Weight regain does not erode cardiometabolic benefits of weight-loss programs
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Key takeaways:
- Even with weight regain, participating in a behavioral weight-loss program is associated with improved CV risk factors at 5 years.
- More data are needed on any long-term CV benefits despite weight regain.
Participants in behavioral weight-loss programs improved several CV risk factors for at least 5 years after an intervention ended, despite weight regain, compared with low-intensity programs or controls, researchers reported.
“We know that many medical professionals and people living with obesity think that, if someone has lost but then regained weight, their weight-loss efforts have not been ‘worth it,’” Jamie Hartmann-Boyce, DPhil, associate professor of evidence-based policy and practice in the Nuffield department of primary care health sciences at the University of Oxford, U.K., told Healio. “However, the data from our review shows that even though most people who lose weight through behavioral weight-management programs do eventually regain some of the weight lost, their risk for CVD appears to be lower for at least 5 years after the program ends.”
Assessing CVD, diabetes risk reduction
Hartmann-Boyce and colleagues analyzed data from 124 randomized controlled trials of behavioral weight-loss management programs with adult participants with overweight or obesity. Comparators had to be another behavioral weight-loss program, an intervention of lesser intensity or no intervention. Studies reported on at least one cardiometabolic outcome at 12 months or longer after program end (median follow-up, 28 months after program end). The median baseline BMI of participants was 33 kg/m2; median age was 51 years. Researchers assessed the differences between more intensive interventions and comparator groups and the impact of weight regain on CVD incidence and risk.
The findings were published in Circulation: Cardiovascular Quality and Outcomes.
Eight studies with 7,889 participants examined the incidence of CVD or CV death after a behavioral intervention, with the longest follow-up being 24 years. The mean weight difference at program end was –2.2 kg. Researchers observed no evidence that weight gain in the behavioral weight-loss management programs compared with controls was associated with changing incidence of CVD.
There were 15 intervention arms from 10 studies (n = 4,202) that reported incidence of type 2 diabetes, with the longest follow-up being 24 years. The mean difference in weight between the intervention and comparator programs at program end was –4.1 kg. There was no evidence that weight change was associated with diabetes incidence.
However, at 1 and 5 years after behavioral weight-loss management programs ended, the total cholesterol/HDL ratio was 1.5 points lower than comparators at both times across 82 studies (n = 19,003). Systolic BP was 1.5 mm Hg and 0.4 mm Hg lower at 1 and 5 years, respectively, across 84 studies (n = 30,836) and HbA1c was 0.38% lower at 1 and 5 years across 94 studies (n = 28,083).
Of the included studies, 22% were judged at high risk of bias, but removing them did not meaningfully change the results, according to the researchers.
“I hope these findings provide reassurance to clinicians and their patients that even if weight is regained after successfully losing weight through a behavioral weight-management program, CV risk factors may still be reduced,” Hartmann-Boyce told Healio.
Hartmann-Boyce said more studies are needed with longer follow-up to assess whether weight loss and weight regain affect type 2 diabetes and CVD risk.
“Very few of the studies in our review contained data after 5 years,” Hartmann-Boyce said.
Long-term benefits after weight regain unclear
In a related editorial, Vishal N. Rao, MD, MPH, an advanced heart failure and transplant cardiology fellow at Duke University School of Medicine, and Neha J. Pagidipati, MD, MPH, associate professor of medicine at Duke University School of Medicine and member in the Duke Clinical Research Institute, wrote that it remains unknown whether temporary improvements in weight and cardiometabolic risk factors after a weight-loss intervention led to long-term clinical benefit.
“In other words, is it better to have lost and regained than never to have lost at all?” Rao and Pagidipati wrote. “In this study, weight loss following a behavioral weight-loss management program and subsequent regain are associated with favorable, although modest changes in cardiometabolic risk factors, yet long-term data are insufficient in characterizing the association between weight changes and cardiovascular death, MI or stroke.”
The authors noted such data would be valuable, as behavioral weight-loss management programs are often resource-intensive and the latest weight-loss therapies are expensive.
“On a population level, it is critical to fully evaluate the economic impact of these weight-loss strategies, especially in a condition that leads to high health care costs,” Rao and Pagidipati wrote.
Reference:
For more information:
Jamie Hartmann-Boyce, DPhil, can be reached at jamie.hartmann-boyce@phc.ox.ac.uk; Twitter: @jhb19.
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Hartmann-Boyce J, et al. Circ Cardiovasc Qual Outcomes. 2023;doi:10.1161/CIRCOUTCOMES.122.009348.
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