Reply to Bray

Individuals that will benefit include older patients (age >80 years), those ineligible to receive tissue plasminogen activator (tPA).

Weighing up dietary patterns
The Seminar by George Bray and colleagues (May 7, p 1947) summarises current guidelines and findings concerning weight loss—an important clinical issue. However, we believe their recommendations are based on fl awed interpretations of the evidence they refer to. Recommendation of weight loss by lifestyle changes, diet, and physical activity seems plausible and is the main approach. However, randomised controlled trials suggest that although weight loss is possible in the short term, it is not sustainable in the long term. Bray and colleagues referred to the look AHEAD study, which reported a weight loss of 4·7% compared with the control group after 8 years, and the Diabetes Prevention Program Outcomes Study, which did not find a statistically significant weight loss compared with the control group after 10 years. Another randomised controlled trial of dietary interventions showed a statistically significant 3·4% weight loss after 6 years for individuals only in the Mediterranean diet group.

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