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lundi 6 janvier 2014


Have you ever heard the term WEIRD? I do not mean it in the deviation from normal, sense of the word but
Western Educated Industrialized Rich Democratic Societies, it is in the first chapter of the book by Jared Diamond: The World Until Yesterday.
He writes, “ yet psychologists base most of their generalizations about human nature on studies of our own narrow and atypical slice of human diversity”. Most of the papers published in psychological journals deal with subjects who are not even typical of the societies they live in, he continues.
So it is always interesting to read Medical Journals in which an “Intensive” treatment regimen is compared to the “usual care”. As it is well known, a large fraction of clinical studies involving drugs or weight loss methods come from the USA. And of course, the lay press and the media would tout the results:
Weight Loss Can be maintained over a Long Period of Time
But if you read the description of the studies, the “Intensive” care is so atypical of the care that is provided and can be afforded by the population of obese people in the United States, where as the usual care is the one most of them can hope to obtain, and in the case of the poor people, have not hope of obtaining. It is good to remember that, in industrialized societies, majority of the poor are overweight or obese.
Experimental: Lifestyle Intervention
Participants in the lifestyle intervention arm are offered individual and group sessions designed to help achieve and maintain weight loss.
Behavioral: Lifestyle Intervention
The lifestyle intervention is implemented
 with individual supervision and group
sessions and is aimed at achieving and
 maintaining at least a 7% decrease in
weight from baseline and 175 minutes
 per week in physical activity.
It is implemented during a four-year
period with the most intensive application
 during the first year, less frequent
 attention during the next three years,
and a minimum of twice yearly contacts
 during an extended follow-up period.
To help participants achieve and
maintain weight loss, a variety of diet
strategies (e.g. prepared meals and
liquid formula), exercise strategies,
and optional weight loss medications
are utilized based on a preset algorithm
and participant progress.
Active Comparator: Diabetes Support and Education
The diabetes support and education arm provides group sessions on diabetes management and social support.
Behavioral: Diabetes Support and
Participants assigned to diabetes
support and education are offered
three sessions each year in diabetes
management and social support.

While we are taught that we must compare oranges to oranges and apples to apples, studies coming out compare oranges to apples and say that oranges are not as sweet as apples or some such.
Studies such as these reinforce the current understanding that societal forces play an important part in the overweight and obesity “crisis” in the industrialized nations, and that we must look at the system rather than the individual for an answer, in addition to the general education of the public as well as availability of reasonably priced, good quality food without much chemical interference!
Social System, write the sociologists,
Sociological idea that society and health are structures that
are well when they are in a homeostatic equilibrium and that change is