Heart health benefits lasted at least five years after losing weight through a lifestyle change program, according to a research review published in Circulation: Cardiovascular Quality and Outcomes
Research Highlights:
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Losing weight with lifestyle changes in an intensive behavioral weight loss program was associated with a decrease in risk factors for cardiovascular disease and type 2 diabetes for at least five years, even if some weight was regained, according to A systematic review of the research, published today in Circulation: Cardiovascular Quality and Outcomes , a peer-reviewed journal of the American Heart Association.
People who are obese or overweight have a higher risk of high cholesterol and high blood pressure, factors that increase the risk of cardiovascular disease; as well as insulin resistance, a precursor to type 2 diabetes. Globally, overweight and obesity contributed to 2.4 million deaths in 2020, according to the American Heart Association ’s 2023 Statistical Update .
Behavioral weight loss programs can help people lose and maintain a healthy weight by encouraging lifestyle and behavioral changes, such as eating healthy foods and increasing physical activity. Gaining some weight back is common after behavioral weight loss programs. Some observational studies suggest that this weight change pattern of weight loss followed by weight regain may increase cardiovascular risk. However, according to the authors of this analysis, data from randomized trials and long-term follow-up studies are lacking.
"Many doctors and patients recognize that weight loss is often followed by weight regain , and fear that this makes the attempt to lose weight futile," said the study’s co-senior author, Susan A. Jebb, Ph. D., professor of diet and population health at the University of Oxford in the United Kingdom. “This concept has become a barrier to offering support to people to lose weight. “For people who are overweight or obese, losing weight is an effective way to reduce the risk of type 2 diabetes and cardiovascular disease.”
In this review, researchers evaluated international scientific studies available in 2018 to compare risk factors for cardiovascular disease and type 2 diabetes between people who followed an intensive behavioral weight loss program with those who followed a weight loss program. less intensive or without weight loss. The studies in the analysis included diet or exercise interventions, partial or total meal replacement, intermittent fasting, or financial incentives contingent on weight loss. The studies were conducted in a variety of settings and included different modes of delivery (in-person, via app, by phone, etc.).
The researchers combined results from 124 studies with a total of more than 50,000 participants, with an average follow-up of 28 months . They used the combined results to estimate changes in risk factors for cardiovascular disease and type 2 diabetes after weight loss. The average weight loss in the different studies ranged from 2 to 5 kilograms or 5 to 10 pounds. Weight regain averaged 0.12 to 0.32 kg (0.26 lb to 0.7 lb) per year. The participants had an average age of 51 years, with a body mass index of 33, which is considered obese.
Compared with people in a less intensive program and those in no weight loss program, participants who lost weight through an intensive weight loss program had lower risk factors for cardiovascular disease and type 2 diabetes. These Lower risk factors lasted at least five years after the weight loss program ended.
According to the pooled results of the studies reviewed, on average:
- Systolic blood pressure was 1.5 mm Hg (millimeters of mercury) lower at one year and 0.4 mm Hg lower at five years after participating in an intensive weight loss program.
- Additionally, the percentage of HbA1c , a protein in red blood cells used to detect diabetes, was reduced by 0.26 at both one and five years after participating in an intensive weight loss program.
- The ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol was 1.5 points lower one year and five years after participating in an intensive weight loss program.
These changes are important because they represent population-level improvements, Jebb explained.
In a preliminary finding, the decreased risk of being diagnosed with cardiovascular disease or type 2 diabetes also appeared to remain lower even after weight regain. However, few studies followed people for more than 5 years and "more information is needed to confirm whether this potential benefit persists," Jebb said.
“Most trials look at whether new treatments are effective and focus on short-term weight change rather than the effect on subsequent disease,” Jebb said. “Individual studies are often too small to detect differences between groups in the incidence of cardiovascular conditions because, fortunately, they affect only a small proportion of the entire group, and the studies may not continue long enough to see the effects.” on ’hard’ outcomes like a new diagnosis of type 2 diabetes or a heart attack.
“Our findings should provide confidence that weight loss programs are effective in controlling cardiovascular risk factors and are very likely to reduce the incidence of cardiovascular disease,” he said.
Evidence suggests that cardiovascular health improves by following the American Heart Association’s Life’s Essential 8 health metrics : eating healthy foods, being physically active, not smoking, getting enough sleep, maintaining a healthy weight, and controlling cholesterol, sugar levels. in the blood and blood pressure.
The analysis had several limitations: the information included in the review was not updated after 2019 and the review focused on research articles published in English, so eligible studies written in other languages may have been missed.
An accompanying editorial notes that there is still much to understand about various weight loss interventions, their long-term impact, and how this impact may diminish with weight regain. Behavioral weight loss programs form the backbone of weight management in clinical practice. However, they are often resource-intensive and emerging drug therapies are expensive, according to editorial authors Vishal N. Rao, MD, MPH, and Neha J. Pagidipati, MD, MPH, both of the division of cardiology at the College of Duke University Medicine. in Durham, North Carolina.
“The present study has interesting implications for the impact of weight regain that may occur after pharmacological therapies,” they write. “What remains unknown is whether these temporary improvements in weight and cardiometabolic risk factors after weight loss intervention (behavioral or pharmacological) lead to long-term clinical benefit. In other words, is it better to have lost and recovered than to have never lost?
Conclusions Despite weight regain, weight management programs reduce cardiometabolic risk factors with effects lasting at least 5 years after program completion and diminishing with weight regain. The evidence that they reduce the incidence of cardiovascular disease or diabetes is less certain. Few studies followed participants for ≥5 years. |
Co-authors are Jamie Hartmann-Boyce, D.Phil.; Annika Theodoulou, M.Clin.Sc.; Jason L. Oke, D.Phil.; Ailsa R. Butler, D.Phil.; Anastasios Bastounis, Ph.D.; Anna Dunnigan, M.Sc.; Rimu Byadya, M.Sc.; Linda J. Cobiac, Ph.D.; Peter Scarborough, D.Phil.; F.D. Richard Hobbs, F.Med.Sci.; Falko F. Sniehotta, PhD; and Paul Aveyard, Ph.D. Author disclosures are listed in the manuscript. This research was funded by the British Heart Foundation and the National Institute for Health Research Oxford Biomedical Research Centre.
