Lifestyle vs. Medication: Which is More Powerful for Maintaining a Healthy Weight?

The increase in obesity and decrease in physical activity in Westernized societies are strongly linked with the increase in prevalence and incidence of type 2 diabetes. People with impaired glucose tolerance have an increased risk of developing type 2 diabetes, and many trials have focused on such individuals. Various treatment methods have been utilized in research, including pharmacological (medications), lifestyle, and herbal remedies.

A meta-analysis published in the British Medical Journal consolidated evidence from 17 clinical trials that studied the effects of lifestyle, drugs, and other methods on men and women with impaired glucose tolerance. Results showed that intervention can reduce the risk of type 2 diabetes in high risk individuals, and lifestyle changes seem to be at least as effective as drug therapy. Compared to individuals who received standard advice only, the effect of lifestyle changes resulted in a 49 percent reduction in the risk of developing diabetes. Exercise alone or exercise combined with a healthier diet was more effective than diet alone. Oral diabetic medications were also effective in delaying or preventing diabetes, but were not as effective as lifestyle changes. Orlistat, an anti-obesity drug, was also effective in reducing risk when compared to control groups.

Although both medications and lifestyle changes were effective in reducing the risk of diabetes, diet and exercise were associated with considerably fewer adverse effects than pharmaceuticals (typically gastrointestinal effects and reduced liver function). Since it is fundamentally a lifestyle issue, the authors had concerns about the practice of treatment with a lifelong course of medication, especially since even minor adverse effects become more significant if a medication is to be taken for life. But they also noted that compliance is generally the key when it comes to lifestyle interventions, so strategies to improve compliance need to be enhanced and put into action.

BMJ 2007;334:299 (10 February)