In the years after an intensive lifestyle intervention for type 2 diabetes (T2D), maintaining weight loss may be important to sustain benefits for cardiometabolic health, according to study results published in the Journal of the American Heart Association.
The aim of this study was to assess the difference in cardiometabolic risk factors in individuals with T2D who either maintained weight loss or regained weight after a 1-year intensive lifestyle intervention as part of the Look AHEAD trial (Action for Health in Diabetes; ClinicalTrials.gov Identifier: NCT00017953). The study included patients with T2D who had a body mass index >27 kg/m² if taking insulin or >25 kg/m² if not taking insulin.
Data were used from patients in the intensive lifestyle intervention group who lost ≥3% of initial body weight. Patients were grouped into cut point increments of 0%, 25%, 50%, 75%, and 100% of weight regained. Maintainers were defined as having a ≤0% weight regain, while regainers were defined as having a weight regain >0%.
Of the 1561 patients included in this study, 797 lost <10% of initial weight and 764 lost ≥10% of initial weight. At the completion the lifestyle intervention, cardiometabolic risk factors were significantly more favorable for patients who lost ≥10% of initial weight vs those who lost less initial weight.
Among some initial weight loss and sex subgroups, the researchers found a consistent inverse pattern between increased cut point of percentage of weight loss regained and decreased difference in cardiometabolic risk factors in maintainers vs regainers.
Overall, for maintainers, there were improvements or no significant changes in cardiometabolic risk factors 3 years after initial weight loss. For regainers, a larger percentage of weight loss regained was positively associated with certain risk factors, though this relationship varied according to sex: fasting plasma glucose levels and glycated hemoglobin had similar responses in men and women who regained weight, but lipid profile and systolic blood pressure responded differently between the sexes. High-density lipoprotein cholesterol concentration, triglyceride concentration, and diastolic blood pressure were not affected by weight regain.
For most risk factors, successful maintenance of weight loss (0% regain) maximally reduced risk factor reduction in individuals who lost ≥10% of initial weight. The researchers did not identify a specific weight regain cut point that maximized risk difference between maintainers and regainers across all sex or initial weight loss subgroups.
Limitations of this study included the inability to correlate cardiometabolic risk factors with long-term disease outcomes or to assess fat distribution.
“[M]aintaining all the weight lost was the most beneﬁcial across all risk factors, but maintaining 75% of the weight loss was also beneﬁcial,” concluded the researchers. “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.”
Berger SE, Huggins GS, McCaffery JM, Jacques PF, Lichtenstein AH. 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: the Look AHEAD Trial. J Am Heart Assoc. 2019;8:e010951.