JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT, Tuesday, January 4, 2005)
JAMA NEWS RELEASES
STUDY FINDS THAT ADHERENCE TO DIET, NOT TYPE OF DIET, MORE IMPORTANT FACTOR FOR LOSING WEIGHT
MAKING EMERGENCY CONTRACEPTION READILY AVAILABLE DOES NOT INCREASE UNPROTECTED INTERCOURSE
BEING OVERWEIGHT HAS A SIGNIFICANT EFFECT ON A CHILD'S QUALITY OF LIFE
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
ATKINS, ORNISH, WEIGHT WATCHERS AND ZONE DIETS EQUALLY EFFECTIVE IN WEIGHT LOSS AND DECREASING HEART DISEASE RISK FACTORS
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Embargoed for Release: 3 p.m. CT, TUESDAY, January 4, 2005
Media Advisory: To contact Michael L. Dansinger, M.D., call Melissa McPherson at 617-636-3265. To contact editorialist Robert H. Eckel, M.D., call Dana Berry at 303-724-1520.
STUDY FINDS THAT ADHERENCE TO DIET, NOT TYPE OF DIET, MORE IMPORTANT FACTOR FOR LOSING WEIGHT
CHICAGO—A comparison of four popular diet plans finds that the key to losing weight may not be which diet plan a person picks, but sticking with the plan that is chosen, according to a study in the January 5 issue of JAMA. The study also found that popular diets can be effective for modest weight loss and reducing several cardiac risk factors, but overall adherence rates were low.
Popular diets have become increasingly prevalent and controversial, according to background information in the article. Many popular plans depart substantially from mainstream medical advice, and the effectiveness and safety of these diets have been questioned. Data regarding the relative benefits, risks, effectiveness, and sustainability of popular diets have been limited.
In this one year study, Michael L. Dansinger, M.D., of Tufts-New England Medical Center, Boston, and colleagues assessed adherence rates and the effectiveness of four popular diets for weight loss and cardiac risk factor reduction. The diets and their principle weight loss strategies were: Weight Watchers (restriction of portion sizes and calories); Atkins (minimize carbohydrate intake without fat restriction); Zone (modulate macronutrient balance and glycemic load); and Ornish (restrict fat).
This trial included 160 overweight or obese adults aged 22 to 72 years, with known hypertension, dyslipidemia (high cholesterol), or fasting hyperglycemia (high blood sugar). Participants were enrolled starting July 18, 2000, and randomized to the diet groups until January 24, 2002. Forty participants were assigned to each of the diet plans. After 2 months of maximum effort, participants selected their own levels of dietary adherence.
Assuming no change from baseline for participants who discontinued the study, the researchers found that average weight loss at 1 year was 4.6 lbs. for Atkins (21 [53 percent] of 40 participants completed), 7.1 lbs. for Zone (26 [65 percent] of 40 completed), 6.6 lbs. for Weight Watchers (26 [65 percent] of 40 completed), and 7.3 lbs. for Ornish (20 [50 percent] of 40 completed). Greater effects were observed in study completers. Each diet significantly reduced the low-density lipoprotein/high-density lipoprotein (HDL) cholesterol ratio by approximately 10 percent with no significant effects on blood pressure or glucose at 1 year. Amount of weight loss was associated with self-reported dietary adherence level but not with diet type.
For each diet, decreasing levels of total/HDL cholesterol, C-reactive protein, and insulin were significantly associated with weight loss with no significant difference between diets.
"...all 4 diets resulted in modest statistically significant weight loss at 1 year, with no statistically significant differences between diets," the authors write. "In each diet group, approximately 25 percent of the initial participants sustained a 1-year weight loss of more than 5 percent of initial body weight and approximately 10 percent of participants lost more than 10 percent of body weight."
"...we found that a variety of popular diets can reduce weight and several cardiac risk factors under realistic clinical conditions, but only for the minority of individuals who can sustain a high dietary adherence level. Despite a substantial percentage of participants who could sustain meaningful adherence levels, no single diet produced satisfactory adherence rates and the progressively decreasing mean adherence scores were practically identical among the 4 diets. The higher discontinuation rates for the Atkins and Ornish diet groups suggest many individuals found these diets to be too extreme. To optimally manage a national epidemic of excess body weight and associated cardiac risk factors, practical techniques to increase dietary adherence rates are urgently needed," the authors write.
"One way to improve dietary adherence rates in clinical practice may be to use a broad spectrum of diet options, to better match individual patient food preferences, lifestyles, and cardiovascular risk profiles. Participants in our study were not allowed to choose their dietary assignment; however we suspect adherence rates and clinical improvements would have been better if participants had been able to freely select from the 4 diet options. Our findings challenge the concept that 1 type of diet is best for everybody and that alternative diets can be disregarded. Likewise, our findings do not support the notion that very low carbohydrate diets are better than standard diets, despite recent evidence to the contrary," the researchers write.
(JAMA. 2005;293:43-53. Available post-embargo at jama.com)
Editor's Note: This study was supported by grants from the General Clinical Research Center via the National Center for Research Resources of the National Institutes of Health (NIH); by a grant from the NIH; a contract from the U.S. Department of Agriculture; and a contract from the Human Metabolic and Genetics Core Laboratory of the Boston Obesity Nutrition Research Center program. Dr. Dansinger was supported by a grant from the Agency for Healthcare Research and Quality.
EDITORIAL: THE DIETARY APPROACH TO OBESITY—IS IT THE DIET OR THE DISORDER?
In an accompanying editorial, Robert H. Eckel, M.D., of the University of Colorado at Denver and Health Sciences Center, Aurora, Colo., discusses the findings by Dansinger and colleagues that no one diet plan was found most effective for weight loss.
"It seems plausible that for maintenance of reduced body mass, the right diet needs to be matched with the right patient. Ultimately, a 'nutrigenomic' approach most likely will be helpful. At present, there are no data to help clinicians practicably match a diet to an individual patient's 'diet response genotype.' Even beyond this consideration, and arguably more important, once weight loss of more than several kilograms from baseline weight occurs, a substantial step-up in the amount of physical activity and conscientious monitoring as part of a more comprehensive behavior modification appear particularly important, and likely are much more relevant adaptations than the macronutrient composition of the diet."
"Arguably, the best treatment of obesity is prevention by careful dietary monitoring and lifestyle and choices, along with regular physical activity. Once overweight or obesity develops, however, the best existing evidence points toward heeding the recently released joint lifestyle recommendations of 3 professional organizations: the American Cancer Society, the American Diabetes Association, and the American Heart Association, in which the recommended macronutrient mix is built on evidence that higher intake of fruits and vegetables, whole grains, and fish are associated with reduced incidences of diabetes mellitus, cancer, heart disease, and stroke. Although this dietary approach may lead to only modest weight changes, similar to the popular diets evaluated by Dansinger et al, physicians and other health care professions should teach obese patients that both quality and quantity of the diet are important, and that sustained weight loss may well be possible with the addition of physical activity and behavioral change strategies to a modest but persistent caloric restriction-the 'Low Fad' approach," Dr. Eckel concludes.
(JAMA. 2005;293:96-97. Available post-embargo at jama.com)
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org (please note new email address).
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Embargoed for Release: 3 p.m. CT, TUESDAY, January 4, 2005
Media Advisory: To contact Tina R. Raine, M.D., M.P.H., call the UCSF Press Office at 415-476-2557. To contact editorialist Iris F. Litt, M.D., e-mail: iris.litt{at}stanford.edu.
MAKING EMERGENCY CONTRACEPTION READILY AVAILABLE DOES NOT INCREASE UNPROTECTED INTERCOURSE
CHICAGO—Making it easier to obtain emergency contraception would not increase unprotected intercourse, lead to abandonment of regular contraception, or increase the risk of sexually transmitted infections (STIs), according to a study in the January 5 issue of JAMA.
It is estimated that half of the 3.5 million unintended pregnancies that occur each year in the United States could be averted if emergency contraception (EC) were easily accessible and used, according to background information in the article. In efforts to increase access to EC, six states (Alaska, California, Hawaii, Maine, New Mexico, and Washington) have implemented pharmacy access legislation whereby women can obtain EC directly from pharmacists without having to see a clinician or obtain a prescription first. An important element in policy debates over making EC more widely available is the concern that it will lead to increased risk-taking, that women would have more unprotected intercourse, increase their risk for STIs, and abandon more effective forms of regular contraception.
Tina R. Raine, M.D., M.P.H., of the University of California, San Francisco, and colleagues conducted a randomized controlled trial to evaluate the effect on pregnancy and STIs of access to EC through pharmacies on receiving the medication in advance. The trial included 2,117 women, ages 15 to 24 years, attending 4 California clinics providing family planning services, who were not desiring pregnancy, using long-term hormonal contraception, or requesting EC. The participants were assigned to one of the following groups: (1) pharmacy access to EC; (2) advance provision of 3 packs of levonorgestrel EC; or (3) clinic access (control).
The researchers found that women in the pharmacy access group were no more likely to use EC (24.2 percent) than controls (21.0 percent). Women in the advance provision group (37.4 percent) were almost twice as likely to use EC than controls (21.0 percent) even though their reported frequency of unprotected intercourse was similar (39.8 percent vs. 41.0 percent, respectively). Only half (46.7 percent) of study participants who had unprotected intercourse used EC over the study period. Eight percent of participants became pregnant and 12 percent acquired an STI; compared with controls, women in the pharmacy access and advance provision groups did not experience a significant reduction in pregnancy rate or increase in STIs. There were no differences in patterns of contraceptive or condom use or sexual behaviors by study group.
"...in our study population, direct pharmacy access did not appear to be any more useful than access through clinics. While study participants had a choice of 13 pharmacies, they could have been reluctant to go to a pharmacy or experienced difficulty getting to a pharmacy or finding a pharmacist on duty who was trained to dispense EC. The requirement to go through pharmacists or clinics to obtain EC appears to be a barrier that limits use. Even though rates of unprotected intercourse were similar across study groups, women in the advance provision group were still almost twice as likely to use EC than women in the clinic access group. Furthermore, contrary to concerns that increased access to EC will entice women to use EC repeatedly, only a small fraction of women in the pharmacy access and advance provision groups used EC more than once over the 6-month period, even though EC was supplied at no cost," the authors write.
"These data support the previous scientific literature that indicates that among young sexually active women, unprotected intercourse leads to EC use, not the converse," they add.
"...our study has important public health implications. While removing the requirement to go through pharmacists or clinics to obtain EC increases use, the public health impact may be negligible because of high rates of unprotected intercourse and relative underutilization of the method. Given that there is clear evidence that neither pharmacy access nor advance provision compromises contraceptive or sexual behavior, it seems unreasonable to restrict access to EC through clinics," the researchers conclude.
(JAMA. 2005;293:54-62. Available post-embargo at jama.com)
Editor's Note: The research was supported by grants from the Compton Foundation, Inc., the Open Society Institute, the Walter Alexander Gerbode Foundation, and the William and Flora Hewlett Foundation. The Women's Capital Corporation, distributor of Plan B, donated the emergency contraception for use in the trial.
EDITORIAL: PLACING EMERGENCY CONTRACEPTION IN THE HANDS OF WOMEN
In an accompanying editorial, Iris F. Litt, M.D., of the Stanford University School of Medicine, Palo Alto, Calif., writes that the report by Raine et al makes an important contribution to current knowledge of EC use and should help dispel concerns that easier access to EC increases the risk of STIs or leads to abandonment of regular contraception.
"The finding that women who were provided EC at a clinic visit prior to the time of need were almost twice as likely to use EC than women in the clinic access control group is critically important, even though a reduction in pregnancy was not demonstrated. Several explanations for this finding, which could not be assessed within the context of the study, include timing of unprotected intercourse in relationship to ovulation, as well as the timing and accuracy of use of EC. The fact remains that women are more likely to use EC if it is readily available. It is similarly significant that no apparent downside of EC was demonstrated in the study. There was no evidence of a decrement in use of other methods of contraception such as oral contraceptives or condoms. Equally important, to counter the frequent argument that provision of EC will increase high-risk behavior, this study demonstrated no increase in STIs or reports of unprotected intercourse."
"The task remains to improve access to EC by expanding the number and types of facilities where it can be obtained. Education about EC for both physicians and the public should be improved, especially now that other agents (including RU-486 [mifepristone]) have been shown to be effective in preventing unwanted pregnancy after an episode of unprotected intercourse. Importantly, physicians may wish to reconsider their position on EC in relation to other contraceptive methods; as this study suggests, regular contraception and EC are not in conflict. Sexually active women who do not desire to become pregnant should be counseled about regular methods of birth control, but they can be assured that EC is available if they are concerned their regular method may not have protected them from the possibility of an unwanted pregnancy," Dr. Litt concludes.
(JAMA. 2005;293:98-99. Available post-embargo at jama.com)
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org (please note new email address).
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Embargoed for Release: 3 p.m. CT, TUESDAY, January 4, 2005
Media Advisory: To contact Joanne Williams, Ph.D., e-mail: jo.williams{at}mcri.edu.au.
BEING OVERWEIGHT HAS A SIGNIFICANT EFFECT ON A CHILD'S QUALITY OF LIFE
CHICAGO—New research indicates that the more a child is overweight, the poorer quality of life that child will experience, though not to the degree reported in a previous study, according to an article in the January 5 issue of JAMA.
The negative effects of childhood overweight and obesity on quality of life (QOL) have been shown in clinical samples, but not yet in population-based community samples. Health-related QOL, as defined by the World Health Organization, includes an individual's physical, mental, and social well-being.
Joanne Williams, Ph.D., of the Royal Children's Hospital and Murdoch Children's Research Institute, Melbourne, Australia, and colleagues, examined the hypothesis that QOL scores would decrease with increasing weight. The research included data collected in 2000 from the Health of Young Victorians Study, which was commenced in 1997. Individuals were recruited via a random 2-stage sampling design from primary schools in Victoria, Australia. Of the 1,943 children in the original group, 1,569 (80.8 percent) were resurveyed 3 years later at an average age of 10.4 years.
The researchers measured health-related QOL using the PedsQL 4.0, a short survey which assesses physical, emotional, social, and school functioning in a child. The survey was completed by a parent and by child self-report. Summary scores for children's total, physical, and psychosocial health and subscale scores for emotional, social, and school functioning were compared by weight category based on International Obesity Task Force cut points.
Of 1,456 participants, 1,099 (75.5 percent) children were classified as not overweight; 294 (20.2 percent) overweight; and 63 (4.3 percent) obese. The researchers found that the parent and child self-reported PedsQL scores decreased with increasing child weight. At the subscale level, child and parent reported scores were similar, showing decreases in physical and social functioning for obese children compared with children who were not overweight. Decreases in emotional and school functioning scores by weight category were not significant.
"Our results indicate that health-related QOL, or functioning, begins to decline as soon as a child is above average weight, with a gradual steepening as Body Mass Index (BMI) increases," the authors write. "The decrease was small for overweight children but more marked for those who were obese. These new observations are less dramatic than the much lower scores reported for children attending tertiary clinics, but are consistent with those observed for adults."
"These findings have both positive and negative implications. As for any chronic condition, a relatively small effect of overweight on children's functioning across multiple domains is welcome. However, if neither children nor parents perceive a health effect, it seems unlikely that they will seek health care or initiate behavioral change that might lead to a healthier BMI, and consequently lessen the long-term health risk for the current generation of children. Our findings may explain why so few parents of overweight children express concern about their child's weight, yet with a quarter of all children now overweight or obese, even a minor reduction in health-related QOL at an individual level is still likely to have a major effect at a population level," the authors conclude.
(JAMA. 2005;293:70-76. Available post-embargo at jama.com)
Editor's Note: This study was supported by grants from the National Heart Foundation, Financial Markets for Children, and Murdoch Childrens Research Institute. Co-author Dr. Wake is supported by a National Health and Medical Research Council (NHMRC) Career Development Award; co-author Ms. Hesketh by an NHMRC Public Health Postgraduate Scholarship; co-author Dr. Maher by an NHMRC project grant to develop a measure of quality of life for children with cerebral palsy; and co-author Dr. Waters by a Victorian Health Promotion Foundation Public Health Research Fellowship.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org
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JAMA REPORTS
ATKINS, ORNISH, WEIGHT WATCHERS AND ZONE DIETS EQUALLY EFFECTIVE IN
WEIGHT LOSS AND DECREASING HEART DISEASE RISK FACTORS
VIDEO:
NAT SOT UP FULL FOR: 04
Four dieters at table eating lunch
AUDIO:
"I had to count my calories."
VIDEO:
B-ROLL
Dieters
Typical Atkins food, Ornish food, Weight Watchers food, Zone food
AUDIO:
EACH OF THESE PEOPLE TRIED A DIFFERENT DIET - ATKINS, ORNISH, WEIGHT
WATCHERS OR ZONE - AS PART OF A STUDY ON WHICH POPULAR DIET IS MOST
EFFECTIVE AT WEIGHT LOSS, AND DECREASING THE RISK OF HEART DISEASE.
VIDEO:
SOT/FULL
@: 16
Super: Deborah Naiman
Dieter
Runs :06
AUDIO:
"I lost 30 pounds and both my blood pressure and high cholesterol
decreased."
VIDEO:
B-ROLL
Deborah eating
Other dieters eating
VIDEO:
GFX/JAMA COVER
AUDIO:
WHICH DIET WAS SHE ON? ATKINS, BUT ACCORDING TO THE STUDY, ALL OF THE DIETS WERE EQUALLLY EFFECTIVE AT WEIGHT LOSS AND HEART DISEASE
PREVENTION. THE STUDY FINDINGS APPEAR IN JAMA, THE JOURNAL OF THE
AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
@: 34
Super: Michael Dansinger, M.D.
Tufts-New England Medical Center
Runs :12
AUDIO:
"We found that all 4 diets worked well for weight loss, heart disease
risk factor reduction, but only in the people who could follow their
diet closely for a year. Only about 25 percent of the participants were able to follow their diet closely."
VIDEO:
B-ROLL
Dr. Dansinger with colleague at computer
AUDIO:
DR. MICHAEL DANSINGER (DANCE-in-ger) AND COLLEAGUES AT TUFTS-NEW ENGLAND MEDICAL CENTER CONDUCTED THE STUDY.
VIDEO:
SOT/FULL
Michael Dansinger, M.D.
Tufts-New England Medical Center
Runs :12
AUDIO:
"We randomly assigned 160 men and women with a heart disease risk
factor, either high blood pressure, high cholesterol, or high blood
sugar, to follow one of the study diets for a year."
VIDEO:
B-ROLL
Dieters eating
AUDIO:
THE STUDY PARTICIPANTS HAD TO STICK CLOSELY TO THE DIET AND ATTEND DIET CLASSES FOR THE FIRST TWO MONTHS. THEN THEY WERE ON THEIR OWN.
VIDEO:
SOT/FULL
Michael Dansinger, M.D.
Tufts-New England Medical Center
Runs :15
AUDIO:
"I was surprised that so many people had so much difficulty sticking to the diets after the classes ended. Many people lost weight, say 20 pounds or more, and they wanted to stick to their plan, but gradually over time found it more and more difficult."
VIDEO:
B-ROLL
Dieters eating
Lady eating Ornish food
Dieters eating
AUDIO:
THE AVERAGE WEIGHT LOSS FOR ALL THE DIETS OVER THE YEAR WAS TEN POUNDS. THE ATKINS AND ORNISH DIETS HAD THE HIGHEST DROP-OUT RATES IN THE STUDY. BUT ATKINS WAS BEST AT INCREASING GOOD CHOLESTEROL, AND ORNISH WAS BEST AT REDUCING BAD CHOLESTEROL. DR. DANSINGER SAYS ASK YOUR DOCTOR TO HELP YOU FIND THE DIET THAT'S BEST FOR YOU.
VIDEO:
SOT/FULL
Michael Dansinger, M.D.
Tufts-New England Medical Center
Runs :08
AUDIO:
"It might be like dating the diets. You have to kiss a few frogs before you find your prince, before you find your long-term, the one."
VIDEO:
B-ROLL
Dieters eating
AUDIO:
BECAUSE NO DIET CAN WORK IF YOU DON'T STICK TO IT. THIS IS MAVIS PRALL REPORTING.
