Wednesday, 27 November 2013

Ethics of Obesity Trials

JAMA Network | JAMA | Effect of Weight Reduction and Cardiometabolic Risk Factor Management on Symptom Burden and Severity in Patients With Atrial Fibrillation: A Randomized Clinical Trial

Good randomised trials in medicine are like good wines - rare and their published account should be savoured slowly and carefully - there are nuggets of useful information that may not feature in the headline statements.

Most published articles unfortunately do not fit into this category - the featured studies are often poorly designed and the not very robust outcomes are headlined in some non scientific publication - like the Sun or Daily Mail!! (UK press). They are the cheap fizzy drink equivalent!
The trial featured in the link at the beginning of this piece belongs to the former group i.e. a good RCT (number of which incidentally ARE for many reasons increasing.)
In the trial, obese patients are studied. Investigators studied the effect of weight reduction on symptoms of atrial fibrillation (AF) - an irregular heart beat which consitutes a risk for stroke. Obesity is a risk factor for the development of atrial fibrillation, as is more potently age. One can immediately see the demographic issues around this - populations are getting older and fatter, and rates of AF are soaring.
A point occurred to me as I slurped the contents of this fine offering - is it ethical to randomise a group of obese patients to a 'general' lifestyle advice or essentially non weight loss measures, as was offered to the control patients in this study? If I was on the ethical committee looking at this trial, i would have questioned it - AF is only one of a myriad of health reasons for the obese to lose wieght!