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