Not only weight loss, but also maintaining a lower weight is important for a good CV risk profile

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

Literature - Berger SE, Huggins GS, McCaffery JM, et al., - J Am Heart Assoc. 2019;8:e010951.

Introduction and methods

Lifestyle interventions can result in substantial weight loss and short-term health benefits [1,2], but it is hard for patients to maintain the achieved weight loss [3,4]. When weight loss is maintained, this is beneficial in terms of reducing development of type 2 diabetes (T2DM) [1] and to sustain favorable cardiometabolic factors [5,6]. Weight regain, on the other hand, is associated with loss of the cardiometabolic benefits associated with weight loss [6,7].

Comparisons of individuals with successful weight loss maintenance (maintainers) and individuals who regained weight (regainers) are scarce. This is related to the fact that various methods are used to define successful weight loss maintenance. Furthermore, different cut points have been used to differentiate maintainers and regainers.

This study used data from the Look AHEAD (Action for Health in Diabetes) trial [8], to examine the difference between maintainers and regainers in cardiometabolic risk factor change from years 1 to 4, after the intensive lifestyle intervention, which targeted ~7% weight loss. After the 1 year intensive lifestyle intervention, followed a 3-year maintenance phase. The current analyses were conducted in participants in the intensive lifestyle intervention group, who lost ≥3% of initial body weight, and who had follow-up data through the end of year 4 (n=1791), excluding those taking niacin or fibrates (n=230, leaving 1561). This study used five cut points for %weight loss, which were used to divide participants into maintainers and regainers (from 0% regain to 100%, at 25% increments). The effects on cardiometabolic risk factors were analyzed, namely HDL-c and triglyceride (TG) levels, systolic and diastolic BP (SBP and DBP), waist circumference (WC), fasting glucose (FG) and HbA1c. An attempt was made to identify a cut point capable of differentiating maintainers and regainers that maximizes the risk difference between the groups.

Main results

  • When analyzing change in cardiometabolic risk factors from years 1 to 4 and comparing the change between maintainers and regainers, an inverse linear pattern of improvement in HbA1c and WC with increasing cut points was seen in men who lost<10% of initial weight, and in women who lost <10% of initial weight for SBP.
  • In men who lost ≥10% of initial weight, linear improvement in HDL-c, HbA1c concentrations and DBP were seen, and women who lost ≥10% of initial weight showed better WC and HbA1c.
  • Greater improvement in some cardiometabolic risk factors were seen, in a non-linear fashion, in maintainers vs. retainers across all or most cut points of % weight loss regained. Irrespective of initial weight loss categories, better HDL-c in women, and better TG concentration in men were seen. In women who lost ≥10% initial weight, better TG level was seen. Women showed losing <10% of initial weight showed improved WC and HbA1c. Among those who lost ≥10% initial weight, men showed better WC, TG, FG and HbA1c and women had better HDL-c, TG and FG concentration and SBP.
  • No single cut point of % weight loss regained was identified to maximize risk difference between maintainers and. retainers, but maintaining 75% of weight loss (25% regain cut point) was generally beneficial.


This study shows that overall, 3 years after having been enrolled in an intensive lifestyle intervention and having achieved weight loss, people with T2DM who maintained the weight loss, showed better cardiometabolic risk factor profile than those who regained the weight lost. No weight regain cut point was identified that maximized the cardiometabolic risk difference between weight maintainers and regainers, to be able to differentiate between the two groups. Different relationships were seen depending on risk factor, sex and magnitude of initial weight loss. Successfully maintaining most (75%) of the weight loss was associated with no change or improvement across all risk factors.


1. Delahanty LM, Pan Q, Jablonski KA et al; Diabetes Prevention Program Research Group. Effects of weight loss, weight cycling, and weight loss maintenance on diabetes incidence and change in cardiometabolic traits in the Diabetes Prevention Program. Diabetes Care. 2014; 37:2738–2745.

2. Look AHEAD Research Group, Pi‐Sunyer X, Blackburn G, Brancati FL, et al. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one‐year results of the Look AHEAD trial. Diabetes Care. 2007; 30:1374–1383.

3. Barte JCM, ter Bogt NCW, Bogers RP, et al. Maintenance of weight loss after lifestyle interventions for overweight and obesity, a systematic review. Obes Rev. 2010; 11:899–906.

4. Wing RR, Phelan S. Long‐term weight loss maintenance. Am J Clin Nutr. 2005; 82:222S–225S.

5. Magkos F, Fraterrigo G, Yoshino J, et al. Effects of moderate and subsequent progressive weight loss on metabolic function and adipose tissue biology in humans with obesity. Cell Metab. 2016; 23:591–601.

6. Action for Health in Diabetes (Look AHEAD) Study Group .Association of weight loss maintenance and weight regain on 4‐year changes in CVD risk factors: the Action for Health in Diabetes (Look AHEAD) Clinical Trial. Diabetes Care. 2016; 39:1345–1355.

7. Hamdy O, Mottalib A, Morsi A, et al. Long‐term effect of intensive lifestyle intervention on cardiovascular risk factors in patients with diabetes in real‐world clinical practice: a 5‐year longitudinal study. BMJ Open Diabetes Res Care. 2017; 5:e000259.

8. Ryan DH, Espeland MA, Foster GD et al; Look AHEAD Research Group . Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Control Clin Trials. 2003; 24:610–628.

Find this article online at J Am Heart Assoc.

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