To the Editor: In their randomized controlled trial, Dr Dixon and colleagues1 compared adjustable gastric banding vs conventional therapy for type 2 diabetes. The authors observed that participants randomized to surgical therapy were more likely to achieve remission of type 2 diabetes compared with those who were assigned to conventional therapy. They concluded that magnitude of weight loss was the primary determinant of diabetes remission.
Given the importance of amount of weight loss in determining outcome, the failure to use a state-of-the-art behavioral weight reduction program that produces representative weight losses is of major concern in interpreting the study's findings. Lifestyle interventions that include frequent contact (typically weekly), group support, and behavioral strategies are most effective for weight loss and maintenance.2 - 4 With this type of program, weight losses of 7% (7 kg) were obtained in the Diabetes Prevention Program at 1 year with approximately 6-kg weight loss at 2 years.3 Recently, Look AHEAD reported weight losses of 8.6% of initial weight at 1 year in more than 2500 overweight or obese individuals with type 2 diabetes who were treated in a comprehensive lifestyle intervention.4 Thirty-eight percent of the individuals in the lifestyle intervention had weight losses of at least 10% of their initial body weight. These weight losses contrast sharply with the extremely modest 1.4% (1.5-kg) reduction obtained by Dixon et al with their conventional therapy.
To inform decision making, a fair comparison of the risks and benefits of lifestyle intervention vs surgical intervention in the treatment of obesity and type 2 diabetes should have included optimal lifestyle intervention, such as that used in the Diabetes Prevention Program.5
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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