Maintaining Weight Loss in Diabetes Is Key to Keeping Benefits

Individuals with type 2 diabetes who maintain weight loss after an intensive lifestyle intervention have sustained improvements in cardiometabolic risk factors, and those who regain weight not only miss out on the benefits but may have a worsening of their metabolic profile, say US researchers.

In a new analysis of data from the Look AHEAD (Action for Health in Diabetes) trial, Samantha E. Berger, PhD, of Tufts University, Boston, Massachusetts, and colleagues studied almost 1600 individuals who followed an intensive lifestyle intervention.

Particularly among participants who initially lost at least 10% of their body weight, maintaining the weight loss over 4 years led to significant improvements in cholesterol levels, blood glucose, and blood pressure, among other parameters, compared with those who regained weight.

The research, published October 9 in the Journal of the American Heart Association, also suggests that people who regain weight could still experience cardiometabolic benefits, as long as they regain no more than 25% of the original weight loss.

Hence, "maintaining 75% of weight loss was generally beneficial," the researchers conclude.

"These findings emphasize the dual importance of not only achieving a heathy body weight but maintaining a healthy body weight," said senior author Alice H. Lichtenstein, DSc, director of the Cardiovascular Nutrition Laboratory at the Human Nutrition Research Center on Aging at Tufts University, in a press release by the AHA.

And although she acknowledged that keeping off the pounds can be "challenging," she cautioned: "If you lose weight and don't maintain it, the benefits are diminished or disappear."

Physicians Need to Emphasize That Keeping Weight Off Is Imperative

Lichtenstein told Medscape Medical News that, in general, "People understand that they need to lose weight."

However, they "frequently go on extreme diets and are successful in losing the weight, but we don't seem to be putting as much emphasis on how crucial it is to keep the weight off," she asserted.

"It may feel terrific" when people lose weight quickly, but "you don't get the metabolic benefits unless you make sustainable changes to daily food intake or the way you moderate your energy intake."

This means maintaining lifestyle changes "essentially over a lifetime" for individuals to be able to "get back in balance."

Weight loss programs, Lichtenstein added, will therefore "have to put a lot more emphasis on what happens after someone successfully loses weight and not just celebrate that point."

Comparing Maintainers With Regainers

In the new article, researchers say few studies have directly compared individuals with successful weight loss maintenance (maintainers) and individuals who regained weight (regainers).

In addition, the impact of weight regain after weight loss on cardiometabolic risk factors "is not well established."

In part of the Look AHEAD randomized controlled trial, individuals diagnosed with type 2 diabetes who had a body mass index (BMI) of over 25 kg/m2, or 27 kg/m2 if taking insulin, were assigned to an intensive weight loss lifestyle intervention or standard care.

The intervention lasted for 1 year and involved group support sessions, calorie and fat gram restrictions, and meal replacement and physical activity recommendations, with the aim of losing approximately 7% of body weight.

The participants, who were recruited from 16 sites across the United States, then entered a 3-year maintenance phase.

For the current analysis, researchers focused on 1561 individuals from the trial who were assigned to the intervention group, had initially lost at least 3% of body weight, and had follow-up data to the end of year four.

Within these groups, participants were classified based on how much weight they regained after the initial weight loss.

Those who gained none (0%) were termed "maintainers" and the rest were termed "regainers." The degree of weight regained was divided into four increments: 25%, 50%, 75%, and 100% of percentage weight-loss regained (weight change from years 1 to 4 as a percentage of the first year of weight loss).

Change in cardiometabolic risk factors after initial weight loss was compared in maintainers and regainers, after controlling for demographics, medications, and baseline and year 1 change in BMI.

The effect was also assessed separately in participants with < 10% weight loss and ≥ 10% initial weight loss. 

As expected, individuals who lost more weight initially were significantly more likely to have improvements in cardiometabolic risk factors at year one than other participants. And those who initially lost more weight were significantly less likely to have started on diabetes and antihypertensive medications, and were significantly more likely to have stopped them during follow-up.

For Those Who Lose ≥ 10%, Try to Keep Off 75% of Weight Lost

Among those who lost ≥ 10% initial weight, the results across most risk factors indicated maximal risk factor reduction among maintainers who successfully maintained 100% of the lost weight.

Successfully maintaining most (≥ 75%) of the weight loss (25% regain cut-point) was also associated with significant maintenance of improved risk factors.

In contrast, regainers showed significant deterioration in some cardiometabolic risk factors from years one to four.

Meanwhile, "For those who lost < 10% initial weight, keeping it off is better than regaining, but it appears the degree of maintaining the weight loss has little impact on cardiometabolic risk factors," the researchers say.

Overall, the findings emphasize the importance of intervention programs focusing not only on weight loss but weight loss maintenance, "given the adverse consequences of the latter," the authors reiterate.

"The important thing is, once you successfully lose weight, to really put a lot of emphasis on keeping it off," Lichtenstein told Medscape Medical News.

Finally, the researchers also say more work in this area is sorely needed.

"The findings from this study emphasize the need to further investigate long-term impact of partial weight regain after a weight loss intervention given the challenge of keeping off all of weight lost," they write.

The Look AHEAD trial was conducted by the Look AHEAD Research Group and supported by the National Institute of Diabetes and Digestive and Kidney Diseases; National Heart, Lung, and Blood Institute; National Institute of Nursing Research; National Institute of Minority Health and Health Disparities; Office of Research on Women's Health; and Centers for Disease Control and Prevention.

The authors have reported no relevant financial relationships.

J Am Heart Assoc. 2019;8: e010951. Full text

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