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Keep off lost weight for continued cardiometabolic benefit

All benefits of losing weight diminished or disappeared in people with type 2 diabetes who regained the weight

Louise Prime

Thursday, 10 October 2019

Intervention programmes in type 2 diabetes should focus on weight loss maintenance as well as initial weight loss, US researchers have recommended. They found in their study*, published in the Journal of the American Heart Association, that people who regained the weight they’d lost had a deterioration of cardiometabolic risk factors, whereas maintainers had stabilisation or further improvement.

The research team analysed data for 1,561 participants in the Look AHEAD (Action for Health in Diabetes) trial with ≥3% initial weight loss during a one‐year intensive lifestyle intervention, and with year four follow‐up data. They categorised people according to whether they regained (regainers) or maintained (maintainers) weight loss defined by five cut points (0%, 25%, 50%, 75%, and 100%) of percentage weight loss regained (weight change from years 1–4 as percentage of first year weight loss). They then compared change in cardiometabolic risk factors after initial weight loss in maintainers and regainers, after controlling for demographics, medications, and baseline and year one change in body mass index – which they also assessed separately in those with <10% and ≥10% initial weight loss, and women and men.

They reported that people who initially lost at least 10% of their body weight and then maintained at least 75% or more of that weight loss four years later saw a significant improvement in all cardiometabolic risk factors assessed, including HDL cholesterol, triglyceride, fasting glucose and glycated haemoglobin concentrations, blood pressure, and waist circumference.

However, those benefits diminished or disappeared among those who regained weight. The study authors commented: “Our findings suggest that in addition to focusing on weight loss, an increased emphasis should be placed on the importance of maintaining the weight loss over the long-term. The bottom line is that maintaining the majority of the weight loss is essential to reducing cardiovascular risk.”

They concluded: “What we need to focus on now is how we can support not only healthy approaches to losing weight but healthy approaches to helping those who are successful in losing weight maintain the weight loss. The latter may be the most challenging.”

*Berger SE, Huggins GS, McCaffery JM, et al. Change in cardiometabolic risk factors associated with magnitude of weight regain 3 years after a 1-year intensive lifestyle intervention in type 2 diabetes mellitus: Look AHEAD Trial. Journal of the American Heart Association, 2019. DOI: 10.1161/JAHA.118.010951

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