Sustained Weight Loss and Disease Prevention
Date: December 15, 2009
Ask Frederick Brancati to sum up his groups’ latest research on obesity, and first, he takes a deep breath.
On the one hand there’s a swath of findings emerging from their work as members of the Welch Center for Prevention, Epidemiology and Clinical Research—a 20-year-old collaboration between Johns Hopkins’ schools of medicine and public health that’s been taking sharp aim at diseases and conditions that impose a substantial burden on the health and resources of the public.
On the other hand are studies driven by their perspective as physicians. Brancati is the chief of general internal medicine, and his collaborators are all like-minded clinicians looking to nail evidence-based ways individual patients can achieve and sustain weight loss.
At the macro level, Brancati and colleagues have been doing systematic reviews and meta-analyses focused on relationships between excess body weight and cancer. Among their most salient findings: Obese patients with diabetes who develop cancer are 40 percent more likely to die than those with cancer not preceded by obesity and diabetes, and obese women are less likely to get mammograms and Pap smears, explaining at least in part why they are more likely to die of breast or cervical cancer.
And fellow internist and Welch Center collaborator Jeanne Clark, says Brancati, “has been leading the charge to describe the epidemiology of fatty liver disease, which leads to diabetes, which leads to hepatocellular carcinoma.”
Yet the goal of Welch Center researchers isn’t to produce statistics, but to translate epidemiologic discoveries into clinical practice. To that end, Brancati, Clark and others are scrutinizing the effectiveness of lifestyle modifications. For example, they’re leading the Hopkins arm of Look AHEAD (Action for Health in Diabetes), a long-range study comparing an intensive weight loss program with diabetes support and education only. In another study called POWER, they’re looking at face-to-face intervention for weight loss versus support via telephone and a Web-based portal. They’re hoping the calls and Web will prove helpful because they could be done on a large scale.
“There’s a lot of serious interest in obesity here,” says Brancati, “We’re working with colleagues in gastroenterology, pathophysiology, behavioral medicine and public health to stem the tide.”