I think Dr. Robert Huizenga is correct that current exercise recommendations aren’t enough. For cardiovascular consequences of exercise, it’s clear that a minimum of 30 minutes a day of aerobic work is required. Most people shortcut the exercise.
But I think we need to ascertain what fraction of the obese population is that motivated and, unfortunately, I suspect it’s not the majority. ... It’s a very intensive program. It requires a lot of mid-level practitioners and allied-level professionals to make this work. To do it well is expensive. It’s not cheaper than prescribing medicines and probably not cheaper than doing a modest bariatric surgical intervention either.
This level of obesity is a lifetime problem. ... We need a better idea about the durability of the effect and about the adverse consequences. He needs long-term follow-up data. In the short run he’s produced major benefits. The question is whether these patients are able to sustain the emotional commitment and the effort involved in doing this long-tem.
Also, since mobility and joint issues are common in obese individuals, does this increased level of exercise put people at risk for further joint disease? I don’t know what happens to the cartilage in their knees and hips. ... Are you setting people up for hip replacements in 10 years? We require long-term follow-up data for everything we do now. This type of intervention should be no different.
Dr. Alan J. Garber, professor in the departments of medicine, biochemistry, and molecular biology and molecular and cellular biology at Baylor College of Medicine, Houston. He is a consultant/advisory board member for Novo Nordisk, Daiichi Sankyo, Merck, Takeda, LipoScience, Boehringer Ingelheim, Sekris, and Lexicon.
