If I pay you privately, would I still need to exercise ?

A research paper was recently published that described a detailed comparison, across multiple studies, of varied diet plans including Atkins, South Beach, Zone, and Weight Watchers. These plans tend to be representative of different philosophies in terms of losing weight through diet. In general, some plans focus on reducing the amount of carbohydrates in what people eat. Other plans  simply focus on reducing overall calorie count with a standard mix of all of the key nutrients.

This research paper is an excellent example of a review that collects  its information from multiple other research papers, and combines them into a single set of conclusions. One of the tremendous advantages of the time we live in is the relative simplicity with which we can extract data from multiple papers and do large-scale comparisons.

When I was a medical student looking up references on a particular topic, I would use an encyclopedia called Index Medicus. This is not the name of a famous Roman captain, but instead it was tens of volumes of keywords, followed by references to individual articles. This encyclopedia was critical to all researchers at the time. It truly is hard to imagine life before Google. But I am living proof that it existed. Needless to say, just finding a list of references that might be appropriate and helpful was a long and arduous task. Then came the process of asking [begging?] the librarian to help find the various journals, and order those that were not on the shelves.

By the way, such a task as finding reference material, used to be a key distinguishing point between smaller, lower quality universities versus the top-tier schools. Some university libraries had almost every journal you could imagine on-site. Other libraries only carried the major  titles. In the past, donations that went towards the building and upgrading of libraries were critical for maintaining the quality of student and research done at a university. Today, especially with the often mentioned IBM Watson program, it truly should be possible to extract never before identified  relevant research papers, in seconds.

In relation to the topic of this post, the mega-research paper came to the conclusion that there was no significant difference between the various diets. Weight Watchers did appear to be more successful, but ultimately the difference between the various diets was measured in single digits. In other words, the difference between one diet and another may have been only a few kilograms over the course of one to two years. There was no diet that clearly led the pack, and helped people easily lose tens of kilograms, and maintain  the weight loss.

If you go into the health and lifestyle section of large bookstores, you will see a tremendous number of books all on the topic of losing weight. I had thought once to publish my own book on the topic, which in fact would have been a direct plagiarism of Maimonides. The book would have been concise, which would have made it ecologically friendly as well. As a physician, I feel it my responsibility to share my wisdom here with you, rather than charge $24.95 via Amazon. So here goes: “Eat in moderation, exercise moderately but frequently, see your doctor once a year,  avoid pink vegetables”. I do appreciate that there are not very many pink vegetables. But I have to have something unique in my text, that will really sell the book.

So it seems, that the plethora of books on the topic of diet are, to a great extent, not based on clear  research outcomes. It raises the very real question, what to do for the patient who must lose weight in order to preserve health and prevent severe disease.

Most people at this point have heard about specialized operations that reduce food intake and also interfere with the absorption of nutrients. As such, these surgeries lead the patient to take in less food, and of the food ingested, to absorb less of it. While such an operation sounds almost like a miracle, and for many many people it has been a lifesaver, still it is major surgery and thus has complications and failures. It also begs the question, are we on the edge of a new era where most humans will have to undergo this major surgical procedure in order to avoid obesity.

A great deal of research has been done on the effects of processed foods in our diets, and correlations [but not proofs of causation] between certain foodstuffs and obesity clearly exist. It does seem as if something “happened” to the human population such that diabetes rates in children  [along with obesity] have skyrocketed.

Very recently, there has been tremendous interest in the group of bacteria that normally reside in our bowels. This is often referred to as the “microbiome”, and appears to have a significant effect on our health. Once upon a time, if a medical student had suggested that giving antibiotics would reduce, or nearly eliminate, stomach ulcers, he or she would have been laughed out of medical school. Today, it is the standard of care. My point is that we may very well find that there is a correlation between bacteria in our bodies, how we process nutrients and our overall health. This is actually the foundation of a significant amount of research being done now.

I believe we are all very hopeful that there will soon be the discovery of some simple connection between an element of our physiology and our environment, that is easily modifiable. I would not be surprised if the end result of such findings is a whole set of startups that have technologies for modifying the microbiome and affecting health is various ways. If the same “miracle” happens as with the treatment of ulcers, obesity and other health issues like diabetes and even high blood pressure may soon be a thing of the past. At least, that is what I tell myself when I look in the mirror every day.

Thanks for listening

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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