… or, So Long Sibutramine
Over two thirds of Americans are overweight. A safe and effective medication that helps people lose weight would be a boon for the health of millions who are struggling to take off the pounds. Unfortunately, this has been an extremely tough nut to crack for the pharmaceutical industry.
The existing medications for weight loss have been only modestly effective, and last week the choices became fewer. Meridia (the brand name of the medicine sibutramine) was voluntari...
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Sleep Deprivation Sabotages Dieting
The correlation between obesity and inadequate sleep has been known for some time. But does one cause the other or are they coincidental? It’s also known that inadequate sleep increases hunger, an effect I can attest to from my memories of medical training. I always ate more than usual on the days following nights spent in the hospital.
So people who don’t sleep enough feel hungrier and presumably eat more than people who get enough sleep. Is that the only mechanism connecting poor sleep to...
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Startling Scientific Finding: Dieting Leads to Weight Loss
What sort of diet helps people lose more weight? Do overweight people lose more weight on a low-carbohydrate diet (like Atkins) or on a low-fat diet (like Weight Watchers and others)?
A carefully designed study published in the current issue of the Annals of Internal Medicine answers that question. The study enrolled over 300 obese adults and randomized them to a low-carbohydrate diet or a low-fat diet. Importantly, patients with diabetes, high cholesterol and high blood pressure were exclud...
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Vitamin C and Vitamin E Do Not Prevent Eclampsia
A friend of mine recently asked me “Is regular soda or diet soda better for you?”
I tried to probe for details. “Are you talking about calories? Obviously, if you’re watching your weight or restricting carbohydrates, you should have the diet soda.”
“No, I don’t mean the calories.”
“Oh, you mean the concern that the citric acid might leach calcium out of your body?”
“No. I just mean overall, are they good or bad for you?”
This precipitated an important revelation that had been percolating...
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Erroneous Evidence about Enough Exercise
This week, a study in the Journal of the American Medical Association received a lot of undeserved media attention. The study wanted to examine the relationship between exercise and long-term weight changes among women who were eating a normal diet (i.e. not dieting). It followed for over a decade 34,000 women who were 45 years old or older and correlated their self-reported physical activity and body weight.
The study found that on average, the women gained about 6 lb during...
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Gastric Banding is an Effective Option for Obese Teens
What’s my advice to my overweight patients? Eat less and exercise more. I give this advice every day, but following this advice is much harder than giving it. Overweight people frequently struggle with diet and exercise for years, sometimes successfully, sometimes regaining their previously lost weight.
And as we become more overweight as a nation, obesity is no longer just a problem for adults. Over 5 million adolescents are estimated to be obese in the US, which predicts bad things for th...
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Normal Weight Obesity: Why Losing Weight Is Not Always the Answer
Weight loss is one of the most common recommendations that doctors make. How do we know if a patient should lose weight? We usually use the Body Mass Index (BMI) which is a way to compare a patient’s weight to her height. (For all you math geeks, it’s the weight in kilograms divided by the height in meters squared. For all you physicists, I know the units make no sense.) A BMI of 18.5 to 25 is considered normal. A BMI of 25 to 30 is considered overweight, and over 30 is considered obese. ...
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Weight Lifting Helps Breast Cancer Survivors with Lymphedema
One of my goals for these posts is to use individual studies to point out the broader trends they suggest. This week I want to focus on our increasing understanding of the value of exercise after illness or injury. A generation ago a heart attack meant weeks of bed rest in the hospital followed by strict instructions from the doctor to take it easy. The weakened heart couldn’t take much exertion, we thought. Now after a heart attack patients are told to start exercising as soon as they’re ou...
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Resolutions for a Healthy 2009
Many people use the occasion of the New Year to reflect on the last year and make specific goals for the next. Resolutions can be very helpful motivators if they are specific, realistic and written down. Just as people make goals for their careers and their relationships, resolutions for your health are a smart way to work for achievable targets in the health-related struggles you face.
So I encourage you this week to write down your health resolutions for 2009. Obviously, what progress is a...
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New Recommendation Against Screening for Prostate Cancer in Men 75 and Older
Two years ago I wrote about the controversy of routine screening for prostate cancer. Screening for prostate cancer is usually done with a blood test called PSA. But whether diagnosing prostate cancer early helps patients is still unknown, and there are many serious complications that result from prostate cancer treatment. That's why in many cases of prostate cancer watchful waiting is a reasonable choice.
The U.S. Preventive Services Task Force recently reviewed the existing evidence for an...
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