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Clinical controversies to watch in 2015

BMJ 2014; 349 doi: (Published 17 December 2014) Cite this as: BMJ 2014;349:g7489
  1. Anna Sayburn, freelance journalist, London

A review of clinical uncertainties to look out for in the new year

Are gastric bands the best treatment for people with obesity?


Repeated studies have shown the difficulty that people who are overweight or obese have in losing a substantial amount of their body weight and especially in keeping that weight off, through diet, exercise and medication. Studies of bariatric surgery, on the other hand, show gastric banding and gastric bypass work quickly and effectively to reduce weight. Even more exciting, they seem to prevent type 2 diabetes in people at high risk of the condition, and even reverse diabetes in some patients.1


Gastric banding is drastic treatment for a condition which should, at least theoretically, be treatable by lifestyle measures. It comes at a risk of serious complications and has a big effect on lifestyle after the operation. Many people are left with excess skin from rapid weight loss, which may require additional cosmetic surgery.

What’s the latest?

NICE guidelines published in November 2014 recommended offering bariatric surgery to people with a body mass index of 35 or over who have recently developed type 2 diabetes.2

Are antidepressants overprescribed?


Prescriptions for antidepressants have risen sharply since the financial crisis of 2008 and represent the biggest increase in volume of prescribing by therapeutic area.3 Critics say depression is defined too loosely and many people diagnosed with depression are simply unhappy, in a rational response to their circumstances. Even for those correctly diagnosed, a Cochrane review found antidepressants helped only 1 in 7 people.4 Guidelines promote the use of psychological therapies such as cognitive behavioural therapy (CBT), but in many areas CBT is underprovided and people have to wait weeks or months for treatment. As a result, antidepressants are being used to plug the gap in the absence of potentially more appropriate therapy. …

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