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Randomized Controlled Trial
. 2016 Aug;39(8):1345-55.
doi: 10.2337/dc16-0509. Epub 2016 Jun 6.

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

Rena R Wing, Mark A Espeland, Jeanne M Clark, Helen P Hazuda, William C Knowler, Henry J Pownall, Jessica Unick, Thomas Wadden, Lynne Wagenknecht; Action for Health in Diabetes (Look AHEAD) Study Group
Randomized Controlled Trial

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

Rena R Wing et al. Diabetes Care. 2016 Aug.

Erratum in

Abstract

Objective: Short-term weight loss improves cardiovascular disease (CVD) risk factors. We sought to determine the longer-term effects of maintaining weight loss or, conversely, regaining weight.

Research design and methods: We used data from Action for Health in Diabetes (Look AHEAD), a randomized trial of intensive lifestyle intervention (ILI) compared to a control condition in overweight/obese individuals with type 2 diabetes. ILI participants were grouped according to weight change patterns, as follows: 1) no weight loss (±3% at years 1 and 4); 2) moderate weight loss (3-8% at years 1 and 4); 3) large weight loss (8-20% at years 1 and 4); 4) moderate loss/full regain (3-8% at year 1/±3% at year 4); 5) large loss/full regain (8-20% at year 1/± 3% year 4); and 6) large loss/partial regain (8-20% at year 1/3-8% at year 4) and changes in CVD risk factors were compared.

Results: Adjusting for baseline differences and medication use, larger weight losses produced greater improvements in HbA1c, systolic blood pressure, HDL cholesterol, and triglycerides at years 1 and 4 (all P ≤ 0.02). Despite maintenance of weight loss, HbA1c levels worsened between years 1 and 4, and remained below baseline only in those with large weight losses. We found no negative associations of losing and regaining weight relative to not having lost weight. Moreover, those who had large initial weight loss but full regain of weight had greater improvements in HbA1c levels at year 4 than those with smaller or no initial weight loss.

Conclusions: Larger initial weight loss should be encouraged in individuals with type 2 diabetes, despite the possibility of regain.

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Figures

Figure 1
Figure 1
Mean change in weight and CVD risk factors from baseline for ILI participants who lost weight and maintained it from year 1 to year 4. The following three patterns are compared: no weight loss (year 1 and year 4 weight are both within ±3.0% of baseline weight; N = 158); moderate weight loss (year 1 and year 4 weights are both ≥3.0% and <8.0% below baseline; N = 204); and large weight loss (year 1 and year 4 weights are both ≥8.0% and <20% below baseline, and weight regain from year 1 to year 4 is <3%; N = 251). With covariate adjustment for sex, race/ethnicity, baseline age, BMI, baseline level of the risk factor, and changes in medication for that risk factor over time. P values are from mixed-effects models that assess the overall differences in the average changes from baseline.
Figure 2
Figure 2
Mean change in weight and CVD risk factors from baseline for ILI participants who all had no weight loss at year 4 but differed in weight loss at year 1. The following three patterns are compared: no weight loss (year 1 and year 4 weight are both within ±3.0% of baseline weight; N = 158); moderate weight loss/full regain (year 1 weight is ≥3.0% and <8.0% below baseline, and year 4 weight is within ±3.0% of baseline weight; N = 289); and large weight loss/full regain (year 1 weight is ≥8.0% and <20% below baseline, and year 4 weight is within ±3.0% of baseline weight; N = 210), with covariate adjustment for sex, race/ethnicity, baseline age, BMI, baseline level of the risk factor, and changes in medication for that risk factor over time. P values are from mixed-effects models that assess the overall differences in the average changes from baseline.
Figure 3
Figure 3
Mean change in weight and CVD risk factors from baseline for ILI participants who had moderate weight loss at year 4 but differed in weight loss at year 1. The following two patterns are compared: moderate weight loss (year 1 and year 4 weights are both ≥3.0% and <8.0% below baseline; N = 204); and large weight loss/partial regain (year 1 weight is ≥8.0% and <20% below baseline, and year 4 weight is ≥3.0% and <8.0% below baseline weight; N = 316), with covariate adjustment for sex, race/ethnicity, baseline age, BMI, baseline level of the risk factor, and changes in medication for that risk factor over time. P values are from mixed-effects models that assess the overall differences in the average changes from baseline.
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References

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