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| Medical Information: Reading JAMA On Obesity is an Adventure |
| Nicholas V. Costrini, M.D. Medical Director Georgia Gastroenterology Group, PC |
| We often come across articles in the non-medical press that quote a report from the Journal of the American Medical Association - aka JAMA. The shortened title is actually the true name of the magazine rather than an abbreviation. JAMA has been in publication for more than a century and commands a great deal of deserved respect from medical and non-medical circles. For these reasons, I am sure you all will enjoy following me as I peruse the April 9,2003 issue of JAMA. First, lets investigate how this literary icon of American medicine is presented. It is a glossy print magazine that resembles Redbook or GQ magazine. The cover always has JAMA in large letters at the top with the date to the right ala Time Magazine. The cover nearly always is adorned with a piece of classic artwork. An oil painting from 1814 entitled Flower Still Life by the Dutch painter Bosschaert decorates our issue. Pretty impressive stuff. This issue reports in the table of contents to have only fifty-one pages. Well, that is not quite true; I counted nearly two hundred pages. The discrepancy is due to the fact that the editors dont count pages that have pharmaceutical advertisements. That policy has always aggravated me. If the reading MDs must sift through the very expensive and distracting ads in order to reach articles about the high cost of medications, the editors could at least acknowledge the presence of the hand that feed them. Medical editors are a nervy bunch anyway. The table of contents of the April 9, 2003 issue of JAMA is packed with heady titles. JAMA titles are always too long and vague. The lead title is: Television Watching and Other Sedentary Behaviors in Relation to Risk of Obesity and Type 2 Diabetes Mellitus in Women. My goodness, neither the Iraq war nor the NBA playoff articles require such long titles. The title could have been changed and shortened as follows: Women Become Fat Diabetics Watching TV. In a six-year study of over fifty thousand nurses, the study found good evidence for what we all suspect. The women who became fat and/ or diabetic over the six-year study period watched more than 2 hours of TV per day and did not participate in much physical exercise. The impressive finding was that 30% of the obesity cases and 43% of the diabetes cases could have been prevented by reducing TV watching to 5-10 hours per week and by walking briskly for more than 30 minutes per day. While we can all accept that TV couch potatoes get fat, the report provides an element of alarm by reporting that diabetes is also a further consequence. We may predict that the next events for the couch potato are heart attacks and blindness. The article also provides hope in reporting that reducing TV viewing and instead walking or even doing household chores for thirty minutes or more reduces the risk of obesity and the health consequences. The articles reported in JAMA also suffer from having too many authors. The second article, with the long-winded title: Weight loss With Self-help Compared with a Structured Commercial Program: A Randomized Trial. is offered by nine scientists. The Braves just beat the Phillies with as many people as took to produce this entry. I dont know what all nine guys on this science team were doing but the results are interesting even if the conclusions are wrong. In a self-help program you may lose five pounds in the first year but you will regain it in the second year. Statistically, a structured commercial program is more effective. You are likely to lose about seven pounds after two years of a Weight Watchers-type of program. The team concluded that group programs are better than self-help weight loss plans. My conclusion is a bit different. These nine guys convinced me that neither self-help nor structured, commercial weight loss programs are of much help if you are fifty pounds or more over-weight. Reading on in this issue of JAMA, the article entitled Health-Related Quality of Life Of Severely Obese Children and Adolescents is heart wrenching. When you carefully assess the physical, emotional, academic and social functional abilities of the obese youngsters, they are far below normal and are as bad as for children with cancer. These limitations are worse for the obese because they may not receive the sensitive care and support that is appropriately given to the child with cancer. The point to be made is that when you are interacting with an obese child, be aware of the psychosocial burdens being carried. For the physician, we are advised also to be aware of more than just the excessive body weight when providing medical care. Finally, the JAMA article Efficacy and Safety of Low-Carbohydrate Diets: A Systematic Review. Wow! The title suggests that we will finally learn if such diets are truly better, or that they are risky, or that they are just diets with more hype. The seven-man team of highly trained medical scientists from Stanford, CA used a computer to pull up every study done over the past thirty-five years relating to the merits and risks of the low carbohydrate diet plans as promoted by the recently-deceased nutrition expert, Dr. Robert Atkins. In contrast to my hopes, the article concluded the following:
What? I want my money back. This is the last article in April 9,2003 JAMA and it reads like a cheap novel. They did all that work and came up with zip. I dont know any more than I did before I read their seven-man review of the literature. On the other hand, from this issue of JAMA I have gained some useful information to use in practice. With scientific accuracy, I may tell my patients to get off the couch, turn off the TV, eat less of anything, do some exercise, and be nice to fat children as they carry around more than their weight. Regarding their questions about the Atkins Diet, perhaps the April 16,2003 issue will give me the answers. I can hardly wait for my copy. You can have it when Im done.
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