Tibolone in Older Postmenopausal Women

n engl j med 359;20 www.nejm.org november 13, 2008 2172 moderately obese subjects in our study was identical to that reported in a recent meta-analysis on long-term pharmacotherapy for obesity.2 In response to Ornish’s letter: the low-carbohydrate diet was based on Atkins’s book, although we encouraged the study participants to consume a variety of protein and fat sources to maintain successful long-term adherence. We specifically reported on retention in detail and noted that adherence was higher in this trial than in any other trial of a similar length that we know of. The setting and methods we used to maximize adherence rates permitted a robust test of the three dietary strategies, as assessed by weight loss and established measurements of lipids, glycemic control, and hepatic and inflammatory biomarkers. As noted by Manzoni and colleagues, we did not assess cost-effectiveness. However, we believe that cost-effective interventions can be implemented in the workplace, with the use of group meetings and by working with food-service providers. Several readers have informed us that our online Supplementary Appendix was incomplete. We have updated the appendix to provide more complete information.