Complex associations between weight regain and cardiometabolic risk
medwireNews: The effect of weight regain on cardiometabolic risk in people with type 2 diabetes varies according to sex, initial weight loss, and the particular risk factor under study, shows an analysis of the Look AHEAD trial.
“We sought to identify a weight regain cut point across both sex and both initial weight loss subgroups that maximized the cardiometabolic risk difference between maintainers and regainers but found none,” write Alice Lichtenstein (Tufts University, Boston, Massachusetts, USA) and co-researchers in JAHA.
Some cardiometabolic risk factors showed a linear relationship with weight regain, in that the cardiometabolic advantage associated with maintained weight loss diminished with increasing regain of weight. But this varied with sex and categories of initial weight loss (<10% or ≥10%), so for example this association applied to high-density lipoprotein (HDL) cholesterol only among men who lost at least 10% of their initial bodyweight and for systolic blood pressure it was evident only among women who lost less than 10%.
By contrast, weight loss maintainers had healthier levels of some risk factors than weight regainers regardless of how much of their initial weight loss they maintained. This was true, for example, for HDL cholesterol levels in women, for triglyceride levels in men, and for waist circumference among women who initially lost less than 10% of their bodyweight but for men with at least a 10% initial weight loss.
“High rates of weight regain across lifestyle intervention programs raise the question of whether weight regain could have adverse effects on cardiometabolic risk factors after the initial weight intensive loss intervention period ended,” say Lichtenstein and team.
“This study suggests that the answer to that question is dependent on the deﬁnition used for successful weight loss maintenance, the relative amount of weight regain, and sex.”
However, the researchers note that, in general, they found that people who lost at least 10% of their baseline weight reaped the greatest benefits from maintaining as much of their weight loss as possible.
They say that for people who lost less of their baseline 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 analysis included data from 1561 people who lost at least 3% of their baseline bodyweight while undertaking the 1-year intensive lifestyle intervention of the Look AHEAD trial and had follow-up data for 4 years after its end. Weight regain during this time ranged from 0%, for 304 participants, to more than 100%, for 301 people.
The researchers caution that “[c]hange in cardiometabolic risk factors cannot be extrapolated to long-term disease outcomes.”
They conclude: “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.”
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