Dr Parr Says…

May is Exercise is Medicine month, so the topic for my Health & Fitness column in the Aiken Standard this week is information about the Exercise is Medicine initiative. A growing body of research suggests that the single best prescription any physician can give is for daily physical activity. But many (or most) physicians either do not make this recommendation or, if they do, do not provide the information or resources that patients need to embark on a program of regular activity. I will probably write about why this is the case — it’s not always the fault of the physician — and what can be done about it in a future column.

You can learn more about the Exercise is Medicine initiative here.

I spend much of my time talking about the benefits of a healthy diet and regular exercise to anyone who will listen–and to some people who won’t. I usually include something about the fact that, for many conditions, lifestyle change is at least as effective as medical management, certainly for preventing diseases like diabetes, hypertension, and dyslipidemia. So it was with some reluctance that I jumped on the bandwagon with a growing number of surgeons who believe that bariatric (weight loss) surgery is an effective treatment for diabetes.  This was the topic of my Health & Fitness column in today’s Aiken Standard.

Let me be clear: This doesn’t mean that diet and exercise don’t work. In fact, successful long-term weight loss requires dietary modification and daily exercise, regardless of how the weight was lost. Ideally, diet and exercise would be the method that everyone uses to lose weight–it works, but only if people a faithful to the treatment. Unfortunately, most people are not, leading to the belief that diet and exercise don’t work. And for some who are extremely obese, it is unlikely that diet and exercise could produce results sufficient enough and quickly enough to treat serious health problems (including diabetes) that are likely in progress. For this reason, many turn to weight loss surgery for a quick fix.

For years I was skeptical, but a growing body of literature, including two recent studies in the New England Journal of Medicine, suggest that obesity surgery can “cure”diabetes. [you can read these studies here and here] The results of these studies show short term benefits, so it is unknown whether this is a permanent cure or not.

Either way, diet and exercise are necessary to maintain the weight loss in the long run as well as treating other health conditions. And a healthy diet, regular exercise, and maintaining a healthy body weight are  still the only ways to prevent diabetes. The bottom line is that the true benefits of weight loss surgery cannot be realized without lifestyle change. And if you adopted a healthy lifestyle from the beginning, you wouldn’t need to even consider obesity surgery.

If you are the podcast type, there is an excellent description of these recent studies as well as a discussion of the risks and benefits of obesity surgery from NPR’s Talk of the Nation.