The Joslin Diabetes Center in Boston is “the world’s largest diabetes research center, diabetes clinic, and provider of diabetes education,” according to Wikipedia. It came as no surprise, therefore, when on February 8, 2012 Joslin shot back at comments made by Richard Kahn, Ph.D., former Chief Scientific and Medical Officer of the American Diabetes Association. The comments were made at a briefing for public health advocates and diabetes researchers regarding his February 7, 2012 article, “Confronting the Growing Diabetes Crisis,” in the journal Health Affairs.
Dr. Kahn controversial statement was, “Even though weight loss can prevent or delay the onset of diabetes, the failure of patients to maintain weight loss beyond an average of four years makes diabetes prevention programs ‘a waste of resources,’ The health system should focus instead on reducing the likelihood of complications once patients have been diagnosed with diabetes.” (Emphasis added by me.)
Joslin’s rebuttal was given by Edward S. Horton, MD, Professor of Medicine at Harvard Medical School (with which Joslin is affiliated), and past President of the American Diabetes Association. He said that Joslin had extensive “experience with innovative weight management programs [that showed] that patients can maintain healthy weight levels well past four years.” “There is a legacy,” he added, “for the initial weight loss even if people cannot maintain it. The 10-year follow up of the patients who completed the diabetes prevention program showed that people who initially lost weight continued to develop diabetes at a lower rate over 10 years than those who did not lose weight, even if they gained part of that weight back.”
This internecine battle of former ADA officers demonstrates clearly that overweight and obesity is a big problem, as well as the surest predictor of incipient Type 2 diabetes. Further, it clearly identifies losing weight as the first line of defense against “developing diabetes at a lower rate” and “the likelihood of complications.”
Type 2 diabetes is also associated with a multiple Diseases of Civilization (CVD, CHD, stroke, Alzheimer’s and some cancers). A recent NY Times story reported, “Researchers found diabetes was associated with a higher overall risk for colon, rectal and liver cancers among both men and women. In women, diabetes was most strongly associated with a higher risk of stomach, anal and endometrial cancers. In men, diabetes was most likely to raise risk for pancreatic and bladder cancers. So, there’s wide recognition for the benefits of “developing diabetes at a lower rate” and avoiding “the likelihood of complications.”
The battle also illustrates the difficulty of losing weight and keeping it off. Even Harvard Medical School’s defenders of Joslin’s programs, in remarks posted in Public Health and Policy (issue 612) one day after Dr. Kahn’s controversial statement, appear to disagree. Enrique Caballero, M. D., said, “Not having a full answer on what to do in the long term does not mean that efforts to identify these strategies and translate them to clinical practice model should be abandoned.”
On the other hand, Martin Abrahamson, M. D., Chief Medical Officer at Joslin Diabetes Center and an Associate Professor of Medicine at Harvard Medical School, said, “Since we know which weight management programs will work in the fight against obesity, the challenge is to find ways to implement them in communities, which we at Joslin are working hard to do” (emphasis added in both quotes).
The problem is that Joslin’s “innovative” weight management programs are not innovative. Joslin and Harvard still cling to the Diet-Heart or Lipid Hypothesis promulgated by Ancel Keys in the early 1960’s and later the American Heart Association: Saturated fat and dietary cholesterol are bad for you. Although increasingly recognized as unproven, this hypothesis still dominates in the medical establishment and suffuses public health policy.Until this “corrupt bargain” is broken, our health will continue to decline as rates of obesity, Type 2 diabetes and “the likelihood of complications” all rise. The Low-Carb, High-Fat Way of Eating advocated here is a solution. Be aware, though, that it is an heretical guide to easy weight loss (without hunger), remission of Type 2 diabetes, and avoidance of the dreaded complications. Your doctor will really like the results of all your blood tests too.