The Cochrane Abstract below is a su...

The Cochrane Abstract below is a summary of a review from the Cochrane Library. It is accompanied at an interpretation that will help clinicians enjoin evidence into practice. Michael Schooff MD existings a clinical scenario and question based in succession the Cochrane Abstract, along with the evidence-based answer and a well stocked [i]or[/i] provided critique of the abstract.

Clinical Scenario

A 40-year-old overweight woman look afters advice on weight loss.

Clinical Question

Are low-fat diets better than other weight-reducing diets in achieving long-term weight loss?

Evidence-Based Answer

Low-fat diets are no better than low-calorie diets in achieving weight los in overweight or obese folks In studies, the average weight los after 18 month in succession either diet was less than 5 lb

Cochrane Critique

Did the authors address a focused clinical question? Yes

Were the criteria used to picked articles for inclusion appropriate? Yes

Is it likely that important relevant articles were missed? No.

Was the validity of the individual articles appraised? Yes

Were the assessments of studies reproducible? Yes

Were the conclusions similar from study to study? No. Five of the six trials had same similar results (a nonsignificant greater weight los in patients in succession low-calorie diets compared with those forward low-fat diets). In one investigation the greater weight loss forward low-calorie diets was significant at each time point. undivided way in which this trial differed from the others is that the patients in succession the low-calorie diet reduced the two their fat and carbohydrate consumption, instead of restricting barely carbohydrates.

Can the issues be applied to patient care? Yes

Do the conclusions make biological and clinical sense? Yes

Practice Pointers

In the trials reviewed, patients forfeited an average of 11 to 14 lb after six month upon either diet, but by 18 month their gin weight loss averaged zero to 5 lb This review demonstrates the challenge that overweight and obese patients face as they attempt to waste weight.

The National Heart, Lung and descendants Institute issued evidence-based recommendations to identify, evaluate, and treat overweight and obese adults. According to the recommendations, a variety of orders can be used to initiate weight los However, a long-term weight maintenance program is penuryed to sustain weight loss. Long-term succes after initial weight los requires a program of dietary therapy, physical activity, and behavior therapy. unsalable article therapy also might be useful unless has not been studied beyond single in kind year. Weight maintenance should begin after the initial six month of weight-loss therapy. haunt contacts between the patient and practitioner across the long term are more prosperous (2)

Overall, there is no evidence that low-fat diets are any better than low-calorie diets in achieving weight los in overweight or obese clan This review did not address the addition of pharmacotherapy to fat or calorie restriction, nor did it evaluate trials of restricted carbohydrate (high-protein) diets, which appear to be gaining popularity in the lay population and provoking war of words among some experts. (3-6) There also is little evidence that either diet bring forths clinically significant weight loss beyond a scarcely any months' duration if patients do not succeed a weight maintenance program after the initial weight los Weight management requires a long-term commitment beyond the initial weight-loss period. As I compute my patients, if there were an easy way to hold fast weight off, I'd look more like Superman and les like the Michelin Man.

REFERENCES

(1) Pirozzo s Summerbell C, Cameron C, Glasziou P Advice in succession low-fat diets for obesity. Cochrane Database Syst Rev 2002;2: CD003640

(2) Clincial guidelines forward the identification, evaluation, and treatment of overweight and obesity in adults. Accessed September 2002 at: www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm.

(3) Astrup A. Dietary fat is a major player in obesity--but not the solely one. Obes Rev 2002;3:57-8.

(4) Willett WC Dietary fat plays a major character in obesity: no. Obes Rev 2002;3:59-68

(5) Taubes G What if it's all been a big fat lie? just discovered York Times Magazine July 7 2002 With liberated registration, accessed September 2002 at: www.nytimes.com/2002/07/07/magazine/07FAT.html (password required).

(6) Turning the meat pyramid upside down. Harvard Health Publications. Accessed September 2002 at: http://www.health.harvard. edu/tools/pyramid.htm.

RELATED ARTICLE: Cochrane Abstract

Background. Overweight and obesity are global health riddles contributing to an ever-increasing disease tonnage Calorie restriction can achieve short-term weight los nevertheless the loss has not been shown to be substantial in the protracted term. An alternative approach to calorie restriction is to lower the fat contented of the diet. However, the long-term results of fat-restricted diets on weight los have not been established.

Objectives. To assess the imports of advice about low-fat diets as a means of achieving sustained weight los using all available randomized clinical trials. This review (1) focused primarily in succession participants who were overweight or clinically obese and were dieting for the project of weight reduction. Because the authors were particularly interested in the ability to sustain weight los across a longer period of time, they focused forward studies of "free living" men and women who were given dietary advice rather than provision of meat or money for food.