Dietary counseling works best when repeated

New studies focus on unwanted and dangerous pounds and even dangle the tantalizing prospect of melting pounds away with a simple injection.

By Susan J. Landers — Posted Aug. 13, 2007

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Physician persistence may play a key role when it comes to patients losing weight and keeping it off, according to a researcher who led a study in the July 3 Annals of Internal Medicine. The study made it clear that without ongoing counseling, any pounds lost after an initial counseling go-round will more than likely pile back on after five years.

While dietary counseling results in an average weight loss of about 10 to 15 pounds in one year, studies found that only half the loss remained after three years and, after five, almost all the lost pounds had been found.

To arrive at their findings, the researchers analyzed 46 trials that included 6,386 people who were participating in counseling-based weight-loss programs and 5,467 who were not involved in such programs.

"We've had a sense for decades that people lose weight and then gradually regain it. Now we have a better handle on the actual numbers," said the study's lead author Michael Dansinger, MD, an assistant professor of endocrinology, diabetes and metabolism at Tufts University School of Medicine in Boston. "But the problem remains that the people who lose the weight gradually regain it, and we want to be able to help people keep the weight off."

With about 65% of the American population overweight, physicians are treating an increasing number of patients with associated medical conditions, such as diabetes and heart disease. Treatment programs include the constant refrain "lose weight and exercise more." But should physicians save their breath?

Not necessarily, said Dr. Dansinger. He is counting on a continuing association with his patients to produce a payoff over time.

As a first step, Dr. Dansinger sees patients with diabetes on a weekly basis for three months to provide lifestyle coaching. "We are focusing on sticking to a healthy eating plan and exercising." After the initial three months, patients return every other week for another three months and then monthly thereafter.

Although modest weight loss that is temporary still has beneficial clinical effects, said Dr. Dansinger, the real prize would be attaining weight loss of 5% to 10% of body weight for five years. "That's where the health care system needs to focus its efforts in the next few decades."

Meanwhile, another study, in the July 1 online edition of Nature Medicine, is attracting attention for its novel, and apparently no-sweat, method for melting fat -- at least the fat of laboratory mice under stress.

The researchers found that by manipulating, via injections, a pathway that activates two types of cells in fat tissue, they were able to prevent fat from collecting around a mouse's midsection. The action is believed to work the same way in humans.

Activated when the mouse is under stress, this pathway may also be the route via which people who are under stress gain more weight than they should based on the calories they consume, said the researchers.

Senior author Zofia Zukowska, MD, PhD, professor and chair of Georgetown University's Dept. of Physiology and Biophysics, has been pursuing the role of stress in weight gain for decades. She wondered why mice lost weight when stressed while humans gained it.

"One of the things that was different was diet," she said. Mice are fed a controlled laboratory diet while humans have an abundance of food. Often, the stressed human reaches for comfort foods, which contain a high level of fat and sugar.

In both mice and humans, this fat positions itself around the midsection, causing the most dangerous kind of obesity, the kind that results in diabetes and cardiovascular disease.

A recent study making headlines

Friends might make other friends obese?

In a nutshell, that message was among the findings of another study, this one published in the June 26 New England Journal of Medicine.

Researchers concluded that the spread of obesity in social networks appears to be a factor in the obesity epidemic. However, they also suggested it may be possible to harness this factor to slow its spread.

They noted that their findings highlight the need to approach obesity not only as a clinical problem but as a public health problem, too, and that the concept of social networks should be taken into consideration in crafting public health interventions.

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