8 responses to “Weight loss in healthy people”

  1. I am a marathon runner who now weighs 10kg less than I did in medical school. Agree with recommending DASH or Mediterranean diet to patients but disagree about lack of benefits of adequate exercise re mental health and osteoarthritis. I have been told by 2 orthopedic surgeons to keep running (10k per day minimum in my case) in order to postpone knee replacement as long as possible. I counsel my patients to stay as fit as possible and that regular daily exercise is possible and better than taking drugs such as metformin and statins.

  2. Excellent summary of what I agree to be true – Thank you!

  3. John,
    Thanks for a précis of a sensible approach, and advice that most people can follow, if they are motivated. And it can be done in a single encounter.

  4. I continue to be astounded by those of my colleagues who think that saying ” Hey, you look great, you must have lost weight” is an appropriate way to compliment anyone. It reveals implicit and widespread beliefs by doctors that A) losing weight is appropriate and healthy for otherwise normal weight individuals and B) being thinner makes a person more attractive. We have a long way to go to conquer these judgmental and UNHEALTHY attitudes. Losing weight if you are otherwise healthy causes more risk to health and longevity than maintaining mild overweight. It is particularly damaging to our young children, teens and young adults. Get with the program.

  5. Thanks John, this is a very helpful distillation of information that I’ve been convinced of for some time and used in my practice, but hear little support for in general medical education. One question I have is about the subset of type 2 diabetics – there is evidence for improved blood sugar control with modest weight loss, but is there evidence for improved outcomes ?

  6. Weight trajectories in type 2 diabetes are interesting. As regards incident weight, it seems apparent that there is an obesity paradox here as well as in coronary heart disease, in that lowest mortalities in diabetic populations are found in the overweight and class 1 obese categories (1).

    The weight loss data is uncertain. A large recent meta-analysis (2) confirms benefit of weight loss in subjects with weight-related co-morbidities. 65% of subjects came from the Look AHEAD study (3), done only on diabetic patients, which showed no mortality benefit from weight loss.

    A paper by Doehner (4) from the proACTIVE study of 5000+ obese diabetics (primarily a glitazone/mortality trial) showed a mortality hazard ratio (HR) of 1.13 per 1% of weight lost, suggesting a significant increased risk of mortality

    Look AHEAD showed no mortality advantage in spite of achieving significant weight loss, and this may have been influenced by the intensive exercise component. This intervention involved, among other things, an average of 175 min of moderate exercise weekly. There is meta-analysis evidence that physical activity confers considerable mortality advantage in diabetes (5,6). It is possible that exercise was protective despite the weight loss. The study was large and well done, but eventually stopped for futility.

    The only other systematic review on this subject is Poobalan in 2007 (7), and it is not specific for diabetes. It relies heavily on a 2000 paper which examined intentional wt loss in 5000 obese diabetics (enrolled in a cancer study), and showed reduced mortality with wt loss. So we basically have one large study each for benefit and harm, the former being somewhat better metholologically. LookAHEAD showed no effect. It was the most appropriate and best done study, including a significant protective exercise component. My conclusion would be the same. Weight loss for diabetics is difficult and problematic. It will improve all the numbers and the quality of life, but has not been shown to improve mortality – it may in fact increase mortality unless the protective effect of exercise is applied effectively. I doubt that we will see another trial of Look AHEAD quality which will change this perspective. Informed consent would seem to be quite important.

    1. Logue J, et al. Diabetes Care 2013; 36: 887–893
    2. Kritchevsky SB, et al. PLoS One. 2015; 10(3): e0121993.
    3. Wing RR, et al. N Engl J Med 2013;369:145-54.
    4. Doehner W, et al. Int. J Cardiol 162 (2012) 20–26.
    5. Sluik D, et al. Arch Intern Med. 2012;172(17):1285-1295.
    6. Sadarangani KP, et al. Diab Care 2014; 37: 1016-1023.
    7. Poobalan AS, et al. Obesity Reviews 2007;99(2):170-176.

  7. A very relevant topic and quite interesting. It’s hard not have personal bias when discussing weight loss approaches with patients. I found Dr Bosomworth’s review quite helpful. Thank-you.

  8. I have begun to incorporate this in my practice.

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