Obesity Facts from NEJM!

NEJM, the world’s premier medical journal has recently published  an article titled ‘Myths, Presumptions, and Facts about Obesity’ in their Feb 5, 2013 issue.

 

In this article they have busted some Myths and Presumptions about Obesity. Some of these are controversial and widely covered in the media.

 

But what was widely agreed upon were the 9 Facts they put forward, as there was considerable evidence to prove the same. These were ignored by the media!

 

Here are nine obesity Facts, highlighted in the NEJM, that should shape our response to obesity.

1. Genetic factors play a large role in obesity, but heritability is not destiny. Moderate environmental changes can promote as much weight loss as the most efficacious pharmaceutical agents available.

2. Diets very effectively reduce weight, but trying to go on a diet or recommending a diet generally does not work well in the long-term.

3. Regardless of body weight or weight loss, an increased level of exercise increases health.

4. Physical activity at a sufficient level helps with long-term weight maintenance.

5. Sticking with something that works for weight loss helps to maintain a lower weight.

6. For children with excess weight, programs that involve the parents and the home yield better weight outcomes.

7. Structured meal replacement programs and products yield more weight loss than less structured meals.

8. Obesity treatment drugs can help patients achieve and maintain meaningful weight loss for as long as they are used.

9. For people with severe obesity, bariatric surgery can be a life-changing and, in some cases, life-saving treatment.

via Beyond Myths: Obesity Facts from NEJM | ConscienHealthConscienHealth.

Treatment for Acute Stroke: Clot buster or Angioplasty?

There are 2 treatment options for patients suffering from acute stroke. One is a clot buster called t-PA which is given intravenously. The second is a procedure called Angioplasty wherein the blocked artery is opened mechanically by a clot aspirating device or giving the drug directly into the artery with the help of small tubes. In some cases, a stent (spring like device) is placed across the artery.

There has been a long standing debate to know which one is a superior treatment option. Physicians consider the Angioplasty option as superior as the doctor is directly opening the artery by a mechanical device. The drug option is considered inferior as the effect of the drug can be limited in some patients.

So for the first time, both these treatment options were compared directly with each other. They found that the Clot buster was more effective when compared to the angioplasty approach. The study got published in the NEJM, a premier medical journal in the Feb 6, 2013 issue.

362 patients with acute ischemic stroke underwent randomization (181 to endovascular treatment and 181 to drug-tPA). Primary outcome of death and disability was studied at the end of 90 days.

A total of 55 of the 181 patients (30.4%) in the endovascular-treatment group survived without disability as compared with 63 of the 181 patients (34.8%) in the intravenous t-PA, drug group (absolute difference, −4.4 percentage points).

At 90 days, 26 patients in the endovascular-treatment group (14.4%) and 18 in the intravenous t-PA group (9.9%) had died.

This trial failed to show that the Angioplasty approach was superior to the drug option: intravenous t-PA. It also challenged the Physicians common notion that Angioplasty is superior to the drug.

It is a victory of a Drug over a mechanical procedure called Angioplasty. Again, reminding us that with the advent of better drugs, equally good and sometimes more effective treatment can be delivered safely!