Giving Up on Weight Loss

It has long been something approaching gospel within the diabetes community — for people who are obese and at risk for Type 2 diabetes, losing weight is the surest way to prevent or delay the onset of the condition. This advice is backed up by serious research; in one prominent study[1], overweight people with elevated blood glucose levels who aimed to lose 7% of their body weight through an organized program had a 58% lower risk of developing diabetes over the course of the study.

But studies showing the diabetes-prevention benefits of weight loss also tend to show something else: that very few people manage to sustain their weight loss once the organized program responsible for it has ended. This challenge is recognized by many experts, and some research has specifically examined how weight loss can best be sustained. But one prominent expert believes that in light of the data, health policy makers should give up on the idea of weight loss as a means of diabetes prevention.

In an article published last month[2] in the journal Health Affairs, Richard Kahn, formerly the chief medical officer of the American Diabetes Association, claims that we don’t know enough right now about the biological processes underlying the body’s regulation of weight to develop effective weight-loss programs that can be applied on a large scale. In the meantime, he writes, public health officials and medical groups should concentrate on finding ways to help people control their diabetes once it develops. This, he believes, is a better use of valuable time and research dollars, since effectively controlling blood glucose levels has shown to be sustainable and leads to a greatly reduced risk of diabetes complications.

Not all medical experts and groups, however, are on the same page. As an article published[3] at notes, several doctors associated with Boston’s Joslin Diabetes Center released a statement indicating strong disagreement with Kahn. Osama Hamdy, medical director of the center’s Obesity Clinical Program, asserted that Kahn was advocating “a surrender in the face of one of the greatest threats to public health the world faces.” Hamdy goes on to say that while maintaining weight loss is “a lifelong battle,” Joslin programs have shown that weight loss can be sustained for long periods of time. One program, he notes, led to a 50% reduction in diabetes medicines taken by participants and a 27% reduction in overall health-care costs.

What do you think — is getting large numbers of people to achieve sustained weight loss an impossible dream? Is it foolish to suppose that programs administered by a leading diabetes research center can be effectively duplicated across the country? Or is Kahn’s approach too pessimistic — or even, as one writer suggests[4], possibly distorted by ties to diabetes drug manufacturers? Leave a comment below!

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