BMJ: Reducing overweight and obesity; so how are we doing?

"I really enjoyed this editorial by the esteemed Dr @lowcarbGP about the state of nutrition research and what every clinician can do to help.

My commentary and elaboration follow:

Dr Unwin reflects on his career, transparently disclosing that – like many clinicians – he used to hand out boiler-plate advice that wasn’t helping his patients: “This included ‘eat less, move more’, ‘everything in moderation’ and advice around calorie counting... It was rarely effective. For 26 years I blamed my patients for their poor results.. It never once occurred to me that my poor advice was the common denominator.”

He goes on to question the manner in which we (the biomedical community) treat nutrition research, placing emphasis on a ‘hierarchy of evidence’ heuristic that has limitations.

While randomized controlled trials (RCTs) have great ‘internal validity’ (where complicating variables are better controlled), they can often be limited in their translatability to real-world outcomes and generalizability, i.e. external validity. (...)"

https://nutrition.bmj.com/content/6/1/46

"Insights from a general practice service evaluation supporting a lower carbohydrate diet in patients with type 2 diabetes mellitus and prediabetes: a secondary analysis of routine clinic data including HbA1c, weight and prescribing over 6 years"

https://nutrition.bmj.com/content/3/2/285

"What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss"