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PRACTICE: Mike Lean, Jose Lara, and James O Hill Strategies for preventing obesity BMJ 2006; 333: 959-962 [Full text]

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A question

ANDREW MONTGOMERY   (3 November 2006)

Strategies in the management of obesity

Surya P Rajeev, Satheesh B Nair, Machester Royal Infirmary.   (6 November 2006)

A question 3 November 2006
ANDREW MONTGOMERY, locum Auckland Send response to journal: Re: A question	My belief is that the government needs to intervene by way of massive regulatory and taxation response to the food industry if anything is to change in New Zealand. There are experts in the field in New Zealand who agree. I would be intrigued to know if there are any British "specialists" or "GPs" who agree that this is necessary in the UK. I frequently work with the most disadvantaged and most obese members of our community and have zero faith in their ability to embrace the "healthy eating, healthy action" message. This is not because I am cynical - but simply because of that which I have observed over the last ten years. I live in hope that my belief has no basis. Competing interests: None declared
Strategies in the management of obesity 6 November 2006
Surya P Rajeev, SHO in Diabetes and Endocrinology Prince Charles Hospital,Merthyr Tydfil,CF47 9DT., Satheesh B Nair, Machester Royal Infirmary. Send response to journal: Re: Strategies in the management of obesity	Obesity is a major contributor to the global burden of diseases and for this reason new therapies and helpful diets to tackle obesity carries great significance.Even though dietary approach has a significant role in the prevention and management of obesity,little is known from studies to date about the long term outcomes of various diets. Modified macronutrient diets, such as libidum diets that restrict the distribution of one of the three macronutrients-fat,carbohydrate or protein-but allow people to eat as much as they want,may result in modest sustainable weight loss in people although few studies have examined thier effect on body weight regulation(1).Low carbohydrate diet have been shown to bring about greater weight loss as well as greater reduction in triglyceride levels,greater increase in insulin sensitivity in subjects without diabetes and greater improvement in glycaemic control in subjects with diabetes than low fat diets though the study was of short duration and limited by poor adherence and high attrition(2).This could be due to the increased protein intake associated with carbohydrate restriction because protein is more thermogenic and a more satiating macronutrient(3).Longer and larger studies are required in this area which is importantin the prevention of obesity. Another important challenge in tackling the toll of obesity is the treatment of people who are currently obese.Rimonabant, a cannabinoid-1 receptor blocker and insulin detemir, an insulin analogue which appears to have less effect on weight gain in type 2 diabetes appears to be promising, but again limited by lack of longer duration studies. In the context of the current obesity epidemic and associated burden on health care resources, clinical tools like waist circumference which was independently associated with all the metabolic syndrome criteria (4), may enable physicians to identify at risk individuals who may benefit from early intervention. Obesity should be given same level of importance as other risk factors like alcoholism or smoking and so the importance of legal strategies to combat obesity(5) are extremely important. References: 1. JAMA, October 4 2006; Vol 296(13):1577-1579. 2. NEJM, May 22 2003; 348: 2074-2090. 3. International Journal of Obesity related Metabolic Disorder 1996; 20:720-732. 4. Diabetes 2004; 53:2087-2094. 5. NEJM, June 15 2006; Vol 354:2601-2610. Competing interests: None declared