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Does Badgering Patients to Exercise and Eat Better Actually Work?

The results of a very prolonged trial in America have just been published in the New England Journal of Medicine. Not encouraging...

by
Theodore Dalrymple

Bio

July 16, 2013 - 11:00 am
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Why hello there…

Doctors are often appalled by their patients’ unhealthy habits, as much for aesthetic as for health reasons. They are also irritated by the refractory nature of those habits and the failure of patients to do anything about them even when repeatedly advised to do so. Such repetition serves a purpose, however. Doctors may not be able to cure their patients, but they can at least make them feel guilty. To do so relieves the doctor’s feelings.

Now that Type II diabetes – that used to be called maturity-onset in the days before children began to get it – has reached epidemic proportions, the scope for medical lifestyle badgering has increased enormously. But does it do any good?

The results of a very prolonged trial in America have just been published in the New England Journal of Medicine. More than 5000 fat Type II diabetics aged between 45 and 75 were randomly allocated to normal treatment and standard advice, on the one hand, and (sinister phrase) “intensive lifestyle intervention” on the other. The investigators ended the trial after most patients had participated in it for about ten years. Something called “futility analysis” revealed that prolongation of the trial was unlikely to produce positive results.

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Top Rated Comments   
This would be a financial burden on the people least able to pay. Unless they are forced to buy expensive health insurance, most of them would not or could not. BTW, I thought the idea behind insurance was to pool the risks to allow lower rates for all participants. Since when has "insurance" become a bludgeon for the Nanny State?
39 weeks ago
39 weeks ago Link To Comment
As PJM's own Instapundit always writes, go ye forth and buy Gary Taubes' "Why We Get Fat" (don't know how to embed the link, sorry). I took off 20+ pounds in two months. Easy peasy.
http://www.amazon.com/Why-We-Get-Fat-About/dp/0307474259/ref=sr_1_1?s=books&ie=UTF8&qid=1374091282&sr=1-1&keywords=why+we+get+fat
39 weeks ago
39 weeks ago Link To Comment
The only thing that will work is when the patient has had enough of being overweight for whatever reason (usually vanity).

I was 100 pounds overweight for years, always wanting to lose the weight in a vague sort of way but not wanting to do any work. Finally about six months ago I'd just had it and made myself start eating healthier and slowly starting to exercise. So far I'm down 30 pounds, long way to go yet, but still.

Nagging or expressed concern, none of it made a difference.
40 weeks ago
40 weeks ago Link To Comment
All Comments   (25)
All Comments   (25)
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My wife hated finger sticks for blood sugar. She acquired a dim view of carbs. She continued to eat as much of everything she wanted, except she would eat something else than carbs. To everyone's surprise, her blood sugar and A1c went to normal and stayed there. Her high cholesterol disappeared and she came off of cholesterol meds. Her high blood pressure disappeared and she came off of diuretic meds. Her weight dropped to what it was in her twenties, all even though wheelchair-confined. And, her life-long depression disappeared.

One wonders what the patient results would be if those with Type II diabetes were excused from finger-stick checking of blood sugar on days when they ate no carbs.
39 weeks ago
39 weeks ago Link To Comment
The same is true of my father. He cut out the carbs, lost 80 pounds, has kept the weight off for more than 5 years, and his blood pressure went down, his cholesterol went down, and even the glaucoma pressure reading in eyes went down.

Additionally, I have a step daughter that reacts to criticism about her weight from her grandparents by shoving every more mouthfuls of food into her mouth. Her grandparents aren't trying to be mean, however, they fail to grasp that words of praise work on this young woman far more than words designed to embarrass and humiliate her. And her silly grandmother keeps telling her to eat more grains....she's sedentary and overweight, carbs = body fat in those conditions, bad advice and bad nurturing.
39 weeks ago
39 weeks ago Link To Comment
In my observation, these healthy habits have to start in childhood. Like reading for pleasure, understanding the monotony and rewards of practicing anything (piano, ice skating, archery, whatever), and any other form of self-discipline.
39 weeks ago
39 weeks ago Link To Comment
It is funny, but television shows you how to do it on shows like The Biggest Loser. Of course, you can't offer $100,000 prizes to every group of 16 fat people.

While I was very physically active as a child, when I got into college, I put on over 100 pounds in about a two year period going from 170 to 280. It took me a year of concerted effort (diet and exercise) to get back to 170. That was 20 years ago, and it requires a lot of self-discipline that no amount of hectoring will ever provide.
39 weeks ago
39 weeks ago Link To Comment
THREE hours a week moderate exercise? I think I've located a major factor here. That approximates the 30 minutes a day I guess, but that's the kind of number you need not to drop dead of sheer inactivity. To approximate normality I'd think you need to double that at the very least and further, avoid life styles where this scheduled activity is the ONLY time of day when you get your body moving and burn a few calories. More exercise may not solve every problem in the book, but I doubt you'll get very far on those problems however else they are addressed, without it.

I'd also wonder if really the experimental group stuck to the diet, unless they were supervised pretty nearly 100% of the time. Badgering may not help, but having a full-time trainer on your back, might, might show further improvements in both immediate health and longer-term outcomes. Just hard to run such an experiment, no doubt.

39 weeks ago
39 weeks ago Link To Comment
I don't exercise, I eat what I want, and I've never in my life weighed over 120 pounds. That's after two children, middle age spread, and now menopause. Simplistic generalization that don't take into account hereditary factors and an individuals metabolic systems are nothing more than propagandizing a one size fits all solution to a problem that has multiple and varied factors.
39 weeks ago
39 weeks ago Link To Comment
The only SENSIBLE way to sell health insurance is by the pound! So simple no one seems to have thought about it. Immediately gets the persons interest.
39 weeks ago
39 weeks ago Link To Comment
This would be a financial burden on the people least able to pay. Unless they are forced to buy expensive health insurance, most of them would not or could not. BTW, I thought the idea behind insurance was to pool the risks to allow lower rates for all participants. Since when has "insurance" become a bludgeon for the Nanny State?
39 weeks ago
39 weeks ago Link To Comment
Technically insurance is not to allow lower rates for all participants. It is so each individual voluntary buyer can manage their own risk. It attracts those who end up paying premiums for very little payout and those who end up getting a lot of payout relative to their premium cost. In the end all participants are happy and the provider of insurance - assuming they evaluate their customer population correctly and set their prices and terms correctly - make money for their shareholders.

The problem of course is that this is a free market mechanism and we can't have that because not everyone is treated the same. Too fat and can't be underwritten in a free market system? Not fair. The government steps in and forces insurance companies to accept such conditions at no premium increase or becomes the insurer itself. The result: no incentive to not be fat. Therefore, Obamacare will increase population obesity to new heights (or girths).
39 weeks ago
39 weeks ago Link To Comment
Since when has "able to pay" been a just criteria for determining price?

39 weeks ago
39 weeks ago Link To Comment
As PJM's own Instapundit always writes, go ye forth and buy Gary Taubes' "Why We Get Fat" (don't know how to embed the link, sorry). I took off 20+ pounds in two months. Easy peasy.
http://www.amazon.com/Why-We-Get-Fat-About/dp/0307474259/ref=sr_1_1?s=books&ie=UTF8&qid=1374091282&sr=1-1&keywords=why+we+get+fat
39 weeks ago
39 weeks ago Link To Comment
35 pounds pretty effortlessly in about 5 months. . . .
39 weeks ago
39 weeks ago Link To Comment
Interesting. I've been saying that "calories in, calories out" is nonsense for as long as I can remember, based soley on a very BASIC understanding of cellular metabolism.
39 weeks ago
39 weeks ago Link To Comment
Thank you for posting this. I was going to make the same comment. The original article that Taubes wrote for the New York Times is still available online. The good doctor and every other nutritionally ignorant doctor need desperately to read it.
39 weeks ago
39 weeks ago Link To Comment
"The good doctor and every other nutritionally ignorant doctor need desperately to read it. "

That would be the overwhelming majority of doctors and nurses and, yes, registered dieticians.
39 weeks ago
39 weeks ago Link To Comment
The only thing that will work is when the patient has had enough of being overweight for whatever reason (usually vanity).

I was 100 pounds overweight for years, always wanting to lose the weight in a vague sort of way but not wanting to do any work. Finally about six months ago I'd just had it and made myself start eating healthier and slowly starting to exercise. So far I'm down 30 pounds, long way to go yet, but still.

Nagging or expressed concern, none of it made a difference.
40 weeks ago
40 weeks ago Link To Comment
Hooray for you! I'm doing the same thing for the same reasons you cited. I just looked at myself one day, and thought, well, that's enough of that. Best of luck to you for continued success on your journey!
39 weeks ago
39 weeks ago Link To Comment
Good for you. Keep it up. Going through the same thing myself.
39 weeks ago
39 weeks ago Link To Comment
Good job!
39 weeks ago
39 weeks ago Link To Comment
Good for you! Three cheers! :)
39 weeks ago
39 weeks ago Link To Comment
No.
40 weeks ago
40 weeks ago Link To Comment
No.

Particularly because my doctor is, himself, overweight.
40 weeks ago
40 weeks ago Link To Comment
Not when the doctor can tell the difference between a high BMI due to muscular development rather than fat and tells you to drop 30 pounds because that's what the chart says. Go back to the scrawny, sickly days? No thanks.
40 weeks ago
40 weeks ago Link To Comment
"Not when the doctor can tell the difference "

Hmmm. Here, let me fix that for ya....

"Not when the doctor can NOT tell the difference "

THAT'S better. ;-)
39 weeks ago
39 weeks ago Link To Comment
Thanks. Missed that typo.
39 weeks ago
39 weeks ago Link To Comment
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