When it comes to weight loss, the article that came out in this week's New England Journal made some helpful points (but it left out a few important points as well);

 

The article covers the non-surgical treatment of obesity. 

 

It starts off by mentioning that the person under discussion is not obese enough to "qualify" for gastric-bypass surgery.  Unfortunately, I know that it happens commonly that when people find out that they don't qualify, they will work to GAIN weight so they can "qualify" for this holy grail of treatments-- where after surgery most people gain most of their weight back and a 1% mortality is acceptable.  Try to imagine a medical doctor where 1 in 100 people who came to his/her office would have to call the undertaker to take them out of the office; yet, this statistic is considered acceptable with gastric bypass surgery.

 

 

Gastric bypass surgery has NEVER been compared head-to-head with agressive medical therapy to see which offers the best solution (the last good study in the New England Journal used obese people who came to get their driver's license as the control group).

 

On the other hand, i do not blame people for looking to the surgeon to help them lose weight when there has been so little agreement on how to help people lose weight without surgery.  Snide remarks like "just push back from the table" unfortunately are still spouted by some physicians.

 

So reading this updated, review of the non-surgical treatment of obesity in the latest New England Journal, I attacked the article with much anticipation--hoping to see new ideas of enlightenment.  Such was not the case; not really.

 

The article backs up the idea that meal replacements have been proven repeatedly to help with weight loss (and I agree).  But, there is almost nothing about the metabolic/hormonal changes that can cause weight gain and nothing about the specifics of how to exactly instruct someone to increase physical activity and make it a life-long habit. 

 

Today, I saw a woman who lost 30 pounds with me after I found a high prolactin level and corrected it.  I find prolactinomas routinely in the obese because I always look for them (blood test).  I saw another woman today who lost 55 pounds with me after I corrected her low testosterone level (yes testosterone is a weigh loss hormone and is supposed to be there in adequate female levels in a woman).  This article mentions nothing of these strategies.

 

As long as medical doctors continue to ignore the research showing that optimization of testosterone, growth hormone, and thyroid will lead to weight loss and correction of metabolic syndrome and diabetes, there will continue to be desperate people who will gain weight so that they might qualify for surgery that increases their risk of suicide and kills around one person for every 10 that it saves.

 

Peace & Health,

 

Charles Runels, MD

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