Intended for healthcare professionals

Rapid response to:

Clinical Review

Treating obesity in individuals and populations

BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7529.1387 (Published 08 December 2005) Cite this as: BMJ 2005;331:1387

Rapid Response:

Turning A Blind Eye To Obesity?

Jain's Clinical Review of obesity treatments (BMJ 9/12/05) makes some
sweeping and incorrect statements about the ineffectiveness of treating
individuals. She states that "these (individual) interventions have
resulted in only small amounts of permanent weight loss with marginal
clinical relevance". However she ignores a body of recent research in a
sub-group of obese or overweight patients- those with prediabetes.

A recent sytematic review of weight-loss interventions in this group
(1) showed that the incidence of diabetes was significantly lower in the
intervention groups in three of five studies examining this outcome after
3-6 years followup. In the US Diabetes Prevention Program, after an
average followup of 2.8 years, the lifestyle intervention
reduced diabetes incidence by 58 percent (2). Other CVD risk factors were
also improved (3). If these benefits are maintained, there is every
reason to believe that CVD endpoints will improve. Similar results were
obtained in the Finnish Diabetes Prevention Study, and an intervention
based on it is now national policy there (4).

The obesity epidemic is a daunting prospect for health professionals,
and unfortunately the blind eye turned by Jain is a frequent, but flawed,
response. As a public health doctor I agree entirely with Jain in hoping
that evidence-based public health interventions emerge quickly. However
health professionals will also need to fully engage with the epidemic to
ensure that their overweight and obese patients receive appropriate
treatment and referral, where it is justified by the evidence. They will
have increasing support to do this- for example, from health trainers.
One hopes that this message will be received not just by primary
healthcare teams but also by those negotiating the new Quality and
Outcomes Framework of the GP Contract.

References

1. Norris SL, Zhang X, Avenell A. Long-term effectiveness of weight-
loss interventions in adults with pre-diabetes. Am J Prev Med 2005; 28:
126-139.

2. Diabetes Prevention Program Research Group. Reduction in the
incidence of Type 2 diabetes with lifestyle intervention or metformin. N
Engl J Med 2002; 346: 393-403.

3. Diabetes Prevention Program Research Group. Impact of Intensive
Lifestyle and Metformin Therapy on Cardiovascular
Disease Risk Factors in the Diabetes Prevention Program. Diabetes Care
2005; 28: 888-894.

4. Tuomilehto J, Lindstrom J, Eriksson JG et al. Prevention of
type 2 diabetes mellitus by changes in lifestyle among subjects with
impaired glucose tolerance. N Engl J Med 2001; 343: 1343-1351.

Competing interests:
None declared

Competing interests: No competing interests

17 December 2005
Michael Soljak
Public Health Advisor
Department of Health, Wellington House, 133-155 Waterloo Road, London, SE1 8UG