Diabetes Study Ends Early With a Surprising Result

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    Oct 21, 2012 1:12 PM GMT
    http://www.nytimes.com/2012/10/20/health/in-study-weight-loss-did-not-prevent-heart-attacks-in-diabetics.html?_r=0

    It seemed logical that diet and exercise would help reduce that risk. An earlier federal study found that an intense diet and exercise program helped prevent overweight or obese people with elevated blood sugar levels from crossing the line into diabetes. The hope was that a similar program could also protect people from heart disease.

    The study randomly assigned 5,145 overweight or obese people with Type 2 diabetes to either a rigorous diet and exercise regimen or to sessions in which they got general health information. The diet involved 1,200 to 1,500 calories a day for those weighing less than 250 pounds and 1,500 to 1,800 calories a day for those weighing more. The exercise program was at least 175 minutes a week of moderate exercise.

    But 11 years after the study began, researchers concluded it was futile to continue — the two groups had nearly identical rates of heart attacks, strokes and cardiovascular deaths.

    The investigators are analyzing their data and will be publishing them in research papers.

    But the outcome is clear, said Dr. David Nathan, a principal investigator and director of the Diabetes Center at Massachusetts General Hospital. “We have to have an adult conversation about this,” he said. “This was a negative result.”

    The study participants assigned to the intensive exercise and diet program did lose about 5 percent of their weight and managed to keep it off during the study. That was enough to reduce cardiovascular risk factors.

    “We showed that meaningful weight loss — let’s put ‘meaningful’ in quotes — could be established and maintained,” Dr. Nathan said. “To me that means we did a good experiment. We had a fair test of this hypothesis.”
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    Oct 21, 2012 7:16 PM GMT
    No surprise here. Diet and exercise have no place in Obama Care either.
    There is no money in health ....only in sickness. All funded research will support the most expensive cures. The real cure is prevention.

    WTF..... The study tracked a 5% weight lose. That's absolutely nothing. A 300 lb diabetic didn't get better at 285 lb ..... Really!
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    Oct 21, 2012 7:25 PM GMT
    Alpha13 saidNo surprise here. Diet and exercise have no place in Obama Care either.
    There is no money in health ....only in sickness. All funded research will support the most expensive cures. The real cure is prevention.

    WTF..... The study tracked a 5% weight lose. That's absolutely nothing. A 300 lb diabetic didn't get better at 285 lb ..... Really!


    Really is right, lol. There's something very wrong in that study.

    In a privatized world of healthcare, healthy people are a liability, not an asset.

    Businesses need an ever growing pool of consumers to post year after year of escalating profits.
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    Oct 21, 2012 7:31 PM GMT
    Only a 5% weight reduction in 11 years? Am I reading that right? No wonder it didn't help.
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    Oct 21, 2012 7:34 PM GMT
    My mother completely reversed her diabetes with diet and exercise. I have a family history. This study is bull-shyte...
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    Oct 21, 2012 7:37 PM GMT
    Alpha13 saidNo surprise here. Diet and exercise have no place in Obama Care either.
    There is no money in health ....only in sickness. All funded research will support the most expensive cures. The real cure is prevention.

    WTF..... The study tracked a 5% weight lose. That's absolutely nothing. A 300 lb diabetic didn't get better at 285 lb ..... Really!


    OP is blocked, but you are right - the US system is set up to incentivise illness- the ancient chinese practice is better. The doctor is paid while you are well. Once you are sick he stops being paid until he´s cured you.
  • Medjai

    Posts: 2671

    Oct 21, 2012 7:46 PM GMT
    GonzoTheGreat said
    Alpha13 saidNo surprise here. Diet and exercise have no place in Obama Care either.
    There is no money in health ....only in sickness. All funded research will support the most expensive cures. The real cure is prevention.

    WTF..... The study tracked a 5% weight lose. That's absolutely nothing. A 300 lb diabetic didn't get better at 285 lb ..... Really!


    OP is blocked, but you are right - the US system is set up to incentivise illness- the ancient chinese practice is better. The doctor is paid while you are well. Once you are sick he stops being paid until he´s cured you.


    Under that system, no one would take on the severe genetic disorder cases. Cystic fibrosis? Good luck. Tay-Sachs? Not gonna happen. And heaven forbid you get cancer or HIV.

    All I see in that system is the sick getting sicker and the healthy getting healthier. It's just like our economy, but with life instead.
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    Oct 21, 2012 8:00 PM GMT
    5145 people, and a 5% weight loss, over 11 years?

    The sample size was too small to begin with; and the 5% weight loss is a fucking joke.

    That's got to be the longest lasting failure in research history.
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    Oct 21, 2012 8:17 PM GMT
    This really isn't about the U.S. healthcare system. Both private and government insurance would save huge amounts of money paying for gym memberships and dietary advice instead of heart/diabetes/cholesterol medication and surgeries. Again, only losing 5% of their weight in 11 years is an epic fail. A diet of up to 1800 calories a day and 25 minutes per day of exercise should have yielded better results. Something is seriously wrong with this study.
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    Oct 21, 2012 8:23 PM GMT
    paulflexes said5145 people, and a 5% weight loss, over 11 years?

    The sample size was too small to begin with; and the 5% weight loss is a fucking joke.

    That's got to be the longest lasting failure in research history.


    The sad part is that you are paying for this "research" scam. The diet was probably straight from a dieticians food pyramid chart. The same low fat one that made america obese in the first place and always has jello on the menu for some insane reason.
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    Oct 21, 2012 8:33 PM GMT
    Medjai said
    GonzoTheGreat said
    Alpha13 saidNo surprise here. Diet and exercise have no place in Obama Care either.
    There is no money in health ....only in sickness. All funded research will support the most expensive cures. The real cure is prevention.

    WTF..... The study tracked a 5% weight lose. That's absolutely nothing. A 300 lb diabetic didn't get better at 285 lb ..... Really!


    OP is blocked, but you are right - the US system is set up to incentivise illness- the ancient chinese practice is better. The doctor is paid while you are well. Once you are sick he stops being paid until he´s cured you.


    Under that system, no one would take on the severe genetic disorder cases. Cystic fibrosis? Good luck. Tay-Sachs? Not gonna happen. And heaven forbid you get cancer or HIV.

    All I see in that system is the sick getting sicker and the healthy getting healthier. It's just like our economy, but with life instead.


    Under that system, which is not going to work in modern USA, the doctor doesn´t chose who he treats. He does all he can for everyone. THose who he keeps well pay him, those who he fails dont (and he still treats them).
  • jtcrew65

    Posts: 29

    Oct 21, 2012 8:41 PM GMT
    This study tries to show that diet and exercise works and falls short. I don't think it proves diet and exercise DOESN'T work, i think it proved that the protocol they used didn't accomplish their weight loss goal or a reduction of diabetic complications. It means doctors will have to try more creative ways to get obese patients to lose large amounts of weight and keep it off. I've seen docs who are successful at it, and their sugars and blood pressures do normalize and they can successfully live drug free lives.
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    Oct 21, 2012 8:58 PM GMT
    Alpha13 saidNo surprise here. Diet and exercise have no place in Obama Care either.
    There is no money in health ....only in sickness. All funded research will support the most expensive cures. The real cure is prevention.

    WTF..... The study tracked a 5% weight lose. That's absolutely nothing. A 300 lb diabetic didn't get better at 285 lb ..... Really!


    Not sure I follow your logic here. The researchers focused on controlling calories when it speaks of diet and adding exercise. There have been a number of studies that have shown that exercise alone do not help you to lose weight. I think the answer lies more with Gary Taubes' line of reporting - (ie good calories, bad calories / carbs)

    http://www.amazon.com/exec/obidos/ASIN/B003WUYOQ6/

    Now as for meninlove's usual rants, there *is* money in healthy productive members of society - a lot more than trying to cure diseases.
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    Oct 21, 2012 9:08 PM GMT
    meninlove said
    Alpha13 saidNo surprise here. Diet and exercise have no place in Obama Care either.
    There is no money in health ....only in sickness. All funded research will support the most expensive cures. The real cure is prevention.

    WTF..... The study tracked a 5% weight lose. That's absolutely nothing. A 300 lb diabetic didn't get better at 285 lb ..... Really!


    Really is right, lol. There's something very wrong in that study.

    In a privatized world of healthcare, healthy people are a liability, not an asset.

    Businesses need an ever growing pool of consumers to post year after year of escalating profits.


    That is patently absurd. Healthcare companies draw fixed premiums for providing healthcare coverage. You think they get wealthier by having sick people draw significantly on the pool of assets the company maintains, with no recourse to increase the premiums that person pays?

    Be serious. This is reflexive, unthinking commentary, which is unusual compared to your many insightful posts on personal issues.
  • FireDoor211

    Posts: 1030

    Oct 21, 2012 9:23 PM GMT
    Alpha13 saidNo surprise here. Diet and exercise have no place in Obama Care either.
    There is no money in health ....only in sickness. All funded research will support the most expensive cures. The real cure is prevention.

    WTF..... The study tracked a 5% weight lose. That's absolutely nothing. A 300 lb diabetic didn't get better at 285 lb ..... Really!


    Good points
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    Oct 21, 2012 10:20 PM GMT
    Alpha13 said
    paulflexes said5145 people, and a 5% weight loss, over 11 years?

    The sample size was too small to begin with; and the 5% weight loss is a fucking joke.

    That's got to be the longest lasting failure in research history.


    The sad part is that you are paying for this "research" scam. The diet was probably straight from a dieticians food pyramid chart. The same low fat one that made america obese in the first place and always has jello on the menu for some insane reason.


    Does it specify type 1 or type 2 diabetics? Does it specify what diet the people were placed on, and did they follow it? Does it look at other risk factors besides just having diabetes, like cholesterol, lipoprotien(a), homocystene, triglycerides, insulin levels, fibrinogen, did they smoke, what kind of fats in diet, there's so much to look at.
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    Oct 21, 2012 10:26 PM GMT
    NYTimes ArticleThe diet involved 1,200 to 1,500 calories a day for those weighing less than 250 pounds and 1,500 to 1,800 calories a day for those weighing more. The exercise program was at least 175 minutes a week of moderate exercise.


    If you were on this program for 11 years, there's no way you'd only lose a mere 5% of your body weight.

    The assumption is that there was 100% consistency. I doubt these people ate healthy foods consistently as part of their "diet" unless this study provided them all with the same foods, for every meal. It probably included "cake" as bread and "ice cream" as dairy.
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    Oct 21, 2012 10:31 PM GMT
    It would suck to know you did a study for 11 years and learn in the end that your methodology was wrong. Ugh.
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    Oct 21, 2012 10:39 PM GMT
    https://www.lookaheadtrial.org/public/LookAHEADProtocol.pdf

    Most intensive intervention was in 1st year, and afterwards really didn't amount much more than your usual diabetes class. At least that's what I got from the protocol.
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    Oct 21, 2012 10:40 PM GMT
    Alpha13 said
    paulflexes said5145 people, and a 5% weight loss, over 11 years?

    The sample size was too small to begin with; and the 5% weight loss is a fucking joke.

    That's got to be the longest lasting failure in research history.


    The sad part is that you are paying for this "research" scam. The diet was probably straight from a dieticians food pyramid chart. The same low fat one that made america obese in the first place and always has jello on the menu for some insane reason.


    Dude, don't blame dietitians. Food Pyramid was like 2 teaching tools ago. There's been MyPyramid and now MyPlate. Also, dietitians don't have a lot of control over what is actually on the menu at a hospital (ie Jello). But seriously, if you think the 25 calorie Jello Cube on your plate made America obese, then you clearly don't understand nutrition.

    Dietitians merely translate the current research into practice.

    If anything money should be going to dietitians for prevention. The dietitian didn't make Americans obese. That's ridiculous. The only thing that made America obese is themselves: fast food is cheap and easy, there's no reason to walk when you can drive, and exercise sucks unless you grew up doing it as an athlete. People don't know how to cook either unless it involves part of the cow with fries on the side.

    Dietitians don't come up with the advice either. Usually the PhDs and PhD, RDs are the ones sitting on government boards coming up with the dietary guidelines.
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    Oct 21, 2012 10:42 PM GMT
    Alpha13 said
    paulflexes said5145 people, and a 5% weight loss, over 11 years?

    The sample size was too small to begin with; and the 5% weight loss is a fucking joke.

    That's got to be the longest lasting failure in research history.


    The sad part is that you are paying for this "research" scam. The diet was probably straight from a dieticians food pyramid chart. The same low fat one that made america obese in the first place and always has jello on the menu for some insane reason.
    I wish they would publish the meal plans used. It wouldn't surprise me if you're right.
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    Oct 21, 2012 10:47 PM GMT
    paulflexes said
    Alpha13 said
    paulflexes said5145 people, and a 5% weight loss, over 11 years?

    The sample size was too small to begin with; and the 5% weight loss is a fucking joke.

    That's got to be the longest lasting failure in research history.


    The sad part is that you are paying for this "research" scam. The diet was probably straight from a dieticians food pyramid chart. The same low fat one that made america obese in the first place and always has jello on the menu for some insane reason.
    I wish they would publish the meal plans used. It wouldn't surprise me if you're right.


    You could just go get the article yourself, track down the authors, and ask for the meal plan. Even then, chances are obese people aren't going to comply to guidelines. It is also questionable how "intense" a "moderate exercise program of 175 minutes a week) is. Did they monitor the intensity with heart rate monitors or VO2 analyzers? Was this incline treadmill walking or cycle ergometer? 175 minutes a week is less than 30 minutes a day, which is hard enough to maintain weight let alone intense enough to cause you to build muscle. We also don't know if the obese people ate the food prescribed in the amounts prescribed.

    Consider this: if the obese person's maintenance calories are 3500/day and they put them on a 1800 calorie diet, that's way too big of a calorie deficit for them to be satisfied. They'll be hungry and compliance will die. They still get paid for the study if they say they did everything asked...
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    Oct 21, 2012 10:51 PM GMT
    Actually, they emphasized a low fat (<30%) diet. Might not be so wise in retrospect...since low carbohydrate diets might work better with more weight loss.

    This is an important negative trial. More negative trials should be published to avoid publication bias.
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    Oct 21, 2012 10:53 PM GMT
    q1w2e3 saidActually, they emphasized a low fat (<30%) diet. Might not be so wise in retrospect...since low carbohydrate diets might work better with more weight loss.

    This is an important negative trial. More negative trials should be published to avoid publication bias.


    Over a year long, you'd lose more weight with low carb than low fat because carbs are stored in the body with water. Much of the initial weight loss is water weight. After a year, low carb and low fat are similar results--both are lower calories...
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    Oct 21, 2012 10:54 PM GMT
    The 1st year results were impressive...but dwindled over time which is not surprising. At least that's what the 2011 summary says:
    http://www.hopewarshaw.com/blog/look-what-look-ahead-study-reveals
    Weight Loss: In the ILI group the mean maximal weight loss at one year was 8.6%. (Many studies have shown maximal weight loss is at one year.) At 4 years the ILI group maintained a mean weight loss of about 5% compared with about 1% in DSE. The rate of weight regain (also commonly seen in weight loss studies) in the ILI group appears to be slowing overtime.
    Fitness: Increased by about 20% in ILI and 5% DSE by year one. At 4 years ILI fitness level was about 5% from the study’s start and over baseline, and interestingly about 1% below the study start for DSE participants.
    Glucose, blood pressure and lipids (blood fats): ILI participants continued to have greater improvements in systolic blood pressure (BP) (the lower number), A1c and HDL-C (the good cholesterol) than DSE at 4 years. These differences were most apparent at year one and not all of these initial improvements were maintained at 4 years. A greater proportion of ILI participants hit the A1c target of <7% advised by the American Diabetes Association. For BP this was true years 1 through 3. Translated these results show that people in ILI group spent more time (over years) at lower risk of heart and blood vessel problems.
    Use of drugs to improve glucose , blood pressure and lipids: By years 3 and 4 DSE people had a greater decrease in LDL-C (bad cholesterol) than ILI participants, but they were using more medications to improve this number (such as statins). A greater proportion of ILI than DSE participants discontinued use of BP or glucose-lowering drugs. And among ILI participants not using any of these drugs at the start of the study, fewer people started them.