The Invasion Has Begun!

John A. Schmidt, MD 

Efficacy of Commercial Weight-Loss Programs

As stated in the April 7 issue of the Annals of Internal Medicine, obesity is a leading health problem in the United States because of its high prevalence and role in many chronic conditions such as diabetes. More than one third of U.S. adults are obese (Body Mass Index (BMI) greater than 30; calculate your BMI on the Healthy Links page at www.SchmidtMD.com). Direct health care costs associated with obesity were estimated at $147 billion in 2008.  Nutrition and physical activity remain the cornerstones of obesity treatment. In the same issue, 32 commercial weight-loss programs were reviewed.  Only 11 had published clinical trial data and only Weight Watchers� and Jenny Craig� reported significantly more weight loss than controls at 12 months (2.6-4.9 percent). Nutrisystem� had similar results at 6 months. Among the crash diet programs, Health Management Resources (HMR) showed the largest weight losses (8-22 percent at three months). Attrition for HMR was surprisingly low but associated with a 6.3 percent risk of gall stone-related complications. Other crash diet programs, including Medifast� and Optifast� resulted in substantially less weight loss, approximately 5 percent. Self-directed programs (Atkins™ and Slimfast™) resulted in negligible to modest weight loss. Three trials involving Internet based programs (The Biggest Loser Club, eDiets, and Lose It!) were ineffective.  The authors, who appropriately focused on long term results, concluded that clinicians could consider referring patients who were overweight or obese to Weight Watchers� or Jenny Craig�. Nutrisystem� holds promise if longer-term weight loss can be documented in future studies. Weight Watchers� and Jenny Craig� topped the U.S. News and World Report commercial diet plans list published on January 6, 2015.

Constipation-ugh!

We have all experienced it at one time or another.  As reported in the April 7 issue of the Annals of Internal Medicine, features of constipation include having to strain, lumpy or hard stools, having to resort to digital maneuvers to remove impactions, and less than three defecations per week. Abdominal pain, nausea, vomiting, weight loss, bloody stools, and a reduction in stool caliber are NOT typical features of constipation and deserve further diagnostic evaluation.  Risk factors for constipation include increased age, decreased mobility and physical activity, consumption of a low-fiber diet, and inadequate hydration. Certain medications such as narcotic pain relievers, calcium channel blockers, and diuretics may predispose to constipation and should be stopped if no longer indicated. Other helpful tips include taking advantage of the gastrocolic reflex after your morning coffee, more fluid intake, fiber supplements (psyllium/Metamucil�, prune juice, and raisins), bulk laxatives (Miralax�), and safe stimulant laxatives (bisacodyl/Dulcolax�).  Some will find Fleets enemas to be helpful. Milk of Magnesia can be used if renal function is normal. Colace�, a widely prescribed stool softener, is less useful than Metamucil�. If these OTC remedies are unsuccessful, there are safe prescription remedies such as lactulose, Amitiza�, and Linzess�. Let me know if I can help you get regular!

Cataract surgery is common.  As reported in the April 16 issue of the New England Journal of Medicine, 1.7 million procedures are performed annually. The surgery is very safe. Furthermore, routine preoperative testing neither decreases the incidence of adverse events nor improves the outcomes of cataract surgery. Since 2002, guidelines from multiple specialty societies have deemed routine preoperative testing unnecessary.