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In This Issue of JAMA
September 3, 2014


JAMA. 2014;312(9):865-867. doi:10.1001/jama.2013.279697

Bilateral mastectomy is increasingly used to treat women with unilateral breast cancer for reasons that are not clear. In an analysis of 1998-2011 California Cancer Registry data from 189 734 women with incident stage 0-III unilateral breast cancer, Kurian and colleagues found that bilateral mastectomy was not associated with lower mortality than breast-conserving surgery with radiation and that unilateral mastectomy was associated with higher mortality than either breast-conserving surgery with radiation or bilateral mastectomy. Bilateral mastectomy is increasingly used to treat women with unilateral breast cancer for reasons that are not clear. In an Editorial, Newman discusses whether contralateral prophylactic mastectomy is a reasonable option for the treatment of unilateral breast cancer.


Author Video Interview

The vagus nerve plays a key role in satiety and metabolism. In a randomized, double-blind, sham-controlled study involving 239 individuals with morbid obesity, Ikramuddin and colleagues evaluated the efficacy and safety of intermittent, reversible vagal nerve blockade therapy for obesity. The authors report that compared with a sham device, use of vagal nerve blockade did not meet prespecified efficacy end points for percentage excess weight loss but was well tolerated. In an Editorial, Arterburn and Fisher discuss limited efficacy of this obesity treatment and the state of the evidence for bariatric surgery.


In a systematic review and network meta-analysis of data from 48 randomized trials involving 7286 overweight or obese adults, Johnston and colleagues found that weight loss outcomes for popular diets categorized by diet class (macronutrient composition) and diet name or branding were small and clinically unimportant—supporting the practice of recommending any diet to which a patient will adhere. In an Editorial, Van Horn discusses caloric intake and successful long-term weight loss.


Author Audio Interview and Continuing Medical Education

Clinical Review & Education

Few studies of bariatric surgery have reported long-term outcomes, precluding definitive conclusions about effectiveness. In an analysis of data from 29 studies (7971 patients) with a minimum 2 years’ follow-up on at least 80% of participants, Puzziferri and colleagues found that gastric bypass had better outcomes than gastric banding procedures for long-term weight loss, type 2 diabetes control and remission, and control of hypertension and hyperlipidemia.


In a discussion of the case of Ms T—a 40-year-old woman with disordered eating as a teenager and progressive weight gain as an adult—Kushner and Ryan summarize current best practices for assessment and lifestyle management of obesity. These include screening all patients for overweight and obesity, assessing determinants of obesity, and initiating or providing referrals for intensive, multicomponent behavioral interventions to modify food and physical activity behaviors.

JAMA Patient Page

An article in JAMA Surgery reported that factors other than body mass index—age, sex, smoking, and diabetes—are important predictors of mortality among patients eligible for bariatric surgery. In this From the JAMA Network article, Dimick and Birkmeyer discuss the need to rethink current eligibility criteria for bariatric surgery.

This Medical Letter article summarizes clinical trial data leading to FDA approval of a new drug (lorcaserin) and a new combination of 2 previously approved drugs—phentermine and extended-release topiramate as adjuncts to diet and exercise for weight management in patients who are obese or overweight with a weight-related risk factor.