Kari Johansson, Martin Neovius, Ylva Trolle Lagerros, Richard Harlid, Stephan Rössner, Fredrik Granath et al
Johansson K, Neovius M, Lagerros Y T, Harlid R, Rössner S, Granath F et al.
Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men: a randomised controlled trial
BMJ 2009; 339 :b4609
doi:10.1136/bmj.b4609
Very low energy diet... a very good starting strategy
Concerns about lack of clinical equipoise in the design and
conduction of
clinical trials that evaluate weight loss for obstructive sleep apnoea are
valid,
but those interventions should be considered as part of a strategy, not as
the
strategy itself.
Several studies have insinuated that weight loss may play a role in
the
attenuation or correction of obstructive sleep apnoea, but the lack of
sound
evidence justifies the studies. If uncontestable evidence is found, it can
be
used to motivate not only the patient but the health provider. Even though
weight loss appears as an obvious intervention, the lack of evidence
prevents
the the patient to make the decision and the assignment of the extra
efforts
that are needed.
Given the fact that overweight is the only modificable risk factor,
it should be
part of the general approach, but it must be considered as a partial
strategy.
In the process of losing weight, strong and continuous stimuli are
needed,
and a very low energy diet does not seem like an appropriate stimulus. But
if
the intervention is considered as the initial step, and a significant
weight
reduction is achieved, there are two fulfilled objectives: weight
reduction, with
its impact on obstructive apnoea, and a powerful stimulus for the patient
to
keep losing weight, or at least to maintain the newly achieved and
healthier
weight.
Most of the strategies and approaches used in weight reduction
programs fail
because they are considered as the one and only way to obtain weight
reduction, and health providers do not see those strategies as a
significant
but partial part of a more global plan.
If a health team provides a patient with a very effective method to
achieve
weight reduction, it is their responsibility not only to see it as the
opening
step of the process, but to help the patient understand that the initial
and
sometimes impressive weight reduction should be taken as an
encouragement or motivation to keep the tendency and to maintain the
reductions.
Competing interests:
None declared
Competing interests: No competing interests