Intended for healthcare professionals

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Analysis

Challenging assumptions in obesity research

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5303 (Published 22 November 2017) Cite this as: BMJ 2017;359:j5303

Rapid Response:

Reply to Sturgiss et al

Thanks for Sturgiss et al paying attention to our response. We have read the reply carefully, and we hope to make a further explanation to the authors' responses so that editors and readers can better understand the relationship between weight loss and compliance.

Sturgiss et al pointed out that medication and lifestyle intervention differ in compliance because of individual differences. Although complying with lifestyle regime is more complex than medication adherence, the ultimate goal of both is consistent. Thus, clinicians pay the same attention to the practice and effect of lifestyle regime despite of individual differences. To solve this problem, we suggest that shared decision making between physicians and patients may help to develop a patient centered treatment, during which patients can act as partners and will be able to fully comply with such interventions (see http://www.bmj.com/content/359/bmj.j4218). On the other hand, weight loss and compliance are never “unconditional”, and are indeed considered in the overall health and willingness of the individual. Regarding the potential health risks of weight loss in obese patients, we believe that these are usually discovered and solved during follow-up, as treatment of chronic diseases is a long-term and interactive process.

In addition, although the clear relationship between weight loss and health outcomes needs further clinical trials to prove, we believe that weight loss may help when treating obese patients with metabolic risk factors or other chronic conditions. A recent study published in the Lancet on December 5th indicates that by intensive weight management, overweight patients with type 2 diabetes can achieve remission to a non-diabetic state and off anti-diabetic drugs (see http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33102-1/fulltext). This is really exciting news to clinicians.

Based on the above reasons and our previous statements, we insist that weight loss, to some extent, can reflect the compliance of obese patients in the clinical practice. Thus, the value of weight loss should not be overlooked.

We welcome the authors’ further reply if any of our statements does not make sense.

Competing interests: No competing interests

10 December 2017
Zhijie Xu
resident physician
Mi Yao; Lizheng Fang
Cadet Brigade, Naval Medical University of Chinese PLA
#800, Xiangyin Road, Yangpu district, Shanghai, China