Weight Loss

The AspireAssist weight loss device, which was the subject of an article in our August 29 issue, provoked a flurry of articles and letters in the New York Times. The first of these, written by 2 directors of weight loss programs and published on September 10th, called the new device “the latest in a desperate search to stem the rising tides of obesity and type 2 diabetes” and criticized the recent decision by 45 international societies, including the American Diabetes Association, to support the use of bariatric surgery in treatment of diabetes. The approach these authors prefer—“better, safer, and cheaper”—is a diet low in carbohydrates, which they say has helped hundreds of patients in their clinics lose weight and stop needing insulin and other medications.

Five days later the Times published a rebuttal, citing the absence of large long-term studies showing an advantage for low-carbohydrate diets, or any particular diet, in the management of diabetes. Several diabetes clinic directors were quoted as saying that the only demonstrated benefit diets offer patients with diabetes comes from losing weight. The letters that followed from Times readers offered impassioned testimonials on the benefits of one diet or another, but none contradicted the benefits of weight loss.

The Medical Letter article on Diet, Drugs, and Surgery for Weight Loss, published February 16, 2015, offers some perspective. Adherence to drugs is poor, we said, and patients usually regain the lost weight when the drug is stopped. Bariatric surgery can produce substantial weight loss, but long-term safety data are still limited. Diet and exercise are preferred, even though long-term failure rates are high. Good studies have shown that diets with various distributions of protein, fats, and carbohydrates have all been equally effective in producing weight loss. There are some mixed data suggesting that high-protein diets may offer an advantage in preventing weight regain. There’s more to it than that, of course, so if you’re interested, we invite you to read our article for yourself.

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