At least LBP "cures" don't have side effects

Lots of words in the press about the Michael Moore movie Sicko-unfortunately, the movie only digs up very old news that has been rehashed hundreds of times.  It offers no practical solutions and even suggests that Cuba's health care system is superior to the U.S.  Irrelevant arguments abound including the statistics on life expectancy and infant mortality rates which are not measures of our health system but American lifestyle.  More on Sicko later.  I want to talk about obesity.

I believe obesity is a good analogue of LBP.  The majority of Americans are overweight and the majority of Americans will experience LBP at some point in their life.  Entire fringe industries have been created to cure both.  Books, products, pills, centers, and even endorsers of products are ubiquitous yet data points to both of these maladies show they are occurring in greater numbers.  Drugs have been put on the market and then taken off for serious side effects (e.g. phen phen and Vioxx).  There is great evidence to support certain interventions for both but these treatments are seldom sought.  Everybody wants a quick fix and each condition can lead to the other (obese patients have higher incidence of LBP and LBP can lead to a sedentary lifestyle which can lead to obesity).  I think you get the point.

 

Which leads me to this very interesting article appearing in the Health Journal portion of the WSJ (available for non-subscribers for 7 days) by Tara Parker-Pope.  Apparently the Drug Alli ("ally") is reporting brisk sales.  This is a new non-prescription drug that purports to prevent the body from breaking down and absorbing fat.  The downside of the drug is that the fat has to come out of your body in some ways which can be embarrassing (gas with oily discharge and loose stools).  The drug's web site even says that it is a "smart idea" to wear dark pants and bring a change of clothes to work if you use Alli (perhaps Michael Moore was on Alli during the filming of Sicko).

More to the point, there has been about 100 trials involving 30,000 subjects of this drug whose main ingredient is Orlistat.  After one year Orlistat users lost 19 pounds compared to 13 for a placebo group (no mention as to how many more pairs of clothes they had to purchase or friends lost).  As you might expect, the dieters couldn't keep the weight off during the second year.  Even the consultant to Glaxo concludes "It's not for the average person who wants to take it and doesn't want to change their diet.  It's for someone who is committed to making a change in diet and lifestyle".  If someone is that committed, they certainly don't need Orlistat and there is strong evidence supporting basic lifestyle changes in losing weight.

Add a screening question about Alli on your next LBP patients.  If the answer is yes, watch your step.

 

Larry

Comments

[Gator PT]

Great post. Very relevant to my clinical situation. I work in an outpatient ortho center specializing in spine care. At least 60% of the referrals to our clinic for LBP are obese (some morbidly so). I've always felt as if these patients should be referred to a nutritionist and/or counselor. For many, being overweight and addressing the need for change involves behavior/belief modification. So many of the patients that I see that are overweight and have LBP mention "Yeah, the doctor said I need to lose weight, but said to come to therapy because you will make me feel better". Physicians would benefit from changing their approach from seeing PT as a passive treatment to getting these patients into a multidisciplinary program that addresses nutrition, behavior, exercise, and lifestyle modifications. You would also think that insurance companies would develop a proactive system that "rewards" people for being healthy (regular exercise, etc). It sure would save a lot of money in meds, and the comorbitities of hypertension, cardiac disease, etc. Thanks again for the great post.

[Jason Silvernail]

Larry-

I'm not aware of obesity or of higher BMI being independent risk factors for LBP.
Can you point me towards a reference?
Thanks.

Jason

[Jim Glinn]

Great post Larry! My question is why are the two (LBP and obesity) so similar? Does cervical pain fit into the same category? How about shoulder pain? Are the similaries largely due to some obscure variables? In my mind you can throw the recent increase in depression being diagnosed in the same category with LBP and obesity. Research supports movement as a treatment for all these maladies! Completely agree with Gator PT and the idea that proactive prevention programs sure seem to make sense.
Curious what others think? Great post!