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Title: 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

Author
item LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item BERGER, SAMANTHA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item HUGGINS, GORDON - Tufts Medical Center
item MCCAFFERY, JEANNE - University Of Connecticut
item JACQUES, PAUL - Jean Mayer Human Nutrition Research Center On Aging At Tufts University

Submitted to: Journal of the American Heart Association
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/7/2019
Publication Date: 10/9/2019
Citation: Lichtenstein, A.H., Berger, S., Huggins, G.S., McCaffery, J.M., Jacques, P.F. 2019. 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. Journal of the American Heart Association. 8(20). https://doi.org/10.1161/JAHA.118.010951.
DOI: https://doi.org/10.1161/JAHA.118.010951

Interpretive Summary: Weight regain after weight loss is common. The impact on heart disease risk factors is not well established. The aim of this study was to test the hypothesis that weight regain after weight loss had a negative effect on heart disease risk factors. Included in the analyses were subjects who participated in a 1 year intensive life-style weight loss trial (Action for Health in Diabetes [Look AHEAD]), and both lost at least 3% of their initial body weight and had year 5 follow-up data. Weight loss maintainers had significant improvements to heart disease risk factors compared to weight loss regainers. Participants who kept off at least 75% of the weight they lost had the greatest benefit for all heart disease risk factors assessed, compared to participants who regained 25% or more of the initial weight they lost. These findings underscore the importance of emphasizing not only weight loss but the importance of maintaining the weight loss after a successful intensive intervention.

Technical Abstract: Background: Weight regain after weight loss is common. The impact on cardiometabolic risk factors is not well established. Methods: Publically available data were analyzed from participants of the Look AHEAD trial with >/= 3% initial weight loss (n=1561) after a 1 year intensive lifestyle intervention and follow up data at year 4. Weight regain (regainers) and weight loss maintenance (maintainers) were defined by dichotomization with five cut points (0%, 25%, 50%, 75% and 100%) of percent of weight loss regained (weight change from years 1 to 4 as percent of weight loss during first year). Change in cardiometabolic risk factors after initial weight loss was compared in maintainers and regainers according to each cut point, controlling for demographics, medications, and baseline and year 1 change in body mass index. The effect was assessed separately in those with <10% and >/= 10% initial weight loss, and in women and men. Results: Maintainers had significant improvements to cardiometabolic risk factors compared to regainers for all risk factors assessed. No single weight regain cut point maximized the risk difference between maintainers and regainers across risk factors and sex/initial weight loss subgroups. For many risk factors, increasing the cut point of percent weight loss regained to allow more regain as part of maintenance diminished the cardiometabolic benefit among maintainers. Conclusion: Maintaining weight loss was better than weight regain for all risk factors assessed. No single cut point maximized risk difference between maintainers and regainers. Maintainers who kept off >/= 75% of weight lost had the greatest benefit for all risk factors. The findings from this study emphasize the need to further investigate long-term impact of partial weight regain after a weight loss intervention given the challenge of keeping off all of weight lost.