Friday, May 29, 2015

Intermittent Fasting As a Dieting Approach

Although the combination of diet, exercise, and lifestyle modification is probably the most preferred approach to weight loss and weight management, employing this combination frequently fails to achieve long-term weight loss. But some diet approaches, being investigated, are adding to our knowledge of potentially effective weight loss methods. One of these methods is intermittent fasting. In intermittent fasting (IF), a person follows a very low calorie diet on some days of the week, and a normal calorie diet on the other days of the week.

One version of intermittent fasting is presented in the book, "The FastDiet." In the book, its author, Michael Moseley, instructs a man, desiring weight loss, to restrict his diet to 600 calories a day for two non-consecutive days. And a woman is instructed to restrict her calories to 500 calories a day for two non-consecutive days. The man or woman is also instructed to eat normally for the remaining five days of the week. The diet appears to be effective for some.

In checking "The FastDiet" book reviews on, you will see more five-star reviews for the diet book than any other star level. As of May 5, 2015, there were 935 five-star reviews, 377 four-star-reviews, 151 three-star reviews, 49 two-star reviews and 59 one-star reviews. One of the reviewers indicated a 3 pound loss in two weeks. Another reviewer indicated a 16 pound loss in 16 weeks. And there was at least one reviewer who indicated an 18 pound loss the first two months while on The FastDiet. So, again, the diet does appear to work for some.

Another version of intermittent fasting is alternate day fasting (ADF). In this diet approach, a person fasts on a very low calorie diet on alternate days of the week, while following a normal diet on the other days. This form of intermittent fasting can also work for some.

In fact, while indicating a need for more research, investigators associated with one  study concluded that alternate day fasting (ADF) "is effective for weight loss and cardo-protection in normal weight and overweight adults." And investigators in another study suggested that combining ADF with endurance exercise can be an excellent therapy which can lead "to positive behavioral changes that may contribute to long term steady weight loss."

On the other hand,  US News gave one form of IF a not so good rating. US News gave the FastDiet two and a half stars out of five in its diet rating report. One of the main problems with the diet is the lack of guidance for the normal calorie days. This leads one to believe that the IF approach may work best if directed by a nutrition-trained professional, who could provide diet guidance for the fasting and the non-fasting days.

At any rate, the above mentioned book and studies show that in some cases, IF can lead to weight loss. But more research is needed. Still, weight loss providers should monitor research on IF. And for specific patients, application of the IF approach might be considered.

Monday, May 18, 2015

Primary Care Physicians and Commercial Weight Loss Providers as Partners

When healthcare providers are considering weight loss methods, they usually concentrate on safety and efficacy. But there is another important consideration. It is the cost of the treatment. Because, even if the  treatment is safe and effective, but not affordable, many people who need the treatment won't get it. The Affordable Care Act mandates that insurers cover counseling for obesity. And some insurers will cover weight loss drugs. Still, weight loss affordability is a problem for many. For primary care physicians who are concerned with weight- loss-program affordability for their patients, partnering  with commercial weight loss providers may be a way to make weight loss more affordable.

Medical economists look at the cost-effectiveness of different kinds of weight loss treatments. Some of these economists use something called the QALY to evaluate the cost effectiveness of a medical treatment. The QALY is defined as a "quality adjusted life year." Researchers look at the "cost per QALY gained" with a treatment to assess the cost effectiveness of the treatment.

Although controversial, some medical economists use $50,000 as the threshold cost per QALY dollar amount. If the cost per QALY is less than $50,000, the given treatment is considered cost effective. If the cost per QALY is greater than $50,000, the treatment could be rejected. And one study showed that the Weight Watchers commercial weight loss program to be the most cost effective program at $34,630.   

Researchers in England have investigated the cost effectiveness of referrals by General Practitioners to commercial weight loss providers. After one year of referrals to commercial weight loss providers, one group of English researchers concluded that the cost per QALY was $10237.83.  This is well below $50,000.

Another group of English researchers concluded that referred-commercial-program "participants view the lifestyle-based, non-medical commercial programme as an appropriate intervention for weight management." Further, program participants "frame their experience of the intervention as medically pertinent with clear health benefits."

Therefore, we may conclude that in some cases, it could be beneficial to the primary care physician and his or her overweight patients to partner with a commercial weight loss provider. This could be a safe, effective, and affordable approach for some patients. 
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