In today’s Dose:
The Medical profession
(Doctor’s firsthand account of the death of Neda Soltan)
Obesity politics
(Mediterranean diet, Weight-loss surgery and cancer)
The medical profession
- There is an amazing firsthand account of the shooting and death of Neda Soltan, the young Iranian woman who became a focal point for protesters after the video of her death was posted online. It’s by Arash Hejazi, a doctor who happened to be nearby and attempted to assist her when she was shot. He immediately realized that she had been shot in the heart and that there was nothing he could do to save her.
With his photo widely publicized, he feared he would not be able to leave the country, but he has returned to his home in Oxford, England. The article appears in The Times of London and is called “Doctor tells how Neda Soltan was shot dead by Ahmadinejad’s basij.”
Obesity politics
- Research shows that you can lose weight by dieting, but it doesn’t last. You regain the weight and, over time, your weight increases. Dieting is a huge industry, however, so you don’t hear the scientific facts too often. Most people have heard that a pattern of yo-yo dieting — losing and gaining — is unhealthy, but there are so many encouragements to diet that we ignore that information. What gets lost in all the promotion of weight loss is the importance of eating healthy food, not simply losing weight.
So it was nice to see the recent article in the British Medical Journal (BMJ) on the Mediterranean diet. The study was not about losing weight. It followed 23,349 Greek men and women for 8.5 years to see which components of the Mediterranean diet contribute to a longer life.
The following elements contributed the most to reducing the chances of dying (mortality risk reduction):
- Consuming a moderate amount of alcohol
- A low intake of meat
- A high intake of vegetables, fruits, nuts, monounsaturated fats (such as olive oil), and legumes (such as peas, beans, and lentils).
A high intake of cereals, fish, and seafood – and a low intake of dairy products – did not show up as statistically significant in reducing mortality. The article points out that the Greek population in the study typically does not eat much fish. The result for cereals may be due to the variety of foods included under cereals, some of which are wholegrain, while others are refined. Similarly for dairy products, the foods considered were a mixture of low fat and full fat products.
The complete BMJ article is available online without a subscription.
- There were lots of stories yesterday about how weight-loss (bariatric) surgery reduces the risk of cancer in women. The study was published by The Lancet Oncology (subscription required). Here’s a summary of the study results prepared for physicians.
The article itself – like all good scientific reports – points out the study’s limitations. It wasn’t a randomized clinical trial. This leaves open the possibility that there’s something about the socioeconomic characteristics of those who have bariatric surgery that may explain the reduction in cancers. There was no correlation between the amount of weight lost and cancer risk, as you might expect if there was a cause and effect relationship between the two.
What I don’t see mentioned is this: Individuals who have bariatric surgery not only eat less after their operation, but often find themselves eating healthier food. I’m thinking of a chapter in Atul Gawande’s book Complications: A Surgeon’s Notes on an Imperfect Science
Gawande’s report is only anecdotal evidence, of course. I don’t know of any studies that analyze changes in food selection after surgery. But isn’t it just possible that, after surgery, patients eat more healthy food and less junk food? When you can only eat a small amount, you need to maximize your nutrient intake as best you can.
I was a little put off by the last sentence in the article that summarized the study for doctors: “[T]he data are intriguing and well worth discussing with patients who are considering weight-loss surgery.” Yes, and that’s especially true if you’re a surgeon who performs this particular operation.
Anyone considering bariatric surgery might want to take a look at this 2007 study published in The New England Journal of Medicine: Long-Term Mortality after Gastric Bypass Surgery. Patients were followed for 7.1 years after surgery in this retrospective cohort study that included a control group. Deaths from specific causes were greatly reduced: Coronary artery disease by 56%, diabetes by 92%, cancer by 60%. But here’s the kicker. The gastric bypass patients didn’t end up living longer. Their rate of death from accidents and suicide was 58% higher than the control group.
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