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News from Annals of Internal Medicine April 7, 2015

April 06, 2015

1. Weight Watchers and Jenny Craig come out on top among commercial weight loss programs

Note: Sound bites, b-roll footage, and image available. Satellite coordinates and feed times are below. Physicians looking for an effective commercial weight-loss program for their overweight and obese patients may want to recommend Weight Watchers or Jenny Craig. According to an updated evidence review of 11 commercial weight-loss programs, only Weight Watchers and Jenny Craig showed evidence for effective long-term weight loss. The review is published in Annals of Internal Medicine.

More than one-third of U.S. adults are obese. The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians screen all adults for obesity and offer or refer overweight or obese patients to intensive, multi-component behavioral interventions for weight loss. Several commercial weight loss programs meet the recommended criteria, but their efficacy is unclear. Researchers reviewed published research to compare weight loss, adherence, and harms of 11 commercial or proprietary weight loss programs. All of the programs studied emphasized nutrition and behavioral counseling or social support components with or without physical activity. Of those, Weight Watchers, Jenny Craig, Nutrisystem, Health Management Resources, Medifast, OPTIFAST, Atkins, The Biggest Loser Club, eDiets, Lose It!, and SlimFast had trials that met inclusion criteria.

The researchers found that only Jenny Craig and Weight Watchers showed evidence that they helped people lose weight and then keep it off for twelve months or more. Other popular programs, such as NutriSystem, showed promising weight-loss results in the short-term, but additional research is needed to determine long-term results.

The author of an accompanying editorial is not surprised that highly structured programs with in-person social support, such as Weight Watchers and Jenny Craig, seem more effective but cautions that weight loss with such programs is modest and likely below patients' expectations. These unrealistic expectations may affect patients' willingness to adhere to any program.

Note: The URL will be live when the embargo lifts. For an embargoed PDF, please contact Megan Hanks. To interview the lead author, please contact Heather Dewar at hdewar@jhmi.edu or 410-502-9463.


2. Physical therapy as effective as surgery for lumber spinal stenosis


Patients with lumbar spinal stenosis (LSS) who followed an evidence-based, standardized physical therapy (PT) regimen achieved similar symptom relief and improvements in physical functioning as those who underwent surgical decompression, according to a study published in Annals of Internal Medicine.

LSS is an anatomical impairment characterized by narrowing of the spinal canal or nerve root foramen that causes pain, weakness in the lower back, buttocks, and thighs. LSS is the most often cited cause for lumbar surgery in the United States and studies comparing surgical with nonsurgical treatment of LSS have been done but outcomes are unclear.

Patients with LSS who were surgical candidates and who provided consent for surgery were randomly assigned to either evidence-based, standardized PT two times per week for six weeks or surgical decompression. After treatment, no differences were detected between the two groups with respect to relieving symptoms and improving function. Both groups began to show improvement at 10 weeks and continued to improve through 26 weeks. Improvements were maintained for both groups through the two-year follow up.

Note: The URL will be live when the embargo lifts. For an embargoed PDF, please contact Megan Hanks. To interview the lead author, please contact Chuck Finder at finderce@upmc.edu or 412-996-5852.


3. Leading internists call for more thoughtful use of CPR


Related online piece 'Betty P.' tackles the topic of advanced directives using an edgy and thought-provoking graphic novel format

Internal medicine thought leaders, Dr. Frank H. Bosch, President of the European Federation of Internal Medicine, and Dr. David A. Fleming, President of the American College of Physicians, remind physicians to incorporate prognosis value and their patients' wishes in decisions to perform cardiopulmonary resuscitation, or CPR. Their commentary is published in Annals of Internal Medicine. The issue includes topically-related content presented in a graphic novel format.

CPR has been dramatically depicted in movies and television shows. In real life, CPR is performed repeatedly and reflexively, regardless of prognosis or patient desires. The authors write that CPR should be performed only when clinically indicated, based on patient preferences and realistic chances of patient benefit. They suggest that hospitals must be environments where patients are informed about their options and prognosis. The benefits and harms of CPR should be explained so that patients can make informed decisions and express their wishes to their physicians.

A vivid scenario involving the decision to perform CPR is depicted in the topically related graphic novel, Betty P.. Betty P. is part of a new feature called Annals Graphic Medicine. Annals Graphic Medicine uses original graphic narratives, comics, animation, and other creative forms to address medically-relevant topics. All of the content is created by those who provide or receive healthcare. Stories may be poignant, thought-provoking, or just plain entertaining. Previously, Annals tackled the topic of patient safety with the graphic novel, Missed It.

Note: The URL will be live when the embargo lifts. For an embargoed PDF, please contact Megan Hanks. To interview Dr. David Fleming, please contact Angela Collom at acollom@acponline.org. To interview the author of Betty P., please contact Megan Manlove at mmanlove@hmc.psu.edu.
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Date: Monday, April 6th, 2015
Times: 10:30 AM - 10:45 AM Eastern
9:30 AM - 9:45 AM Central
8:30 AM - 8:45 AM Mountain
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Date: Monday, April 6th, 2015
Times: 2:00 PM - 2:15 PM Eastern
1:00 PM - 1:15 PM Central
12:00 PM - 12:15 PM Mountain
11:00 AM - 11:15 AM Pacific
Ku-Band Digital Satellite: AMC-1 @103W
Transponder: 06 SLOT A
Downlink: 11,828.0 (V) Audio: Ch 1 & Ch 2
FEC: 3/4 Symbol Rate: 6.1113
9.000 MHz Bandwith

Date: Tuesday, April 7th, 2015
Times: 1:30 PM - 1:45 PM Eastern
12:30 PM - 12:45 PM Central
11:30 AM - 11:45 AM Mountain
10:30 AM - 10:45 AM Pacific
Ku-Band Digital Satellite: AMC-1 @103W
Transponder: 06 SLOT A
Downlink: 11,828.0 (V) Audio: Ch 1 & Ch 2
FEC: 3/4 Symbol Rate: 6.1113
9.000 MHz Bandwith

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American College of Physicians

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