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Diabetes Expert Disses Weight-Loss Programs

This article in MedPage Today is so frustrating. Richard Kahn, PhD, who was the chief scientific and medical officer of the American Diabetes Association for nearly 25 years, said that community programs are ineffective at achieving weight loss. No shit, Sherlock, what was your first clue? He told this to public health advocates and diabetes researchers at the Health Affairs briefing Tuesday, which was a stark contrast to the "prevention works" message of the event's other speakers.

Kahn -- who now teaches medicine at the University of North Carolina at Chapel Hill -- said that just sustaining significant weight loss, even with intensive dieting, exercise, and coaching, "requires near-heroic measures" in the face of a "very hostile food environment."
He outlined his views in a paper published in the January edition of Health Affairs, in which he wrote that there are two ways to dramatically reduce the toll of diabetes: One is to detect diabetes early and then treat it so effectively that complications from the disease are practically zero. The other is to prevent diabetes before it even happens.
Thousands of public health campaigns are aimed at prevention, and for diabetes, that generally means losing weight. But people have the "fundamental problem" of not being able to maintain weight loss, so preventing diabetes in a person at high risk for the disease is extremely difficult, Kahn said.

So, they're saying that community programs are ineffective at achieving weight loss, but for preventing diabetes, pretty much all they recommend is losing weight. Sounds to me like they're dooming people to have diabetes if that's all they can come up with (and I happen to know there are other solutions to delaying/preventing the onset of type 2 diabetes that don't entail weight loss, depending on your genetic risk factors for it).

His paper looked at diabetes prevention studies, including the large Diabetes Prevention Program, in which patients lost an average of between 4% and 6% of their body weight (but gained about 40% back by the end of the nearly three-year trial). It also looked at the government-funded Look AHEAD trial, which found that intensive lifestyle changes resulted in a major reduction in cardiovascular risk factors, but the effects greatly diminished after four years when many participants gained weight and lost their improved fitness.
Kahn said those studies, along with the Finnish Diabetes Prevention Study -- in which the greatest diabetes prevention benefit occurred in people who lost at least 5% of their body weight -- suggest that "without substantial, sustained weight loss, progression to diabetes will probably resume." Progression to diabetes may be delayed for a few years, but the long-term effects are uncertain, he said.

So, losing weight helps, but it can't be maintained in the majority of cases (tell us something we didn't know about maintenance) and the benefits of weight loss disappear when the weight returns. Doesn't sound like such a good recommendation to me.

"The main argument is that implementing a nationwide community intervention program is not going to do anything, I believe, except waste resources," Kahn told MedPage Today.
Kahn said that there are too many unanswered questions about how weight loss works that must be answered before a national program would ever succeed in preventing diabetes in the long term.
"We really need to know what is going on with this complex system we have," he said. "What is going on in our physiology that precludes us from losing weight and keeping it off?"
Another issue that prevents people from keeping weight off is the ubiquity of the "cheap, widely available, delicious food that we eat again and again."
He suggested "painful policies" as the solution -- such as raising the price of all food except for fruits and vegetables, and offering financial incentives to people who can keep weight off, while penalizing overweight people with higher insurance premiums.
He acknowledged those aggressive policies likely would be unpopular among members of Congress and doctors.

Those "painful policies" are going to be unpopular among members of Congress and doctors? What planet is he living on? Congress won't give a shit about raising the price of all food except fruits and vegetables, or penalizing fat people with higher insurance premiums. If it isn't going to affect the pocketbooks of the members of Congress personally, they don't care. As for offering financial incentives to people who can keep weight off, that will be one of the cheapest programs to finance, what with the success rate of diets, as Kahn well knows.
The disconnect between Kahn saying " community programs are ineffective at achieving weight loss" and "raising the price of all food except for fruits and vegetables, and offering financial incentives to people who can keep weight off, while penalizing overweight people with higher insurance premiums" is staggering. Does he realize how two-faced he sounds? Does he realize what an asshat that kind of thinking makes him? "Weight loss is nearly impossible, but if you don't lose weight and keep it off, you're going to pay more for your insurance, even though it's not your fault and there's nothing you can do about it, we're going to fuck you over anyway because you're fat and we think you should be thin because only thin people are healthy."

He added that the best doctors can offer right now is to suggest to overweight patients that losing 4% body weight and keeping it off can reduce the risk for serious complications of diabetes by 15% to 20%.

The best he can offer? Even though he knows it's damn near impossible to keep the weight off, he still recommends losing weight as the best way to reduce the risk for serious complications of diabetes. Kahn, I have some suggestions for you - carb counting, controlling blood glucose, regular exercise, and regular check-ups with an endocrinologist who is well-educated about type 2 diabetes will go farther to reduce the risk of the complications of type 2 diabetes than losing weight ever will. Pull your head out of your ass and wake the fuck up before you do more harm than you already have.

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DeeLeigh's picture
January 12th, 2012 | Link | The tunnel vision that guy

The tunnel vision that guy has is astonishing. He's obsessed with weight loss as the only thing that could possibly impact diabetes' risk and control. It's so simple minded. I love the "it's not the pure fatties' fault, but let's punish them anyway!" thing as well. And the idea of raising the price of food during a recession. Niiiiiiiice.

richie79's picture
January 12th, 2012 | Link | There seems to be an

There seems to be an increasing number of this type of article around lately, the basic gist of which seems to be 'safe, permanent weight loss through ELMM is very difficult if not impossible, but confers so many benefits that's it's worth attempting anyway'. Most of them then ultimately conclude by suggesting WLS (AKA being forced to 'eat less') as the answer; a quick Google of Dr Khan's name doesn't throw up much evidence of him being a gastric mutilation evangelist but I certainly wouldn't rule it out.

In any case, and as you point out, the comments regarding 'painful policies' display a staggering lack of understanding / deliberate downplaying of a climate in which a sadistic desire for the authorities to 'punish' fat people has become casually accepted. I couldn't imagine the Obama administration having any qualms whatsoever about introducing a fat tax; in fact given the brownie points it would probably score with Jamie Oliver, Bloomberg and various other (il)liberal darlings, would likely jump at the chance if they thought it would fly.

"What is right is not always popular and what is popular is not always right" - Albert Einstein

loniemc January 12th, 2012 | Link | I noticed a lot of this

I noticed a lot of this cognitive dissonance lately. What I think is happening, people are finally seeing that dieting doesn't work. Yet, so many people are invested (some quite literally) in dieting that they can't give up on it. This phase, the disillusionment with dieting, is common in the individual at the beginning of their journey towards fat acceptance. Maybe it is a good sign; maybe our society is moving towards fat acceptance.

Marshfield January 13th, 2012 | Link | I read somewhere the ADA is

I read somewhere the ADA is grudgingly making room in their literature for a controlled-carbohydrate approach to diabetes management (everything old is new again). This must chafe their Pharma and processed-grain sponsors no end.

vesta44's picture
January 13th, 2012 | Link | I think the only reason the

I think the only reason the ADA is grudgingly making room for the controlled carbohydrate approach to controlling blood sugar is because so many type 2 diabetics are using it and telling the ADA (or their doctors) that this is what works, along with exercise and medication, and they (T2Ds) aren't going to stop using that approach. And you should see how pissed those T2Ds get when they're hospitalized and the nurses/doctors don't have a clue how to treat them or feed them in order to keep their blood sugar down (I belong to a couple of diabetes lists and I get to read all the diatribes about that kind of thing).

WLS - Sorry, not my preferred way of dying. *glares at doctor recommending it*

pani113's picture
January 13th, 2012 | Link | Chapel Hill North Carolina

Chapel Hill North Carolina gets tons of diet company money! Draconian recommendations are really about scaring people into drugs, surgery and other quackery. Thank God many of the progressives are FINALLY beginning to make the connection between pesticides, endocrine disrupters, antibiotics and other pollution and diabetes. Years from now, the mediocre medical minds who think fat causes diabetes will be regarded in the same category as those who thought the earth was flat!

"Fat can be beautiful. Intolerance is ALWAYS ugly!"

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