For the third time in two years, the FDA has approved a drug to help people lose weight. The new drug, Contrave, combines two generic drugs, naltrexone and bupropion. Naltrexone is used to help kick an addiction to alcohol or narcotics. Bupropion is used to treat depression and seasonal affective disorder. Many people also take bupropion to stop smoking. Neither naltrexone nor bupropion by itself has been approved for weight loss. Specifically, Contrave was approved for use by adults who are obese (meaning a body-mass index of 30 or higher) and by overweight adults (body-mass index between 27 and 30) who have at least one other weight-related condition or illness, such as high blood pressure or type 2 diabetes. Across the clinical trials on which the FDA based its approval, some people lost more than 5% of their body weight. But it’s important to note that more than 50% had minimal or no weight loss. Side effects ranging from seizures and high blood pressure to diarrhea and constipation were reported.
Diet and Weight Loss
The results of a clinical trial reported in yesterday’s Annals of Internal Medicine showed that low-carb diets helped people lose weight better than low fat diets. A report in today’s Journal of the American Medical Association tells a somewhat different story. A review of 48 head-to-head diet trails showed that average weight loss on either a low-carb or low-fat diet for 12 months was the same, about 16 pounds. And when the researchers compared named diets, which ranged from the low-carb Atkins and South Beach diets to moderates like Weight Watchers and Jenny Craig and low-fat approaches like the Ornish diet, all yielded similar weight loss. The main message from careful comparisons of different diets is that there’s no single diet that’s right for everyone. Any healthy diet can help people lose weight. And there’s more to a diet than weight loss. What’s needed for long-term health is an eating plan that can be followed day in and day out that is good for the heart, bones, brain, and every other part of the body. One eating strategy that can provide all that is the so-called Mediterranean diet.
Trans fats, once seen as harmless additives that ended up in everything from Twinkies to French fries, are finally getting the reputation they deserve—bad for health. For years, the FDA has labeled trans fats as “generally recognized as safe.” That term applies to substances added to foods that experts consider safe, and so can be used without testing or approval. Yesterday the FDA proposed removing trans fats from the generally recognized as safe list, a step that would eliminate artificial trans fats from the American food supply. Oils rich in trans fats, long a workhorse of the food industry, boost harmful LDL cholesterol. They also depress protective HDL, which trucks LDL to the liver for disposal; have unhealthy effects on triglycerides; make blood platelets more likely to form artery-blocking clots in the heart, brain, and elsewhere; and feed inflammation, which plays key roles in the development of heart disease, stroke, and diabetes.
There’s something satisfying about getting immediate feedback about exercise, sleep, and other activities. That’s why more and more people are joining the “quantified-self” movement. It involves formal tracking of health and habits, usually using apps and devices that feed data to them—from heart rate, activity, and sleep monitors to Bluetooth connected scales. But with so many apps and connected devices on the market, it can be hard to decide which ones are worth trying. Wellocracy, a website launched by the Harvard-affiliated Center for Connected Health, aims to give people impartial information about fitness trackers, mobile health apps, and other self-help technologies. It reviews dozens of sleep trackers, wearable activity trackers, mobile running apps, and mobile pedometer apps, lets you compare apps and devices in each category, provides a guide for beginners and offers tips for adding activity “bursts” throughout the day.
William Howard Taft was America’s heaviest president. He would have preferred being seen and remembered for something else, and took steps to lose weight. Taft’s story of weight loss and regain, described in today’s Annals of Internal Medicine, sounds completely familiar today, more than 100 years later. Using correspondence and archival sources, Deborah Levine, an assistant professor at Providence College in Rhode Island, tells the story of Taft’s struggles with his weight. In 1905, with the help of a British physician, Taft went from 314 pounds to 255. He was pleased with his accomplishment. But three years later, when Taft was inaugurated as the nation’s 27th President, he tipped the scales at 354 pounds. His story and struggle with weight are no different than what many people experience today.
For many people, a late-night “snack” is a daily habit. There are two types of nighttime eating disorders. Sleep-related eating disorder is a highly-publicized though uncommon malady. People with this problem eat while sleepwalking or while in a twilight state between sleep and wakefulness. A better-documented problem is night eating syndrome, in which people do the majority of their eating late at night. It may affect 1 or 2 out of 100 people in the general population. Sleeping and eating are almost certainly connected, given the link between lack of sleep and weight gain. So getting plenty of sleep may be a helpful substitute for nighttime trips to the refrigerator. Being mindful of the problem and trying to identify its triggers, or stress-reduction techniques, may help avert trips to the refrigerator. Some people benefit from talk therapy.
Long-awaited results from a nearly 10-year trial exploring the effect of changes in diet and exercise among people with diabetes weren’t what most people expected. The Look AHEAD trial found that intensive efforts to lose weight by eating less and exercising more didn’t provide any more protection against heart disease—a common co-traveler with diabetes—than standard diabetes support and education. The spin from some media reports is that weight loss doesn’t reduce heart disease risk among people with type 2 diabetes, but I think that’s the wrong interpretation. The results of the Look AHEAD trial don’t contradict the value of lifestyle changes. People in the intensive change group improved their blood sugar with fewer drugs, saving an estimated $600 per year, they were also less likely to have developed chronic kidney disease and less self-reported vision problems. The Look AHEAD results reinforce for me that diabetes care needs to be tailored to the individual.
City dwellers often think of rural America as a throwback to past “good old days.” But when it comes to obesity and diabetes, people living outside urban areas offer a frightening glimpse of the future. While more than 8% of Americans now have diabetes, in some rural counties 20% of the residents have diabetes. Those counties also tend to have high rates of obesity. Barriers to healthy living contribute to both obesity and diabetes. So does lack of primary care physicians. One answer may be greater reliance on community health workers—lay people trained to provide diabetes education and outreach. In Birmingham, Alabama, the Cities for Life program has doctors refer people with diabetes to “patient navigators” who help them find local resources such as nearby exercise classes or mobile farmers’ markets.
The Mediterranean diet has been getting a lot of press as being the very best for health. But there’s another diet that appears to be equally good: a vegetarian diet. A study published in JAMA Internal Medicine found that people who ate a vegetarian diet were 12% less likely to have died over the course of the five-year study than nonvegetarians. The benefits were especially good for men, who had a significant reduction in heart disease. This study underscores the idea that meat consumption influences long-term health, and not in a good way. Should you consider ditching the Mediterranean diet and becoming a vegetarian instead? Either one is healthier than the typical American diet, so it’s really a matter of personal choice.
New Jersey Governor Chris Christie’s revelation yesterday that he had secretly undergone weight-loss surgery back in February shouldn’t come as a big surprise. He has been publicly (and privately) struggling with his weight for years and fits the profile of a good candidate for this kind of operation. In general, weight-loss surgery is appropriate for people with a body mass index (BMI) of 40 or higher, as well as for those with a BMI of 35 to 39.9 and a severe, treatment-resistant medical condition such as diabetes, heart disease, and sleep apnea, who had tried to lose weight other ways. Christie had a BMI of at least 41. He also acknowledged trying to lose weight many times, using different weight loss programs. He underwent laparoscopic gastric banding, also known as lap banding. There are also two other types of weight-loss surgery, gastric bypass and the gastric sleeve procedure.