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      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

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          Abstract

          Background

          Weight regain after weight loss is common. The impact on cardiometabolic risk factors is not well established.

          Methods and Results

          Publicly available data were analyzed from participants of the Look AHEAD (Action for Health in Diabetes) trial with ≥3% initial weight loss (n=1561) during a 1‐year intensive lifestyle intervention and with year 4 follow‐up data. Participants who regained (regainers) or maintained (maintainers) weight loss were defined with 5 dichotomized 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). 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 body mass index. The effect was assessed separately in participants with <10% and ≥10% initial weight loss, and women and men. Maintainers exhibited significant improvements to the cardiometabolic risk factors assessed compared with regainers. No weight regain cut point maximized risk difference between maintainers and regainers across risk factors or sex/initial weight loss subgroups. For many risk factors, allowing more regain as part of maintenance (increasing cut point) diminished the cardiometabolic benefit among maintainers.

          Conclusions

          Maintaining weight loss was better than regain for all risk factors. No single cut point maximized the risk difference between maintainers and regainers. Maintainers who kept off ≥75% of weight lost had the greatest benefit. These findings emphasize the importance of intervention programs focusing not only on weight loss but weight loss maintenance, given the adverse consequences of the latter.

          Clinical Trial Registration

          URL: http://www.clinicaltrials.gov. Unique identifier: NCT00017953.

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          Most cited references16

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          Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial.

          Xavier Pi-Sunyer, George Blackburn, Frederick Brancati … (2007)
          The effectiveness of intentional weight loss in reducing cardiovascular disease (CVD) events in type 2 diabetes is unknown. This report describes 1-year changes in CVD risk factors in a trial designed to examine the long-term effects of an intensive lifestyle intervention on the incidence of major CVD events. This study consisted of a multicentered, randomized, controlled trial of 5,145 individuals with type 2 diabetes, aged 45-74 years, with BMI >25 kg/m2 (>27 kg/m2 if taking insulin). An intensive lifestyle intervention (ILI) involving group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity was compared with a diabetes support and education (DSE) condition. Participants assigned to ILI lost an average 8.6% of their initial weight vs. 0.7% in DSE group (P < 0.001). Mean fitness increased in ILI by 20.9 vs. 5.8% in DSE (P < 0.001). A greater proportion of ILI participants had reductions in diabetes, hypertension, and lipid-lowering medicines. Mean A1C dropped from 7.3 to 6.6% in ILI (P < 0.001) vs. from 7.3 to 7.2% in DSE. Systolic and diastolic pressure, triglycerides, HDL cholesterol, and urine albumin-to-creatinine ratio improved significantly more in ILI than DSE participants (all P < 0.01). At 1 year, ILI resulted in clinically significant weight loss in people with type 2 diabetes. This was associated with improved diabetes control and CVD risk factors and reduced medicine use in ILI versus DSE. Continued intervention and follow-up will determine whether these changes are maintained and will reduce CVD risk.
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            Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain.

            K Elfhag, S Rössner (2005)
            Weight loss is difficult to achieve and maintaining the weight loss is an even greater challenge. The identification of factors associated with weight loss maintenance can enhance our understanding for the behaviours and prerequisites that are crucial in sustaining a lowered body weight. In this paper we have reviewed the literature on factors associated with weight loss maintenance and weight regain. We have used a definition of weight maintenance implying intentional weight loss that has subsequently been maintained for at least 6 months. According to our review, successful weight maintenance is associated with more initial weight loss, reaching a self-determined goal weight, having a physically active lifestyle, a regular meal rhythm including breakfast and healthier eating, control of over-eating and self-monitoring of behaviours. Weight maintenance is further associated with an internal motivation to lose weight, social support, better coping strategies and ability to handle life stress, self-efficacy, autonomy, assuming responsibility in life, and overall more psychological strength and stability. Factors that may pose a risk for weight regain include a history of weight cycling, disinhibited eating, binge eating, more hunger, eating in response to negative emotions and stress, and more passive reactions to problems.
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              Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men.

              Youfa Wang, Eric Rimm, Meir J. Stampfer … (2005)
              Obesity is a strong risk factor for type 2 diabetes. However, few studies have compared the predictive power of overall obesity with that of central obesity. The cutoffs for waist circumference (WC) and waist-to-hip ratio (WHR) as measures of abdominal adiposity remain controversial. The objective was to compare body mass index (BMI), WC, and WHR in predicting type 2 diabetes. A prospective cohort study (Health Professionals Follow-Up Study) of 27 270 men was conducted. WC, WHR, and BMI were assessed at baseline. Covariates and potential confounders were assessed repeatedly during the follow-up. During 13 y of follow-up, we documented 884 incident type 2 diabetes cases. Age-adjusted relative risks (RRs) across quintiles of WC were 1.0, 2.0, 2.7, 5.0, and 12.0; those of WHR were 1.0, 2.1, 2.7, 3.6, and 6.9; and those of BMI were 1.0, 1.1, 1.8, 2.9, and 7.9 (P for trend /=24.8), WC (>/=94 cm), and WHR (>/=0.94) were 82.5%, 83.6%, and 74.1%, respectively. The corresponding proportions were 78.9%, 50.5%, and 65.7% according to the recommended cutoffs. Both overall and abdominal adiposity strongly and independently predict risk of type 2 diabetes. WC is a better predictor than is WHR. The currently recommended cutoff for WC of 102 cm for men may need to be reevaluated; a lower cutoff may be more appropriate.
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                Author and article information

                Contributors
                Alice H. Lichtenstein: alice.lichtenstein@tufts.edu
                Journal
                Journal ID (nlm-ta): J Am Heart Assoc
                Journal ID (iso-abbrev): J Am Heart Assoc
                Journal ID (doi): 10.1002/(ISSN)2047-9980
                Journal ID (publisher-id): JAH3
                Journal ID (hwp): ahaoa
                Title: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2047-9980
                Publication date (Electronic): 09 October 2019
                Publication date Collection: 15 October 2019
                Volume: 8
                Issue: 20 ( doiID: 10.1002/jah3.v8.20 )
                Electronic Location Identifier: e010951
                Affiliations
                [ 1 ] Friedman School of Nutrition Science and Policy Tufts University Boston MA
                [ 2 ] Jean Mayer USDA Human Nutrition Research Center on Aging Tufts University Boston MA
                [ 3 ] Molecular Cardiology Research Institute Center for Translational Genomics Tufts Medical Center and Tufts University Boston MA
                [ 4 ] Department of Allied Health Sciences University of Connecticut Storrs CT
                Author notes
                [*] [* ] Correspondence to: Alice H. Lichtenstein, DSc, Jean Mayer USDA Human Nutrition Research Center on Aging, 711 Washington St, Boston, MA 02111. E‐mail: alice.lichtenstein@ 123456tufts.edu
                Article
                Publisher ID: JAH34409
                DOI: 10.1161/JAHA.118.010951
                PMC ID: 6818027
                PubMed ID: 31594431
                SO-VID: e163d863-d4ea-4cc6-9abc-2eefe57180f6
                Copyright © © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                Date received : 13 December 2018
                Date accepted : 07 August 2019
                Page count
                Figures: 4, Tables: 2, Pages: 15, Words: 6849
                Funding
                Funded by: Look AHEAD Research Group
                Funded by: National Institute of Diabetes and Digestive and Kidney Diseases
                Funded by: National Heart, Lung, and Blood Institute
                Award ID: T32‐HL069772
                Funded by: National Institute of Nursing Research
                Funded by: National Institute of Minority Health and Health Disparities
                Funded by: Office of Research on Women's Health
                Funded by: Centers for Disease Control and Prevention
                Funded by: Department of Agriculture
                Funded by: USDA Agricultural Research Service
                Award ID: 58‐1950‐4‐003
                Categories
                Subject: Original Research
                Subject: Original Research
                Subject: Epidemiology
                Custom metadata
                source-schema-version-number 2.0
                component-id jah34409
                cover-date 15 October 2019
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.7.0 mode:remove_FC converted:15.10.2019

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: cardiovascular disease risk factors,diabetes mellitus,lifestyle intervention,look ahead (action for health in diabetes) trial,obesity,weight loss,weight regain,cardiovascular disease,diabetes, type 2,epidemiology,lifestyle
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: cardiovascular disease risk factors, diabetes mellitus, lifestyle intervention, look ahead (action for health in diabetes) trial, obesity, weight loss, weight regain, cardiovascular disease, diabetes, type 2, epidemiology, lifestyle

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