5-Year Follow-up After Lifestyle Intervention Examines Cardiovascular Effects of Keeping Weight Off

Losing weight boosts health in many ways, bringing improvements in cardiovascular (CV) risk factors. Unfortunately, not everyone who loses weight keeps it off. What’s been unclear until now, however, is whether those initial benefits of weight loss linger even if some is regained.

A 5-year study led by Osama Hamdy, MD, PhD, director of the Obesity Clincial Program at Joslin Diabetes Center, sought answers for those questions, as well as a more basic one: can an intense intervention in a clinical setting keep the weight off for the long haul?

Researchers found that it can, but patients’ chances improve if they manage to lose at least 7% of their body weight in the first year. The study also found that gains in glycated hemoglobin (A1C) and triglycerides made with weight loss are the first to erode if weight is regained, while other improvements in lipid levels are sustained.

Hamdy presented the findings Saturday at the 75^th Scientific Sessions of the American Diabetes Association in Boston. The study, “The Long-term Effects of Intensive Lifestyle Intervention on Cardiovascular Risk in Patients with Diabetes in a Real-World Clinical Setting: a 5-Year Longitudinal Study,” is the winner of this year’s Michaela Modan Memorial Award.

“When it comes to weight loss, we know that some people maintain it for a longer duration and some people regain that weight back,” Hamdy said. “It is unclear to us what the impact of sustained weight loss versus weight regain is on cardiovascular risk factors.”

The findings come from the work at Joslin’s “Why WAIT” initiative, which stands for Weight Achievement and Intensive Treatment, a 12-week program for persons with type 1 or type 2 diabetes mellitus. ‘Why WAIT” features a structured diet with meal replacements, adjustments to diabetes medications to promote weight loss, education sessions, and an exercise program.

On Saturday, Hamdy emphasized the importance of the exercise program, which increases from 20 to 30 minutes up to 4 times per week to 45 to 60 minutes per day 6 times per week. Strength training is a key element, as Hamdy said patients who stuck with this component had greater success in keeping weight off.

Researchers at Joslin selected 129 patients with diabetes and obesity who had been enrolled in “Why WAIT” for 1 year and divided them into 2 groups, based on their weight loss: Group A, which included 47.3% of the participants, had filed to maintain weight loss of 7%, and Group B (52.7%) had maintained 7% weight loss.

All participants lost an average of 23.8 pounds and maintained an average weight loss of 16.2 pounds at the 5-year mark. Group A maintained a weight loss of 8.4 pounds, compared with 23.1 pounds for Group B after 5 years.

Group A’s A1C levels decreased from 7.5 ± 1.3% to 6.7 ± 0.9% at 12 weeks, but at the 1-year mark A1C had increased to 7.7 ± 1.4%, and at 5 years it had increased further, to 8 ± 1.9% after group members regained some measure of weight.

Group B’s A1C levels decreased from 7.4 ± 1.2% to 6.4 ± 0.9% at 12 weeks and increased to 6.8 ± 1.2% at 1 year and 7.3 ± 1.5% at 5 years as they maintained their weight loss.

“Despite weight regain, Group A maintained significant improvement in (low-density lipoprotein) and (high-density lipoprotein) cholesterol, no change in blood pressure, but had worsening of serum triglycerides,” the researchers wrote in their abstract. Group B maintained a similar lipid profile for 5 years and the same blood pressure for the first 18 months.

Reference

Hamdy O, Mottalib A, Morsi A, et al. The long-term effects of intensive lifestyle intervention on cardiovascular risk in patients with diabetes in a real-world clinical setting: a 5-year longitudinal study. Diabetes. 2015; 64(suppl1) abstract 58-OR.