Are medical procedures useless, or worse, even dangerous? A New York Times article explores the question posed in the "Mayo Clinic Proceedings" and it may give you pause the next time you're faced with undergoing a medical procedure.

Healthy Consumer July 26, 2013, 2:30 pm

Medical Procedures May Be Useless, or Worse

By NICHOLAS BAKALAR

 

We usually assume that new medical procedures and drugs are adopted because they are better. But a new analysis has found that many new techniques and medicines are either no more effective than the old ones, or worse. Moreover, many doctors persist in using practices that have been shown to be useless or harmful.

Scientists reviewed each issue of The New England Journal of Medicine from 2001 through 2010 and found 363 studies examining an established clinical practice. In 146 of them, the currently used drug or procedure was found to be either no better, or even worse, than the one previously used. The report appears in the August issue of Mayo Clinic Proceedings.

More than 40 percent of established practices studied were found to be ineffective or harmful, 38 percent beneficial, and the remaining 22 percent unknown. Among the practices found to be ineffective or harmful were the routine use of hormone therapy in postmenopausal women; high-dose chemotherapy and stem cell transplant, a complex and expensive treatment for breast cancer that was found to be no better than conventional chemotherapy; and intensive glucose lowering in Type 2 diabetes patients in intensive care, which not only failed to reduce cardiovascular events but actually increased mortality.

In some instances, doctors routinely refused to give beneficial therapies despite a lack of evidence that they were harmful. Vaccines were unnecessarily withheld from multiple sclerosis patients in the belief that they increased flare-ups; women with lupus were denied oral contraceptives for fear they increased the severity of the disease; and epidural anesthesia was delayed during childbirth on the theory it increased the rate of Caesarean sections. Yet good studies showed that none of these fears was justified.

“Contradicted practices don’t disappear immediately,” said the lead author, Dr. Vinay Prasad.

“There’s an inertia, a 10-year period of time when the contradicted procedure continues to be practiced.”

Dr. William E. Boden, chief of medicine at the Stratton VA Medical Center in Albany, who was not involved in the work, found the study useful and provocative. “It’s challenging us to look at things we’ve done and attempt to find whether there’s evidence to support their use,” he said. “There’s going to be increasing pressure to come forward with making sure that the health care dollars we’re allocating are being well utilized.”

Dr. Prasad, chief fellow in medical oncology at the National Cancer Institute, said that new medical appliances present a special problem. “Devices are particularly bad because they can be approved if they’re similar to ones already on the market,” he said. He cited as an example the Swan-Ganz catheter, a device threaded into the heart to monitor heart function and blood flow. It gives accurate information, Dr. Prasad said, “but that information doesn’t help. We continue to introduce new catheters all the time, lacking good evidence that they work. This is a tremendous waste of resources.”

Often doctors persist with procedures that lack evidence because they seem to make sense, Dr. Prasad said. “They all sound good if you talk about the mechanisms,” he said. “You have cholesterol-clogged arteries, it makes sense that if you open them up it will help. But when that was studied, it didn’t improve survival.”

Patients, too, like to talk about mechanisms, Dr. Prasad added. “They tend to gravitate toward the nuts and bolts — what does it do, how does it work?” he said. “But the real question is: Does it work? What evidence is there that it does what you say it does? What trials show that it actually works? You shouldn’t ask how does it work, but whether it works at all.”

While we enjoy the benefits of modern technology, here's a reminder to keep such enjoyment in perspective: According to a new report published in "Pediatrics", a MedPage staffer writes that over the past two decades, the rate of child injury from falling TVs has increased a whopping 95%! Parents and guardians should take note and consider preventive measures.

Pediatrics

More Kids Hurt by Falling TVs

Published: Jul 22, 2013

By Cole Petrochko, Staff Writer, MedPage Today

Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania

The rate of child injury from falling televisions has increased by 95% over the past 22 years, researchers found.

From 1990 to 2011, the average annual injury rate attributable to televisions in children was 2.43 per 10,000 children younger than 18, according to Gary Smith, MD, of the Research Institute at Nationwide Children's Hospital in Columbus, Ohio, and colleagues.

Among children younger than 5, the number of injuries related to falling televisions increased by 125.5% over the 22 years, equivalent to an overall rate increase of 95.3%, they wrote online in the journal Pediatrics.

Prior research on this topic has shown that pediatric injuries stemming from televisions tipping over have gone up recently, with children ages 4 and younger at highest risk for injury.

The authors studied the epidemiology of television-related injuries though 380,885 reports from the National Electronic Injury Surveillance System from children reporting to an emergency department for such an injury from 1990 to 2011.

The surveillance report included data on age, gender, injury diagnosis, injured body region, products involved, location of the injury, disposition from the emergency department, and circumstances related to the injury.

Based on injury circumstances, injuries were categorized as a television fall, patient striking a television, injury while moving a television, or other. These narratives also included furniture which was used to support the television, such as a dresser, entertainment center, shelf, table, cabinet, wall mount, or other support.

Televisions were also categorized as being 27 inches and larger or 26 inches and smaller.

Injury codes included laceration, contusion, soft tissue injury, fracture, strain, and other -- which included shocks, burns, dislocations, and dental injuries.

Mean patient age was 4.7, and children younger than 5 represented 64.3% of injured patients, while children ages 5 to 10 24.3% and those ages 11 to 17 made up 11.4% of injuries. Most of the children injured were male (60.8%).

Television-based injuries were mostly consistent over the study period.

Television falls were the most common type of injury, accounting for more than half of all injuries (52.5%), followed by striking a television (38.1%).

Falling television injuries increased significantly over the study period, from 0.85 per 10,000 children in 1990 to 1.66 per 10,000 children in 2011 (P<0.001).

Injuries from striking a television decreased significantly over the 22-year period by 71.9% from 1.53 injuries per 10,000 children in 1990 to 0.43 injuries per 10,000 children in 2011.

The rate of injuries associated with a TV falling from a dresser, bureau, chest of drawers, or armoire rose by a significant 344.1% during the study period, the authors noted.

"Despite the relatively low documentation ... of the type of furniture on which falling TVs were placed, the frequency of dressers/ bureaus/chests of drawers/armoires being used to support TVs (almost half of the cases in this study) is alarming," they wrote. "As noted in previous studies, children may pull dresser drawers open to use as stairs to help them reach the TV, potentially pulling both the dresser and TV over onto themselves."

Children were most commonly injured in the head and neck (63.3%), followed by the lower extremities (21.5%). Head and neck injuries were associated with a 36% increased likelihood of hospital admission (95% CI 1.03-1.80) compared with other areas of bodily injury.

Children younger than 5 were 36% more likely to receive a head or neck injury and 22% more likely to be injured by a falling television.

Over two thirds of injuries were lacerations or soft tissue injuries (36.7% and 35.1%, respectively), though few injuries required hospital admission or less-than-24-hour observation (2.6%).

The authors attributed the increased number of television fall injuries to the rising number of televisions in homes, though they cautioned that if that were the only cause of such injuries that injuries from striking a television would have also risen instead of going down.

"The disparity between injury rates associated with falling televisions and striking a television is provocative, especially given the more serious outcomes associated with falling televisions," they wrote, adding that the location of television placement may account for the differences in injury rates, as has the decline of cathode tube televisions for flat screen technologies.

The authors noted that their study was limited by potential underestimates of television-related injuries, absent data on fatalities, inconsistent amounts of details in recorded data, biases in descriptive data, and missing data on types of televisions responsible for injuries.

The study was supported by the Ohio State University College of Medicine.
The authors declared no conflicts of interest.

---

Primary source: Pediatrics
Source reference:
Smith GA, et al "Television-related injuries to children in the United States, 1990-2011" Pediatrics 2013; DOI: 10.1542/peds.2013-1086.

New York Times Magazine: Injections for back pain don't work and physicians are frustrated in trying to provide relief. Hmmm....maybe they should consider chiropractic manipulation, exercise strategies and nutritional approaches.

Alternatives for Back Pain Relief

By GRETCHEN REYNOLDS

 

 

This column appears in the July 21 issue of The New York Times Magazine.

If you have never suffered from lingering low back pain, you’re lucky or, more likely, young. Up to 80 percent of us will experience low back pain at some point. And for most, there won’t be an identifiable cause.

In the past 10 years, the most popular nonsurgical medical treatment for “chronic, nonspecific” low back pain has been injection therapy, or shots into the lower back of various substances — usually cortisone but also liquid ibuprofen, morphine and vitamin B12.

Doctors have been turning to injection therapy at a “disproportionately escalating rate,” according to an overview of back-pain treatments by a team led by Dr. Janna Friedly, a back specialist and an assistant professor of rehabilitation medicine at the University of Washington in Seattle, because it’s relatively easy to administer, less invasive than surgery, can provide some pain relief for a few weeks for some people and is profitable for physicians.

But the benefits do not last, the latest science shows. In a commentary published in May in The Journal of the American Medical Association (JAMA), researchers from the Netherlands point out that there is almost no evidence that the shots ease most people’s pain long term, even after multiple injections.

Other recent studies have concluded that injections also do not significantly reduce the likelihood of back surgery later. And in a particularly sobering study published in February, researchers found, to their surprise, that a small group of subjects with pinched nerves in their backs showed less improvement after injection therapy than a control group during a four-year follow-up period. Based on the available data, the JAMA authors conclude, doctors “should not” recommend injection therapy to their patients with chronic low back pain.

The lack of other options that can be administered in a doctor’s office, however, is frustrating to physicians and their patients, says Dr. Friedly. Doctors “want to be able to do something,” she says. But it may be that in their desire to treat back pain, doctors are compounding the problem and creating a disease state where none may exist. “I think we’ve begun pathologizing pain,” she says.

Since most adults develop an aching back at some point, Dr. Friedly says, it shouldn’t always be viewed as an abnormal condition that requires costly medical care. Having some back pain can be a normal aspect of aging that should be met with acknowledgment, patience and, even more important, a change in lifestyle, particularly exercising more.

According to a study published in March, a simple walking program can help adults strengthen their aching backs as much as a more complicated series of back exercises. A comprehensive review published in May in The Clinical Journal of Pain finds that there is “strong evidence for short-term effectiveness” of yoga against back pain, although whether the benefits last beyond a year is less certain.

Other experiments have found that Pilates, stretching classes, acupuncture and stationary bicycling each provide some people with some pain relief, although in head-to-head studies, no one of those options is superior to the others.

And perhaps all of them work, to some degree, simply by distracting people. In a 2012 Japanese study, when adults suffering from chronic back pain visited an amusement park, their self-reports of pain dropped significantly, only to climb again as soon as the trip ended.

As a new LA Times article claims society is continuing to gain weight despite improved exercise, it becomes clear that poor diets contribute greatly to the dilemma. People need to reduce their intake of simple carbohydrates (sugar, white flour products, alcohol), sugar substitutes, trans-fat, and hormone fed beef and poultry while eating more vegetables and fruits. Most people can lose weight on a low-glycemic diet while exercise burns calories and improves metabolic pathways.

 

We're exercising more but still fighting obesity, study shows

Residents of two-thirds of the nation's counties have become more physically active, but obesity rates have climbed, researchers concluded.

A runner jogs at Salt Creek Beach Park in Dana Point on Tuesday. (Cheryl A. Guerrero / Los Angeles Times / July 9, 2013)

By Noam N. Levey and Anna Gorman

July 10, 2013, 7:57 p.m.

Americans are exercising more, but that has not done much to slim their waistlines, underscoring the immense challenge confronting doctors and health advocates fighting the nation's obesity crisis.

In more than two-thirds of the nation's counties — including some of the unhealthiest — men and women became more physically active over the last decade, according to data published Wednesday in the online journal Population Health Metrics. Three-quarters of California's counties saw gains in physical fitness for both men and women.

Women made much more progress than men in raising the level of physical activity. The percentage of California women who got sufficient weekly exercise increased from 50.7% to 59.2% from 2001 to 2011, while the percentage of physically active men increased from 59.4% to 61.3%.

But these improvements have done little to reduce obesity, researchers at the University of Washington's Institute for Health Metrics and Evaluation concluded.

In California, obesity rates increased in every county between 2001 and 2009. National rates also climbed, although some recent evidence suggests the rates may be leveling off.

"There has been a lot of progress on physical activity," said Christopher Murray, lead author of the research. "But we probably also need to do more. There are still more calories coming in ... than calories going out in physical activity."

Today, more than one-third of U.S. adults and about 17% of children are obese, according to the federal Centers for Disease Control and Prevention.

Many health experts say exercise helps prevent disease but that the only way to lose weight is through dietary changes. People need to reduce their insulin levels by drinking less alcohol and eating less sugar, trans fats and corn-fed beef and chicken, said Robert Lustig, a neuroendocrinologist and clinical professor at UCSF School of Medicine.

"There is not one study anywhere in the world that shows that exercise causes weight loss," he said. Poor diet also reduces the will to exercise, he said. "The biochemistry drives the behavior."
A separate paper by the institute published Wednesday in the Journal of the American Medical Assn. identified poor diet as the No. 1 factor contributing to America's poor health compared to other industrialized nations.

At a White House event Wednesday for community leaders involved in the fight against obesity, First Lady Michelle Obama cited the newly released research, noting it "makes clear that poor nutrition is the single greatest cause of preventable diseases."

"Seems obvious, but we still resist the truth," she said.

Life expectancies in the United States stagnated for women in 1,405 counties and for men in 154 counties between 1985 and 2010, researchers reported. And Americans living in the nation's worst-performing counties, in Appalachia, now live shorter lives than people in Vietnam, Yemen and Sudan.
Despite the grim news, Murray and others believe the uptick in exercise is likely eventually to deliver significant health benefits.

"Exercise has amazing virtues," said Georges C. Benjamin, executive director of the American Public Health Assn. "It helps prevent cardiovascular disease, build muscle tone and reduce bone loss. It improves mental health, and it reduces stress. … All of those are vitally important."

Some of the biggest gains in physical activity over the last decade occurred in America's unhealthiest counties in the Deep South and Appalachia. Overall, six of the 10 counties that improved most for men and seven of the 10 that improved most for women are in Kentucky.

Counties around California also saw significant increases in physical activity, according to the report. The counties that improved the most for women were Stanislaus, Mariposa and Merced, and for men, Stanislaus, Tehama and Lake.

In Los Angeles County, 59.5% of men and 55.5% of women got sufficient exercise in 2011. Researchers defined sufficient physical activity as 150 minutes of moderate activity a week or 75 minutes of vigorous activity.

Researchers did not say what may explain the successes. But George Flores, a physician and program manager at The California Endowment, said he believed increased awareness, neighborhood changes, the first lady's exercise initiative and policy changes all contribute to people exercising more.

Flores said that the messages about the benefits of healthy eating and exercise are getting through to many people and communities. Cities across the state have built parks, added sidewalks and invested in farmers markets and grocery stores. But there is still a "patchwork of progress," he said. "Things have to change so there are fewer barriers to healthy behaviors."

Even with the improvements, huge disparities exist in California and the U.S. in both exercise patterns and obesity. In the least healthy counties nationally, fewer than a third of women and fewer than four in 10 men got sufficient physical exercise, according to the report.

In California, only 45% of women and 46% of men were sufficiently active in Imperial County in 2011, the lowest percentage in the state. On the other end of the spectrum, 74% of women in Marin County and 72% of men got sufficient exercise — the highest in the state.

Merced County had the highest obesity rates for men and women in 2011, and San Francisco County had the lowest.

Did you ever wonder why you seldom see thin people walking around drinking diet soda? Well, here's the sad news - diet sweeteners increase obesity, Type II diabetes, cardiovascular disease and metabolic syndrome.

 

Consumption Of Artificial Sweeteners Associated With Obesity, Type 2 Diabetes, Metabolic Syndrome, Cardiovascular Disease

Article Date: 12 Jul 2013 - 1:00 PDT

More and more Americans are consuming artificial sweeteners as an alternative to sugar, but whether this translates into better health has been heavily debated. An opinion article published by Cell Press in the journal Trends in Endocrinology & Metabolism reviews surprising evidence on the negative impact of artificial sweeteners on health, raising red flags about all sweeteners - even those that don't have any calories. 

 

"It is not uncommon for people to be given messages that artificially-sweetened products are healthy, will help them lose weight or will help prevent weight gain," says author Susan E. Swithers of Purdue University. "The data to support those claims are not very strong, and although it seems like common sense that diet sodas would not be as problematic as regular sodas, common sense is not always right."

Consumption of sugar-sweetened drinks has been linked to obesity, type 2 diabetes, and metabolic syndrome - a group of risk factors that raises the risk for heart disease and stroke. As a result, many Americans have turned to artificial sweeteners, which are hundreds of times sweeter than sugar but contain few, if any, calories. However, studies in humans have shown that consumption of artificially sweetened beverages is also associated with obesity, type 2 diabetes, and metabolic syndrome as well as cardiovascular disease. As few as one of these drinks per day is enough to significantly increase the risk for health problems.

Moreover, people who regularly consume artificial sweeteners show altered activation patterns in the brain's pleasure centers in response to sweet taste, suggesting that these products may not satisfy the desire for sweets. Similarly, studies in mice and rats have shown that consumption of noncaloric sweeteners dampens physiological responses to sweet taste, causing the animals to overindulge in calorie-rich, sweet-tasting food and pack on extra pounds.

Taken together, the findings suggest that artificial sweeteners increase the risk for health problems to an extent similar to that of sugar and may also exacerbate the negative effects of sugar. "These studies suggest that telling people to drink diet sodas could backfire as a public health message," Swithers says. "So the current public health message to limit the intake of sugars needs to be expanded to limit intake of all sweeteners, not just sugars."

With doctor reimbursements declining, patient premiums rising and insurance profits increasing, reform was needed. The Affordable Care Act may or may not fix some problems but not until insurance industry protection from antitrust regulatory violations is addressed will the playing field be leveled. In the meantime, will doctor's disillusionment with the system hurt the care you receive? Will we ever again have quality in our doctor patient relations?

 July 2013

‘A Profession in Decline’ Survey Highlights Physician Disillusionment with Medicine

At a time when physicians are in short supply, more than half the doctors responding to a recent national poll said they intended to cut back on patients, work part-time, switch to concierge medicine or otherwise take steps that may reduce patient access to care over the next three years.

The revelation raises questions about how the health system will accommodate the influx of newly covered patients expected as a result of insurance mandates included in the Patient Protection and Affordable Care Act.

The survey of more than 13,500 physicians -- released in September and conducted by the Physicians Foundation -- paints a bleak picture of current physician attitudes about medicine and skepticism about the impact of healthcare reform.

According to the survey:1

• More than 84% of physicians believe that the medical profession is in decline, with “too much regulation/paperwork” cited as the most important factor behind the decline, followed by “loss of clinical autonomy,” “physicians not compensated for quality” and “erosion of the physician/patient relationship.”
• More than 75% of physicians are somewhat pessimistic or very pessimistic about the future of the medical profession.
• More than one-third of physicians would not choose medicine if they had their careers to do over.
• About 57% would not recommend medicine as a career to their children or other young people.
• Nearly 60% of physicians indicate that the passage of the Patient Protection and Affordable Care Act has made them less positive about the future of healthcare in America.
• About 62% said that Accountable Care Organizations) are either unlikely to increase healthcare quality and decrease costs or that any quality/cost gains will not be worth the effort.
• More than 50% of physicians have limited the access Medicare patients have to their practices or are planning to do so.
• Approximately 26% of physicians have closed their practices to Medicaid.
• Physicians are seeing 16.6% fewer patients than they did in 2008, a decline that could lead to tens of millions fewer patients seen per year, according to the survey.
• Physicians spend about 22% of their time on non-clinical paperwork, resulting in a loss of some 165,000 full-time employees.

Dropping Insurance

The prospect of fewer physicians being available to treat new patients in the post-reform era was underscored in a recent article on NYTimes.com, which described how more and more doctors are no longer accepting health insurance.2 Instead, the physicians have adopted a `cash only’ or a concierge approach. The latter payment system typically involves an annual retainer paid by patients, along with other fees.

According to the article, efforts by insurers aimed at constraining healthcare costs by holding down physician reimbursement, especially for primary care doctors, appears to be accelerating the trend, and some patients report that it is becoming harder to find an in-network doctor.

The article notes that a June report by the Medicare Payment Advisory Commission found that 30% of privately insured individuals who were looking for a new primary care doctor in 2011 reported problems finding one, versus 26% in 2008.

According to the Association of American Medical Colleges, the U.S. will face a shortage of about 100,000 physicians by 2025. The shortfall will be especially critical in the primary care area, according to the New York Times article.

Said one anonymous physician in the comments section of the Physicians Foundation survey:

“Physicians continue to enjoy treating patients. However, we still run a small business and find it increasingly difficult to make ends meet, which decreases our employees’ salaries and benefits and decreases physicians’ willingness to provide indigent care.”

1 “A Survey of America’s Physicians: Practice Patterns and Perspectives,” Survey conducted on behalf of The Physicians Foundation by Merritt Hawkins, September 2012 

http://www.physiciansfoundation.org/uploads/default/Physicians_Foundation_2012_Biennial_Survey.pdf

2 Roni Caryn Rabin, “When Doctors Stop Taking Insurance,” NYTimes.com, Oct. 1, 2012 http://well.blogs.nytimes.com/2012/10/01/when-doctors-stop-taking-insurance/

Many of my patients deal with weight issues due to a diet too high in high-glycemic carbohydrates (pasta, bread, white flour products and processed foods). A new study indicates that consumption of such food may lead to spikes in blood sugar, hypoglycemia, and cravings to eat more food and more often.

How Carbs Can Trigger Food Cravings

By ANAHAD O'CONNOR

 

 

 

Are all calories created equal? A new study suggests that in at least one important way, they may not be.

Sugary foods and drinks, white bread and other processed carbohydrates that are known to cause abrupt spikes and falls in blood sugar appear to stimulate parts of the brain involved in hunger, craving and reward, the new research shows. The findings, published in The American Journal of Clinical Nutrition, suggest that these so-called high-glycemic foods influence the brain in a way that might drive some people to overeat.

For those who are particularly susceptible to these effects, avoiding refined carbohydrates might reduce urges and potentially help control weight, said Dr. David Ludwig, the lead author of the study and the director of the New Balance Foundation Obesity Prevention Center at Boston Children’s Hospital.

“This research suggests that based on their effects on brain metabolism, all calories are not alike,” he said. “Not everybody who eats processed carbohydrates develops uncontrollable food cravings. But for the person who has been struggling with weight in our modern food environment and unable to control their cravings, limiting refined carbohydrate may be a logical first step.”

Regardless of the diet they choose, most people who lose a great deal of weight have a difficult time keeping it off for good. For many people, despite their best efforts, the weight returns within six months to a year. But a few studies of weight loss maintenance, including a large one in The New England Journal of Medicine in 2010, have reported some success with diets that limit high-glycemic foods like bagels, white rice, juice and soda.

In addition to raising blood sugar, foods that are sugary and highly caloric elicit pronounced responses in distinct areas of the brain involved in reward. Earlier imaging studies have shown, for example, that the main reward and pleasure center, the nucleus accumbens, lights up more intensely for a slice of chocolate cake than for blander foods like vegetables, and the activation tends to be greater in the brains of obese people than it is in those who are lean.

But do rich desserts have a select ability to change our longer-term eating habits?

To get a better idea, Dr. Ludwig and his colleagues recruited a dozen obese men and then fed them milkshakes on two different occasions separated by several weeks. In each case, the milkshakes were nearly identical: flavored with milk and vanilla, and containing the same amount of calories, carbohydrates, protein and fat.

But on one occasion, the shakes were made with high-glycemic corn syrup; on the other, a source of low-glycemic carbohydrates was used. “These test meals were identical in appearance and tastiness, and we verified that our subjects had no preference for one or the other,” Dr. Ludwig said.

As expected, blood sugar levels rose more quickly in response to the high-glycemic milkshake. But the researchers were especially interested in what happened several hours later, about the time most people are ready for their next meal.

What they found was that four hours after drinking the high-glycemic shake, blood sugar levels had plummeted into the hypoglycemic range, the subjects reported more hunger, and brain scans showed greater activation in parts of the brain that regulate cravings, reward and addictive behaviors. Although the subject pool was small, every subject showed the same response, and the differences in blood flow to these regions of the brain between the two conditions “was quite substantial,” Dr. Ludwig said.

“Based on the strength and consistency of the response,” he added, “the likelihood that this was due to chance was less than one in a thousand.”

Previous research suggests that when blood sugar levels plummet, people have a tendency to seek out foods that can restore it quickly, and this may set up a cycle of overeating driven by high-glycemic foods, Dr. Ludwig said. “It makes sense that the brain would direct us to foods that would rescue blood sugar,” he said. “That’s a normal protective mechanism.”

Christopher Gardner, a nutrition scientist at Stanford University who was not involved in the new study, said that after decades of research but little success in fighting obesity, “it has been disappointing that the message being communicated to the American public has been boiled down to ‘eat less and exercise more.’”

“An underlying assumption of the ‘eat less’ portion of that message has been ‘a calorie is a calorie,’” he said. But the new research “sheds light on the strong plausibility that it isn’t just the amount of food we are eating, but also the type.”

Dr. Gardner said it was clear that the conventional approach of the past few decades was not working. A more helpful message than “eat less,” he said, may be “eat less refined carbohydrates and more whole foods.”