Institute of Medicine: Obesity is not caused by lack of willpower

In a 48-page report, the Institute of Medicine “refutes the idea that obesity is largely the result of a lack of willpower on the part of individuals.” [You know the IOM, the same folks who brought you the “98,000 people are killed each year by medical errors” report, the accuracy of which has been challenged.]

According to a spokesman for the IOM, “"When you see the increase in obesity you ask, what changed? And the answer is, the environment. The average person cannot maintain a healthy weight in this obesity-promoting environment."

The report goes on to say, “People cannot truly exercise ‘personal choice’ because their options are severely limited, and biased toward the unhealthy end of the continuum."

Quoting further from an article about this revelation from the IOM, “The panel recommended tax incentives for developers to build sidewalks and trails in new housing developments, zoning changes to require pedestrian access and policies to promote bicycle commuting.”

"We've taken fat and sugar, put it in everything everywhere, and made it socially acceptable to eat all the time. We're living in a food carnival, constantly bombarded by food cues, almost all of them unhealthy," said David Kessler, former head of the U.S. Food and Drug Administration. Maybe Kessler should have done something about this when he was in charge of the FDA.

Are they serious?

Things like this really aggravate me. [Lots of things aggravate me.]

Everyone who drinks alcohol doesn’t become an alcoholic. The IOM says it's not willpower. How is it then that some who are exposed to the same environmental factors and food cues as obese people manage to maintain a normal weight?

How much did the IOM’s 48-page report cost and who paid for it?

Do you think building sidewalks and promoting bicycle commuting will really decrease obesity?

What do you think of the IOM report?

A version of this post appeared on Sermo yesterday. Most of those who commented felt that the IOM was out of touch with reality or al least, mistaken.

Proposed ban on large sized sweet drinks in New York is hypocritical & likely to fail

New York City’s Mayor Bloomberg has proposed a ban on the selling of sugar-containing drinks in containers larger than 16 ounces in all types of eating establishments including street vendors, movie theaters, delicatessens and even stadiums. The purpose is to limit sugar intake and theoretically help people lose weight by saving them from themselves.

The plan has received mixed reviews with some calling it a “nanny state” action. Also since a consumer can buy more than one 16 ounce bottle at a time, detractors point out that the truly motivated sugar addict will not be deterred. Supporters say that anything that limits sugar consumption is good. A recent poll shows that slightly more than half of New Yorkers think the idea is bad.

I don’t think it will have any impact on the general public at all. There is no proof that obesity is related to the size of a drink container. One wonders if the mayor is simply grandstanding.

But more importantly, the mayor could have far more influence if he addressed something he can control. That is the selling of sweetened sodas and junk food at the 11 acute care hospitals owned and run by the city serving mostly indigent New Yorkers.

On nearly every floor of the city owned hospitals, vending machines are stocked with mostly non-nutritious snacks and sodas containing sugar. Cafeterias and coffee shops feature similar fare.

If the mayor wants to do something constructive about obesity, he should mandate that his hospitals lead the way and stop giving obese patients and those with diabetes access to products that are not good for them. It makes no sense to counsel a hospital patient about a diabetic or weight-loss diet and then provide that same patient a vending machine full of junk 100 feet from his hospital room.

While he’s at it, the mayor should ban the sale of junk food and sodas in the more than 40 other private and not-for-profit hospitals in the city’s five boroughs.

That would be a real obesity prevention program, not a publicity stunt.

Less is more. Conventional wisdom challenged in two NEJM articles

Classical views on fluid resuscitation and nutrition in critically ill patients were questioned in two papers published today in the New England Journal of Medicine.

A large study involving febrile, under-perfused children in Africa reveals that those aggressively resuscitated with fluid boluses of either saline or albumin had higher mortality rates than a control group who were not given boluses of fluid. The study was stopped earlier than planned when the research group’s data and safety monitoring committee performed an interim analysis. This paper adds to a growing body of research that shows that large-volume fluid resuscitation may be harmful in many situations.

A second article demonstrated that in some 4600 critically ill patients given enteral nutrition, late (day 8 of ICU admission) initiation of parenteral nutrition to supplement the enteral nutrition and achieve caloric goals leads to fewer complications and faster discharge from the ICU than patients whose parenteral nutrition was started within 48 hours of their ICU stay.

The papers are accompanied by editorials (here and here) that provide perspective and as usual caution against overly interpreting the results.

Although the messages seem quite clear (especially regarding large-volume fluid resuscitation), clinicians should read both papers and decide for themselves.