Saturday, December 29, 2012

Does bariatric surgery cure diabetes?


Bariatric surgery has been heavily promoted to treat Type 2 diabetes. Bariatric surgery is now being considered for those with less severe obesity, a body mass index (BMI) less than 35.

Surgery generates a lot of revenue for surgeons and the hospitals where they work. The Lap-Band System generates substantial revenue for its manufacturer. But just how effective is bariatric surgery for diabetes?

Does bariatric surgery cure diabetes? For the sake of clarity, let’s use the term "complete remission" instead of "cure".

The definition of complete remission of diabetes has been agreed upon to mean normal blood glucose measurements lasting at least a year without the need for medications.

It has been known for decades that weight loss dramatically improves glucose levels in persons with Type 2 Diabetes.

Modest weight loss of even 5% reduces the need for medication to treat the diabetes.

With weight loss, insulin works better and the pancreas can produce more insulin. 
The amount of weight lost appears to be the main reason for the improvement in glucose after weight loss surgery.

A recently published trial called STAMPEDE was conducted at the Cleveland Clinic. This trial received a lot of media coverage. You might know that the "clinic",  as it is known in Cleveland,  has an outstanding marketing department. 
The goal of STAMPEDE was to test whether bariatric surgery was better than “intensive medical therapy” to control blood glucose in obese adults with Type 2 Diabetes.

The average BMI was 36 before surgery. 
A third had a BMI less than 35.
And either sleeve-gastrectomy or gastric bypass surgery was performed.

The investigators started off with 150 patients and determined the likelihood of these patients getting to a Hemoglobin A1c of less than 6% after 12 months. Now, a HgbA1c of less than 6% is really good blood glucose control and is lower than our goal for most patients with Type 2 Diabetes.
Patients were randomly assigned to one of the surgical treatments or to the so called "intensive medical therapy".

This study had obvious flaws that most people fail to see.
The main flaw is calling the medical therapy “intensive medical therapy”. This "intensive" treatment was a visit to the clinic every 3 months. That’s a joke! 
That is not intensive therapy!

The intensive therapy in the 10, 000 person ACCORD trial which also targeted a Hemoglobin A1c below 6% meant a visit every 2 weeks for 4 months and then at least monthly. And at the visits treatment was really intensified.

In STAMPEDE, there was minimal increase in the use of medications despite this supposed "intensive" therapy.  
STAMPEDE appears to have been designed by the surgeons to show that surgery was better.  
Well,  it clearly suggested that surgery is better than minimal medical therapy.  

And in this Cleveland Clinic trial, among those who had surgery, 22% in the gastric bypass group were still on medication for their diabetes at 12 months. And that number was 49 % for those who had undergone a sleeve gastrectomy!
And a recent analysis of 357 patients with Type 2 Diabetes who had  a BMI less than 35  before surgery found that about 20% fail to go into remission after surgery.

And another large recent analysis  of over 4400 patients who underwent gastric bypass showed that about 32% failed to have a complete remission of their diabetes within 5 years. These people were not “cured” of their diabetes. And of those who did have a complete remission, about 35% saw their diabetes come back within the next 5 years.

Those persons most likely to have a complete remission were those before surgery who were not using  insulin and those who had  shorter duration of their diabetes. 
Another recent large study of diabetes remission among over 1100 patients showed that 38 % still had diabetes 6 years after gastric bypass surgery.

So taken together these studies tell us that about 40% or more adults still will have to deal with treatment of their diabetes despite having had bariatric surgery.

Bariatric surgery helps many patients in many ways but it  is no "cure all" for Type 2 Diabetes.

Every treatment for diabetes has its pros and cons. 
And that includes surgery which does not “cure” diabetes in a significant number of patients. 
Daniel Weiss MD CDE FACP PNS CPI
Your Diabetes Endocrine Nutrition Group













Sunday, December 23, 2012

Will fish oil make your baby smarter?

Will fish oil make your baby smarter?


Women who are pregnant are often advised by their doctors to take fish oil supplements, especially DHA.
DHA is short for docosahexaenoic acid. DHA is one of the two main omega-3 fatty acids found in fish oil. The other is abbreviated EPA.

Many people believe  that if mom takes DHA during pregnancy the baby will be smarter or otherwise better off.

Is any of this true?

Various clinical trials tested the benefit of DHA during pregnancy.
Doses of DHA used in these trials ranged from 400-1100 milligrams daily.
All these studies were randomized, double-blind, placebo controlled clinical trials. 
And all studies showed no benefit in the child's cognitive development whether the children were tested at 18 months as was done in one large Australian study or at 6 1/2  years.   

A small trial in which fish oil supplements were given only during breastfeeding  suggested worse cognitive function when children were tested at 7 years.

Visual function requires good brain and nerve function. 
One study that assessed visual function  showed no benefit. 
Another published this year showed no benefit in either visual or auditory function. 

So is there anything good about taking DHA during pregnancy?

Well there might be some benefits on immune function. Maybe.
Allergic or atopic eczema appeared to be less in a trial that used a 900 mg of fish oil supplement containing 800 mg of DHA.
Another smaller study with a lower dose of DHA  failed to show less atopic eczema.
One study showed benefit only in the infant’s first year but not in the second year. This last trial suggested less likelihood of egg allergy in the infant's first year as well as less eczema.

One small study showed better infant sleep within 48 hours of birth in those infants of mothers who received the DHA supplement. 
But how about after 48 hours? Many parents would like to know the answer to that!

The symptoms of the common cold and some other symptoms seemed less in infants in one study in those mothers who had received DHA supplements. But those infants also had more vomiting.


So where does all this leave us?
The results of DHA and fish oil supplements in general during pregnancy are singularly unimpressive. 
Pregnant women should take folic acid supplements, avoid alcohol and tobacco and prepare a safe home for their baby. Avoiding cow's milk and cow's milk formula in the first 6 months of life is also important.

And here's one last smart move:  get a knowledgeable and caring pediatrician.
  

Sunday, December 9, 2012

Sex, Death and Fidelity


Sex, Death and Fidelity


Patients with diabetes often have heart disease.
Those who have had a heart attack may worry about having sex after they've recovered.
Will sexual activity give them another heart attack?
Can sex cause sudden death in a person at high risk for heart attack?

It is clear that regular physical activity reduces your risk of heart attack, technically known as myocardial infarction.

Sexual activity can be considered a form of mild to moderate physical activity. I discussed this in a previous post.

In 4 studies of adults, the majority of which were men in their 50s and 60s, those who had been sedentary, physically inactive, had a 3 fold increased risk of myocardial infarction during the time of sex as compared to when they were not engaged in sexual intercourse.

But for those physically active persons, the relative risk of myocardial infarction was only 1.2.

Overall, the so-called absolute risk of a myocardial infarction during sexual intercourse is quite low. Less than 1 % of all myocardial infarctions occur in close relation to sexual intercourse. And the chance of another myocardial infarction during sex is also very low in those who have had a previous myocardial infarction.

How about suddenly dying during sex?
Sudden death can occur during sex from a myocardial infarction or life threatening arrhythmia (heart irregularity) . Although the increases in heart rate and blood pressure during orgasm and sex are about the same in women as for men, about 90% of those who suddenly die during sex are men. 

Interesting isn’t it?

In 3 autopsy reports of thousands of persons who suffered sudden death, only 0.6% had sudden death related to sexual activity. That is only 6 out of every thousand who died suddenly.
So, in general, your chances of dying suddenly during sex are fairly low, especially if you are healthy with few risk factors for heart disease.

But here’s a key point.
About 75 percent of those sudden deaths during sex occurred with sex outside of marriage.

The lessons I take away from this are:
·      stay physically active,
·      remain faithful to your partner and
·      talk to your doctor about your sexual concerns. 

This statement from the American Heart Association has much more in the way of guidance and recommendations for patients and their doctors.


Take care and be well,
Your Diabetes Endocrine Nutrition Group


Thursday, November 22, 2012

Dr. Oz: lycopene lowers cholesterol?


Does lycopene lower cholesterol?

Well, if you believe one of the most well known doctors in the United States, Dr. Oz, you would think that lycopene lowers LDL cholesterol “as much as statins”.
Dr. Oz is often cited by my patients.
Dr. Oz has a TV show, and along with Dr. Roizen, he has a regular newspaper column providing a “tip of the week”.

In their recent column, they advise that we can simply consume a half-cup of tomato sauce daily to lower LDL cholesterol as much as statins.

I say: get real!
Okay even if we were to consume that much tomato sauce (sauce not juice) daily, what is the evidence that lycopene found in such foods as tomatoes, actually lowers LDL cholesterol (the bad cholesterol)?

Quick answer: none. No evidence.

There are absolutely no randomized, placebo controlled clinical studies that demonstrate cholesterol lowering with lycopene.
And there are no studies examining lycopene versus statin.

And the best published study I could find with lycopene showed no effect on LDL cholesterol levels.

And you may ask what is lycopene? 


It is the chemical that gives tomatoes and red bell peppers their red color.
It also has antioxidant properties. And if you have read my previous post on antioxidants you can see through those dubious antioxidant claims.

Okay, but where did Oz and Roizen come up with this idea about lycopene?

I really don't know. I did not call and ask either of them before writing this post.

But I think they probably got excited after seeing a recent publication.
That epidemiologic study found that men who had higher lycopene levels in their blood seemed to have fewer strokes over a 12 year period of time.
This study is interesting but it proves nothing. 

As with all studies of associations, this report does not prove that consuming lots of foods high in lycopene will reduce your risk of stroke. And this study did not evaluate the effect of lycopene on cholesterol. 

Drs. Oz and Roizen often make bold statements based upon this kind of association type study.
These judgments on their part represent uncritical, uninformed thinking.
This type of conclusion misleads.
This type of conclusion is junk science. Other physicians have been very critical of Dr. Oz.

You may ask: do I recommend my patients eat a variety of foods including fruits and vegetables?
Of course I do.
And I also recommend that they not read or watch Dr. Oz.

Sunday, November 11, 2012

Eat more to lose weight?

Should you eat more to lose weight?

This is one of the stupidest recommendations my patients have read or been told.

But many people seem to believe this advice:

      that if you don't eat enough, your body will go into "starvation mode" and you will not lose weight.

Another way of stating this is that below a certain calorie intake, you will stop losing weight.

Let me make this perfectly clear: this is complete nonsense.

There is excellent science on calorie intake and weight loss. See a recent post.

To believe that taking in more calories helps you lose weight is as stupid as:

      if you want to jump higher, put weights on your shoes, that really helps a lot.

Or, if you want to go really fast while driving your car, step on the brake along with the gas pedal.
 
Weight loss is not easy.

But the laws of physics remain:  you need to take in less calories than you burn up.

And eating fewer calories, always helps weight loss efforts.

New medications like Qsymia can help.

Good luck in your efforts!

Your Diabetes Endocrine Nutrition Group



Wednesday, November 7, 2012

Osteoporosis Drug Risks


Osteoporosis Drug Risks

There has been a lot of recent concern recently about osteoporosis drug risks.
Osteoporosis is a condition of the bones that increases the risk of fractures.

One in 2 women and one in 4 men over the age of 50 will break a bone due to osteoporosis.
About 2 million fractures related to osteoporosis occur each year in the United States.
About 300,000 are hip fractures.
Hip, wrist and vertebral (spine) fractures cause untold suffering and disability.

Guidelines and online calculators  and an app for the iphone are available to guide physicians as to who should be treated with medication. Those persons who have had a so-called fragility fracture are much more likely to have another fracture.

The most commonly used drugs to treat or prevent osteoporosis are called bisphosphonates. The four bisphosphonates used for osteoporosis in the U.S are alendronate, ibandronate, risedronate, and zoledronic acid.
The brand names for these are Fosamax, Boniva, Actonel and Reclast.

Reclast is given once a year intravenously. Boniva is available by mouth given monthly and intravenously once every 3 months . Fosamax and Actonel are given by mouth.

Doctors never want to cause more harm than good with a medication.
Recently, a possible increased risk of unusual fracture of the “thigh bone”, the femur, has been seen. This atypical fracture is thought to be possibly increased in those persons on long-term bisphosphonates.

In this post I will focus on these so called atypical sub-trochanteric fractures. 
Some may be concerned about osteonecrosis of the jaw (abbreviated ONJ)  with bisphosphonates. When bisphosphonates are used for osteoporosis, ONJ appears to be very rare and not clearly caused by the drug at these doses. 
A recent article discusses safety concerns of bisphosphonates.

The American Society of Bone and Mineral Research has provided a detailed report on atypical sub-trochanteric fractures. Of all hip and femur fractures, less than 1% are these atypical sub-trochanteric fractures. These atypical sub-trochanteric fractures appear more likely, perhaps two and half times more likely, in those who have taken bisphosphonates for more than 5 years.

That sounds bad but the risk of such fractures is very low.
Atypical sub-trochanteric fractures occur at a rate of about 3 in 10,000 women over 1 year  who are 65 years or older.
But typical hip fractures overall are 30 times more frequent: 103 in 10,000 women aged 65 or older over 1 year.

And bisphosphonates have repeatedly been proven to reduce fractures in those at increased risk for fracture. 
Bisphosphonates reduce fractures by 30-70% depending on the drug studied and the particular fracture.

So what should be done while we wait to learn more about these atypical sub-trochanteric fractures?

Those who really need treatment should be treated. FRAX can be very useful. But sound judgement and clinical expertise needs to be coupled with FRAX.    I often see patients who probably do not need the medication they are taking for their bones.

We should consider discontinuing treatment in those who are doing well and who are at lower risk after 5 years of oral bisphosphonates or 2-3 years of intravenous bisphosphonates. Recent data suggest that FRAX may be helpful in deciding when to stop treatment with a bisphosphonate.
At this time, there are no studies on how long treatment might be stopped.
Many people, especially those with more severe disease and history of fractures, will do best by continuing treatment.

Keep in mind that we do not have data on  atypical fractures in those treated with Prolia long term.
And Prolia is not a bisphosphonate but it appears to be highly effective.

Discuss matters with your doctor who should be keeping up to date with developments in this area.
And remember no treatment is without risk. 
We should weigh risks versus benefit. 
There may be no clear right or wrong answer here.
And if in doubt, patients and or doctors should get another opinion.
In general, endocrinologists and rheumatologists are the specialists with expertise in osteoporosis.

I hope this helps in thinking about osteoporosis drug risks versus benefits.



Monday, October 29, 2012

How much physical activity should I get?


How much physical activity should I get?


That depends. 
Exercise is good for everyone.

But first, let’s use the term physical activity here.
Physical activity appears to not be so bad a word as exercise.
It seems very few people want to exercise but many more are willing to be physically active.

In general, the more physical activity you get, the better. And all adults should avoid being inactive. The American Heart Association strongly endorses this view.

Perhaps the most evidence for benefit from physical activity relates to the risk of coronary heart disease.

Coronary heart disease causes about 1 in every 6 deaths in the United States
Of course, there are other forms of heart disease such as heart failure but coronary heart disease is the most common type of heart disease.

Coronary heart disease causes heart attacks.
The medical term for heart attack is myocardial infarction.


Okay, so how much physical activity should you get to reduce your risk of coronary heart disease?

A recent analysis of 33 studies appears to confirm that the more leisure time physical activity, the lower the risk of heart disease. All of these studies were epidemiologic studies not randomized controlled trials. Randomized controlled trials would be better but for many reasons are not possible to address this question.

So in this analysis, a 14% reduction in risk of heart disease was seen in those who had engaged in about 150 minutes of moderate intensity exercise each week. That risk compares to those who are inactive.

Double that amount of activity and the risk of coronary heart disease was reduced about 20% as compared to inactive persons.

And those who already have coronary heart disease appear more likely to survive if they participate in a cardiac rehabilitation exercise program.

So what is moderate intensity physical activity?

Brisk walking like walking 2 miles in 30 minutes, or bicycling, raking leaves, gardening or sex with your usual partner are examples of moderate physical activity. See this link for other options.

And physical activity helps in so many other ways

So start moving, stay active and stay well.

Daniel Weiss MD CDE FACP PNS CPI

Sunday, October 21, 2012

Does Eating Soy Affect Your Thyroid?


More people are eating soy products these days. Some eat soy because they avoid all animal products. Vegans know that soy is an excellent source of protein.

Some post-menopausal women are eating soy to help their bones. 
But recent long term, randomized, controlled clinical trials do not show bone benefit from soy. 
And, in most trials,  hot flashes do not improve with soy.
And the earlier trials with soy also failed to show bone benefit from soy. 
Although a recent study suggested that there might be a slight positive effect on bone strength.

Many people who eat soy are concerned that high soy intake can affect their thyroid.

So what do the controlled, clinical trials show with respect to soy and thyroid?

One of those trials looking at bone effects of soy in postmenopausal women showed no effects of soy on thyroid hormone levels.

In most men or women who have normal thyroid function to begin with, soy has no effect on thyroid activity. Trials in women were published in 2003, 2007, and 2011.

The exception regarding soy and thyroid:  in those who are deficient in iodide or who have a failing thyroid, high soy intake is three times more likely to lower thyroid hormone levels further. The mechanism of this effect has been studied.

So high soy intake could make the thyroid more underactive if the thyroid is struggling to make enough hormone to begin with. 
Iodide deficiency is simply not an issue in most developed countries. 
See my previous posts on thyroid.

A failing thyroid is most commonly caused by the autoimmune condition called Hashimoto’s thyroiditis. Underactive thyroid is called hypothyroidism. Borderline hypothyroidism can be considered to be a failing thyroid and is usually called subclinical hypothyroidism.

So besides Hashimoto' disease, who else is more likely to have subclinical hypothyroidism? 
Those who have only part of their thyroid because of surgery.
And those who have been treated with radioactive iodide for an overactive thyroid. 
Both of these groups of people should be getting regular blood tests to monitor for hypothyroidism. 

The best test to follow for those with hypothyroidism is the TSH. 
TSH stands for thyroid stimulating hormone.
TSH is increased in those with inadequate thyroid hormone levels. 
As the hormone production by the thyroid gland goes down, the TSH from the pituitary gland goes up. Check this out to learn more.

If you are already taking thyroid hormone for hypothyroidism it's no big deal if you eat soy. 
Your TSH level ought to checked regularly by your doctor. 
Your thyroid dosage should be adjusted according to those blood tests. 

So be reassured that soy intake should not cause thyroid problems unless you are more likely to have untreated hypothyroidism to begin with. 
If you have not had thyroid surgery and never was treated for overactive thyroid and do not have Hashimoto's disease, then eating lots of soy should cause no problems. 
And if you are taking thyroid hormone for hypothyroidism, again no problem.

Ask your doctor if you are concerned. Your TSH level can be checked. 

In general, if your TSH level is below 3, you are okay. 
Above 3, generally means your thyroid hormone levels are not quite enough.
Go ahead and enjoy your soy in any case.

I hope this update helps those soy consumers out there. 
Now please excuse me while I prepare my tofu stir-fry.

Daniel Weiss MD CDE FACP PNS CPI



Sunday, October 14, 2012

How do you prevent leg cramps?


Leg cramps are common. Most involve the calves. Most occur at night while sleeping.
How do you prevent those painful leg cramps?

Now, I am not talking about cramps that happen with exercise, like running in a marathon; those are a completely different problem. And they are far less common than nighttime leg cramps.

First keep in mind that some medications can make cramps more likely.
Those medications that reduce the concentration of potassium or of sodium in your blood may increase your risk of leg cramps.
These include certain diuretics and probably certain inhalers for asthma called beta agonists.

But most people with leg cramps have no electrolyte imbalance.
Their serum levels of potassium, sodium, calcium and magnesium are fine.  
Low thyroid hormone levels, hypothyroidism, can also cause muscle cramps. 
Once the thyroid hormone levels are normal, the cramps should go away.

Statins can cause muscle aching, but muscle cramps on the other hand, in my experience are not usually an issue with statins.
So, if my patients on statins have muscle cramps at night, when taken off the statin, they usually still have those cramps just as badly.

Some drugs cause leg cramps for unclear reasons. A few of these are estrogen, teriparatide (Forteo) and raloxifene (Evista).

So how about preventing leg cramps.
Non-drug treatments are always preferred. But it seems most don't work.

Fortunately,  recent evidence confirms the benefit of calf stretches at night to reduce calf cramps.

But for goodness sake don't drink pickle juice!
That's another goofball idea one of my patients heard from Dr. Oz.
Pickle juice has been studied for treating exercise associated muscle cramps
It might work for treatment of those cramps, but not prevention.

Quinine clearly works to reduce calf cramps as confirmed in a recent review. Around 300 milligrams is the dose that seems to have shown benefit.
Since 1994, in the U.S., quinine has only been available with a prescription.
Qualaquin is the only quinine available in the United States. The FDA warns patients and doctors about Qualaquin.
And Qualaquin is not approved for prevention of nighttime muscle cramps. By the way, the amount of quinine in tonic water is so low,  don't expect that to help.

Other treatments, like gabapentin or verapamil, have less convincing data to support their benefit. But they are safe and may be worth a try.

So, sadly, I do not have any great ideas to prevent leg cramps besides avoiding electrolyte imbalance and doing calf stretches.

What have you done that works? I'd like to know.

Daniel Weiss MD CDE FACP PNS CPI








Tuesday, October 9, 2012

Electronic Medical Record Scam


The electronic medical record (EMR) is a scam. 

EMR is the most expansive and expensive scam foisted on the public by the federal government. 
And the EMR scam is funded by billions of our taxpayer dollars. Those who have read my previous posts on EMR will understand.

A recent New York Times piece restates my concerns with the EMR and highlights safety issues of the EMR.
             
As I have stated, there is no solid evidence of patient benefit from use of an EMR. Security and privacy issues are worrisome. The EMR destroys the patient narrative and disrupts the physician-patient relationship. Humans do not speak “template”. As psychiatrist Dr. Scott Monteith has stated, “it really affects how we think”.  
Read the comments of health information technology expert Dr. Scot Silverstein to learn more.
             
It is time for the Centers for Medicare and Medicaid Services (CMS) and the federal government to call a halt to further implementation of this costly, inefficient and potentially dangerous intervention. 

Dan Weiss MD CDE FACP PNS CPI

Sunday, September 30, 2012

Is organic food better for you?


Is organic food better for you?

Organic food sure costs more but is it worth the extra cost?

Is organic food more nutritious than conventional food?

Is organic food safer?

Two recent studies addressed these questions. One study published in 2010 asked whether there were nutritional related health outcomes from eating organic foods. They examined over 50 years of studies. They found no evidence of benefit from organic foods as compared to conventional.

A study published this year examined the question of safety and nutritional content of organic foods versus conventional foods. This rigorous analysis looked at 223 studies of nutrient and contaminant levels in organic and conventional foods.

Although a previous study  of produce had suggested better content of micronutrients in organic produce as compared to conventional, this more extensive analysis showed no benefit in terms of nutrients in any organic foods.

Organic certification varies by country. The process is complicated and burdensome. 
The United States Department of Agriculture (USDA) has a long, complex set of requirements.

Synthetic pesticides cannot be used. So it is no surprise that this recent study concluded that there is less pesticide residue on organic produce as compared to conventional produce. 
The differences were quite small however.

The USDA has a National List of Allowed and Prohibited Substances for the National Organic Program. Only certain fertilizers can be used. There are many other restrictions.

Perhaps because of the restriction on fertilizer use,  organic farms have lower crop yields than conventional.
The need for more land would mean more deforestation to grow crops and less biodiversity. 
So you might feel better about the environment if you buy organic, but organic foods are in some ways actually less eco-friendly.

Poor people with small farms in developing countries are likely to do all they can to maximize yield. Organic farming is not for them. Maybe organic farming is more for wealthier countries and those with ample land.

As for produce, almost all of us should try to consume more fresh produce.
Those on a tight budget should not buy the more expensive organic produce.

So there is no good evidence thus far that organic foods are worth the extra price.
I would advise that you have the money and prefer organic foods, for whatever reason, go ahead buy organic.   

But don't feel holier or healthier if you do! 

What do you think? Am I wrong? Let me know.

Dan Weiss MD CDE FACP PNS CPI




Sunday, September 23, 2012

How do I lose a pound?


How do I lose a pound?

For many years we were told that you if you consumed 3500 calories less each week you would lose 1 pound every week. That meant, eating 500 calories less each day and you would lose one pound every week.
Or if we exercised to expend 3500 calories more each week we would lose a pound that way.
Many dietitians and doctors still use those estimates.

Well it turns out those estimates are frequently way off.
One reason for the inaccuracy of those estimates is that our metabolism changes as we lose weight. Lots of things change over time. Our bodies are not static; they are dynamic.

Now sophisticated mathematical models allow for more accurate estimates of body weight changes with changes in calorie intake or physical activity.
These dynamic models factor in changes in our metabolism as weight is lost.
The previous static models failed to do so.

Much of this is the work of physicist Kevin Hall .
Dr. Hall received the Lilly Scientific Achievement Award at the annual scientific meeting of The Obesity Society this year.

Dr. Hall’s dynamic model showed that a 20% tax on sugar-sweetened beverages would lead to a trivial amount of weight loss. A static model vastly overestimates the weight that would be lost.

You can access the online body weight simulator here.

Are you working on weight loss? Are you counseling patients?

Access the body weight simulator for guidance. 
Now you know how to lose a pound. 
Are you surprised by the results?


Dan Weiss MD CDE FACP PNS CPI


Sunday, September 16, 2012

Does Calorie Posting on Menus Reduce Calorie Intake?


Does Calorie Posting on Menus Reduce Calorie Intake?

McDonald’s recently announced that they would post calorie content of their foods on their menu boards. The so called Patient Protection and Affordable Care Act (PPACA), un-fondly known as Obamacare, mandates that chain restaurants with 20 or more locations post calorie content on their menus. That mandate takes effect in 2013.

So how about it?

Does calorie posting on menus reduce calorie intake?

A study in 2006 indicated that calorie labeling would be either misunderstood or unused. 
A recent critical analysis of published studies on fast food restaurants concluded that the data do not show reduced calorie intake from calorie posting on menus.

Two recent randomized trials were too brief and not real world.  One of these was performed by a vocal proponent of government intervention and showed positive results. The other study showed no benefit

In 2008, New York City required posting of calorie content on menus for all restaurant chains with locations in the city. The only study since then to determine the effectiveness of this regulation showed no impact on calorie intake.

In fact, posting calories on menus in fast food restaurants may actually do more harm than good. Some financially strapped customers may choose the most calories for their dollar. Others may be more anxious and conflicted seeing the calorie content of their food.

Assorted online responses to the McDonald’s announcement were really worth reading.

So, like most government mandates, this one does not have the science or data to support it.  

Those persons ready and motivated to lose weight or those trying to control their weight can choose smaller portions and lower calorie items.

All others are likely to say like one online responder: “just leave us alone”.

What do you think?  Are you surprised by these findings?
Share your thoughts and comments.

Dan Weiss MD CDE FAPC PNS CPI