If one is overweight, losing even a few pounds can go a long way in maintaining good health. Behavioural weight loss programs, although intensive, can help in reducing risk factors for cardiovascular disease and Type 2 diabetes.
A review of the data on behavioural weight reduction programs found that weight loss was linked to lowered risk factors for cardiovascular disease and Type 2 diabetes for at least five years — even if some weight was regained. When compared to those who did not participate in a program or took part in a less intense behavioural weight loss program, those who lost weight through an intensive behavioural weight loss program had lower systolic blood pressure levels, a lower total cholesterol-to-good cholesterol ratio, and lower levels of HbA1c (a diabetes marker).
According to a systematic review of the literature that was published in Circulation: Cardiovascular Quality and Outcomes, a peer-reviewed American Heart Association journal, losing weight through lifestyle changes in an intensive behavioural weight loss program was linked to a reduction in risk factors for cardiovascular disease and Type 2 diabetes for at least five years — even if some weight was regained.
Behavioural weight loss programs help maintain healthy weight
People who are obese or overweight are more likely to have high blood pressure, high cholesterol, and insulin resistance, which are all risk factors for cardiovascular disease and Type 2 diabetes, respectively. According to the American Heart Association’s 2023 Statistical Update, overweight and obesity contributed to 2.4 million deaths globally in 2020.
By encouraging changes in lifestyle and behaviour, such as consuming healthier meals and increasing physical exercise, behavioural weight reduction programs can help people achieve and maintain a healthy weight. Following behavioural weight loss programs, weight gain is frequent. According to some observational studies, this pattern of weight change—weight loss followed by weight gain—could raise cardiovascular risk. However, the authors of this analysis claim that there is a dearth of information from long-term follow-up studies and randomized trials.
Losing weight is an effective way to reduce the risk of Type 2 diabetes and cardiovascular disease
“Many doctors and patients recognize that weight loss is often followed by weight regain, and they fear that this renders an attempt to lose weight pointless,” said study co-senior author Susan A. Jebb, Ph.D., a 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 with overweight or obesity issues, losing weight is an effective way to reduce the risk of Type 2 diabetes and cardiovascular disease.”
Researchers compared risk factors for cardiovascular disease and Type 2 diabetes in adults who followed an intensive behavioural weight loss program to those who followed a less intensive or no weight loss program in this evaluation of current international scientific studies. The studies analysed included intermittent fasting, partial or complete meal replacement, diet and/or exercise interventions, and financial incentives linked to weight loss. The investigations were conducted in various locations and used a range of delivery methods (in-person, app-based, telephone, etc.).
Results from 124 trials with a combined participant count of more than 50,000 and an average follow-up of 28 months were collated by researchers. They calculated changes in cardiovascular disease and Type 2 diabetes risk variables following weight loss using the pooled results. The average weight loss throughout the course of several investigations was 2–5 kilograms or 5–10 pounds. Average annual weight regains ranged from 0.12 to 0.32 kg (0.26 to 0.7 pounds). Participants had a body mass index of 33, which is considered obese, and an average age of 51.
Lower risk factors persist for five years
Participants who lost weight through an intensive weight reduction program showed fewer risk factors for cardiovascular disease and Type 2 diabetes compared to those in a less rigorous program and those in a control group. After the weight loss program was finished, these lower risk factors persisted for at least five years.
Based on pooled results of the studies reviewed, on average:
- Systolic blood pressure, the top number in a blood pressure reading, was 1.5 mm Hg (millimeters of mercury) lower at one year, and 0.4 mm Hg lower at five years after participation in an intensive weight loss program.
- In addition, the percentage of HbA1c, a protein in red blood cells used to test for diabetes, was reduced by 0.26 at both one and five years after participation in an intensive weight loss program.
- The ratio of total cholesterol to good cholesterol – known as high-density lipoprotein (HDL) cholesterol — was 1.5 points lower one year and five years after participation in an intensive weight loss program.
According to Jebb, these modifications are significant since they represent improvements at the population level.
Weight loss programs are effective in controlling cardiovascular risk factors
A preliminary finding indicated that even after weight restoration, the reduced risk of developing cardiovascular disease or Type 2 diabetes appeared to remain lower. Few studies, meanwhile, tracked subjects for longer than 5 years, and “more information is needed to confirm whether this potential benefit persists,” according to Jebb.
“Most trials look at whether new treatments are effective and focus on weight change in the short-term rather than the effect on later 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 whole group, and studies may not continue long enough to see the effects on ‘hard’ outcomes, such as a new diagnosis of Type 2 diabetes or a heart attack.
“Our findings should provide reassurance that weight loss programs are effective in controlling cardiovascular risk factors and very likely to reduce the incidence of cardiovascular disease,” she said.
Impact of weight regain that may occur after pharmacologic therapies
The American Heart Association’s Life’s Essential 8 health metrics, which include eating well, exercising, quitting smoking, getting enough sleep, maintaining a healthy weight, and managing cholesterol, blood sugar, and blood pressure levels, appear to improve cardiovascular health.
The analysis has several limitations, including the fact that the material included in the review was not updated until 2019 and that it only looked at research papers published in English, which may have overlooked some eligible studies written in other languages.
An editorial that goes along with the study points out that there is still much to learn about different weight loss strategies, their long-term effects, and how gaining weight may lessen such effects. The core of weight management in clinical practise is behavioural weight loss programmes. According to the editorial’s writers Vishal N. Rao, M.D., M.P.H., and Neha J. Pagidipati, M.D., M.P.H., both from the cardiology department at Duke University School of Medicine in Durham, North Carolina, they are frequently resource-intensive and expensive.
“The present study has interesting implications for the impact of weight regain that may occur after pharmacologic therapies,” they write. “What is still unknown is whether these temporary improvements in weight and cardiometabolic risk factors after weight loss intervention (behavioural or pharmacological) lead to long-term clinical benefit. In other words, is it better to have lost and regained than never to have lost at all?”
Materials provided by the American Heart Association. Note: Content may be edited for style and length.
Jamie Hartmann-Boyce, Annika Theodoulou, Jason L. Oke, Ailsa R. Butler, Anastasios Bastounis, Anna Dunnigan, Rimu Byadya, Linda J. Cobiac, Peter Scarborough, F.D. Richard Hobbs, Falko F. Sniehotta, Susan A. Jebb, Paul Aveyard. Long-Term Effect of Weight Regain Following Behavioral Weight Management Programs on Cardiometabolic Disease Incidence and Risk: Systematic Review and Meta-Analysis. Circulation: Cardiovascular Quality and Outcomes, 2023; DOI: 10.1161/CIRCOUTCOMES.122.009348
American Heart Association. “Shedding pounds may benefit your heart — even if some weight is regained.” ScienceDaily. ScienceDaily, 28 March 2023. <www.sciencedaily.com/releases/2023/03/230328145442.htm>.
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