big problem of obesity by getting down and dirty with “diets” and drugs. As usual, lifestyle issues win out and James and Mike celebrate this news by pigging out – but it’s OK because we used small plates.

Show Notes

1) Lifestyle beats out drugs

Stopping patients with IGT going to DM

Metformin, acarbose, rosiglitazone: NNT = 7-14 (?)1-4

Lifestyle NNT= 4-9 1,5,6

Developing the metabolic syndrome 7

Metformin vs Lifestyle NNT: Resolve = 20 vs 5

IGT to DM long-term

7 years 8 (3 yrs without intervention): NNT = 32/yr

20 years 9 (14 yrs without intervention): NNT 7 (or 140/yr) with 93% vs 80% DM

References for the above

1. NEJM 2002;346:393-403

2. Lancet 2002;359:2072-7

3. Diabetes Care 2006;29:2095-101

4. Lancet 2006;368:1096-105

5. Diabetes Care 1997;20:537-44

6. NEJM 2001;344:1343-50

7. Ann Intern Med 2005;142:611-19

8. Lancet 2006;368:1673-79

9. Lancet 2008;371:1783–89

2) Little evidence for any one commercial diet over another

Ann Intern Med 2005;142:56-66

Am J Med 2005;118:991-7

Obesity 2007;15:421-9

JAMA 2004;292:2482-90

Int J Obes 2004;28:1349-52

3) No difference if you eat fat or protein or carbs

Int J Obes 2006;30:552-60

Arch Intern Med 2006;166:1466-75

Am J Clin Nutr 2005;81:1298-306

Arch Intern Med 2004;164:210-7

J Int Med 2007;261:366-74

Am J Clin Nutr 2006;84:813-21

JAMA 2003; 289:1837-50

Cochrane 2002;2:CD003640

JAMA 2007;297:969-77

Int J Obes 2004;28:1283-90

Ann Intern Med 2004;140:778-85

N Engl J Med 2008;359:229-41

4) Top 10 tips for weight loss

Int J Obesity 2008;32:700–7

5) Smaller plates

Arch Intern Med 2007;167:1277-83

6) Drugs for weight loss Sibutramine and orlistat

Diabetes Care 2007;30:27-32

JAMA 2001;286:1331-9

J Intern Med 2000;248:245-54

Fluoxetine vs sibutramine or orlistat

Arch Intern Med 2004;164:1395-404

Cochrane 2004;3:CD004094

Ann Intern Med 2005;142:532-46

7) Surgery for weight loss

Ann Intern Med 2005;142:547-59

Int J Obes 2006;30:129-33

Ann Intern Med 2006;144:625-33

Cochrane 2003;2:CD003641

Episode 41: Obesity – what’s the big deal?

In episode 41, we start to tackle the big problem of obesity by getting the advice of 2 Mikes for the price of one. We discuss how classification is more useful from an epidemiologic perspective than it is from an individual patient perspective – which is often the case in medicine. In the end, the team heads to a local fast food restaurant to verify the evidence for caloric binging.

Show Notes

1) Depression and obesity

Synopsis of the 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children.

CMAJ 2007;176(8 suppl):S1-13

2) Obesity and increased mortality

Ann Intern Med 2003;138:24-32

3) Being a little bit overweight is OK

JAMA 2007;298:2028-2037

Lancet 2006;368:666-78

J Am Geriatr Soc 2005;53:2112-8

4) Metabolic syndrome – who cares?

Metabolic syndrome classification predicts CVD risk no better than just using the regular CVD factors like age, sex, cholesterol, blood pressure, diabetes etc.

Diabetes Care 2006;29:1693

Framingham risk score was a better predictor of CHD and stroke than the metabolic syndrome

Arch Intern Med 2005;165:2644-50

Episode 40: Keeping up with the medical literature – 101

In episode 40 we discuss 4-5 different and fairly simple ways to keep up with the medical literature and we both come to the conclusion that the best way to keep up is to listen to these podcasts. Unfortunately we were unable to find any evidence to support such a belief. Mike critically appraises James and finds a number of fatal flaws in his design.

Show Notes

1) InfoPOEMS http://www.essentialevidenceplus.com/product/features_dailyip.cfm

2) ACP journal club http://www.acpjc.org

3) Evidence-based medicine http://ebm.bmj.com

4) Quickscan reviews http://www.cmeonly.com/QSR/qsrdemo.html

5) NetNewsWire – RSS reader for Mac users http://www.newsgator.com/INDIVIDUALS/NETNEWSWIRE

6) Amedeo http://www.amedeo.com

Episode 39: New trials you need to know about – Part II

In episode 39 we get to the 4 studies we didn’t get to in the previous podcast. We discuss evidence that BMI is as useful as cholesterol when it comes to estimating cardiovascular risk, inhaled corticosteroids increase risk of pneumonia in patients with COPD – but don’t worry just put them on daily erythromycin – and finally we discuss yet another antihypertensive trial. Mike demonstrates some sensitivity approaches to medicine in general and James ignores him.

Show Notes

1) BMI predicts risk as well as knowing a patient’s cholesterol

Lancet 2008;371:923-31

2) Meta-analysis of inhaled corticosteroids in COPD – no difference in mortality, reduction in exacerbations but pneumonia was increased by 4% (absolute) over a period of a year

JAMA 2008;300:2407-16

3) Erythromycin 250 mg BID for one year compared to placebo – exacerbations reduced to a similar degree as to that seen with inhalers

Am J Respir Crit Care Med 2008;178:1139–47

4) ACCOMPLISH – Benazepril plus Amlodipine or Hydrochlorothiazide for Hypertension in High-Risk Patients

N Engl J Med 2008;359:2417-28

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