From the Journal I Can’t Believe This Ever Got Published (ok, in this case from Obesity Reviews) comes The challenge of keeping it off, a descriptive systematic review of high-quality, follow-up studies of obesity treatments.
The paper apparently is meant to be a counterpoint to other systematic reviews of long term weight loss where,
“conclusions are generally positive and give the impression that weight loss interventions work and that weight loss can be maintained“
Well we can’t have that now can we?
It appears these authors sure couldn’t because here are the criteria they used in selecting papers for their systematic review that concluded long term weight loss is impossible:
- Studies must have follow up periods of at least 3 years
- Patients must not have had any continued interventions during the follow up period
- Medications approved for weight management aren’t allowed
So what they ended up with were 8 studies of varied protocols being administered temporarily for a chronic medical condition. But guess what, chronic medical conditions require ongoing treatment, and what happens when you actually provide it? Well you get studies that would spoil the impossible narrative as noted by the authors of this paper,
“several of the non-included studies report a majority of participants achieving satisfactory weight loss and little regain, especially among studies with continued interventions during the follow-up period.”
Imagine that! Appropriately treating a chronic medical condition with continued interventions works!
And this notwithstanding the fact that many (most? all?) of those studies that provided ongoing interventions likely did not include the appropriate prescription of medications to either help with losses or to prevent regain (just as we would with any other chronic condition) because weight loss medications are almost always excluded from use in weight loss diet studies. Which is odd by the way. Consider hypertension for instance. Sure some people might be able to resolve theirs by way of such things as lower sodium diets, increased exercise, and weight loss, but there’s zero doubt that patients with hypertension will receive regular ongoing follow up visits with their physicians, and where appropriate, will be prescribed medications to help. Why? Because that’s how chronic condition are managed! Which is why we’ll never see a systematic review of hypertension treatments demonstrating that brief lifestyle counselling and the explicit exclusion of medications didn’t lead to lower blood pressure 3 years later.
Leaving me to wonder, why publish a paper with the literal conclusion,
“that the majority of high-quality follow-up treatment studies of individuals with obesity are not successful in maintaining weight loss over time“
when really all your systematic review (of just 8 papers all with different dietary/lifestyle interventions) has proven is that delimited, lifestyle counselling doesn’t miraculously cure a chronic medical problem, and where you admit in your paper that the appropriate provision of ongoing care might well in fact lead to sustained treatment benefits?
But I don’t really need to wonder. Because the only reason that this paper was conceived and published is because of weight bias, whereby obesity has different rules applied to it, in this case, the notion that unlike so many other chronic medical conditions that are impacted strongly by lifestyle changes (eg. hypertension, type 2 diabetes, GERD, heart disease, COPD, gout, osteoarthritis, osteoporosis, kidney stones, and many more) people believe that for obesity some brief counselling should be enough to do the job, because that in turn plays into the trope of obesity being a disease of willpower and a deficiency of personal responsibility.
(Thanks to Dr. Andrew Dickson for sending my way)
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