Does Badgering Patients to Exercise and Eat Better Actually Work?

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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.