Even if weight loss is not sustained, adopting long-term behavioral changes such as regular exercise can lead to substantial improvements in health. A recent study has revealed that individuals who followed intensive weight loss programs experienced a decline in the risks of heart disease and diabetes.
While it is already known that weight loss can enhance heart health and reduce the likelihood of developing diabetes, the challenge lies in maintaining the weight loss after shedding the pounds.
The study found that individuals who engaged in an intensive behavioral weight loss program managed to sustain lowered systolic blood pressure levels, improved ratios of total cholesterol to good cholesterol, and reduced diabetes biomarkers for at least five years. This was in contrast to individuals who did not participate in any program or those who followed a less intensive behavioral program.
What’s particularly significant is that these benefits were sustained even when participants regained some weight.
“Even if weight is regained — which most people do — the health benefits persist,” said Paul Aveyard, PhD. He is one of the study’s authors and a professor of behavioral medicine at the University of Oxford in England. “This should serve as encouragement for people to try to lose weight and do so in the most effective way, by joining a behavioral weight loss program.”
Receiving Intensive, Little, or No Behavioral Support
An analysis, which was published in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes on March 28, examined 124 controlled trials involving over 50,000 participants. The trials randomly assigned individuals to either a behavioral weight management program or a control group that received minimal or no weight loss support.
These programs, such as WW (formerly Weight Watchers), aim to facilitate weight loss through non-pharmacological and non-surgical methods. Typically, they involve weekly meetings led by a facilitator who provides motivation, support, advice, and progress monitoring. The interventions may include promoting weight loss through exercise, healthy eating, meal replacements, intermittent fasting, or providing financial incentives.
The participants in the analysis had an average age of 51 and a body mass index (BMI) of 33, indicating obesity. The World Health Organization has recognized obesity as an epidemic, with millions of deaths occurring annually due to complications associated with excess weight. The American Heart Association (AHA) states that obesity directly contributes to cardiovascular risk factors such as high cholesterol, type 2 diabetes, high blood pressure, and sleep disorders.
Behavioral Support Lowered Risk Factors for Heart Disease and Diabetes
Throughout the various studies conducted in this research, the average weight loss achieved ranged from 5 to 10 pounds. Dr. Aveyard reports that after the conclusion of the weight loss program, individuals who were randomly assigned to receive support regained approximately 0.26 to 0.7 pounds per year more than those who received minimal or no support. Conversely, due to the fact that individuals who received support experienced a weight loss of approximately 5 pounds more than the control group by the end of the program, they still maintained a lighter weight overall.
Dr. Aveyard emphasizes that individuals’ unguided efforts towards weight loss did yield some positive results, but researchers observed several advantages for those who participated in the weight management group compared to those in the control group.
“The control group had reductions in risk factors, but the intervention group experienced a benefit over and above that,” he explained.
Individuals who received behavioral support showed improvements in various health indicators. After one year, their average systolic blood pressure was reduced by 1.5 millimeters of mercury (mmHg), and after five years, it was reduced by 0.4 mmHg. Additionally, both at one and five years, their HbA1C levels, a protein used to test for diabetes, were lower by 0.26, and their ratio of total cholesterol to HDL cholesterol was 1.5 points lower. These findings suggest a reduced risk of heart disease, as higher numbers in this ratio indicate a higher risk, according to the Mayo Clinic.
Furthermore, even after weight regain, the individuals who received behavioral support maintained a lower risk of cardiovascular disease or type 2 diabetes diagnosis.
Lasting Impact Even When Some Weight Was Regained
Christopher Gardner, PhD, a nutrition scientist and a professor of medicine at Stanford School of Medicine in California gave kudos to the research for how deeply it delved into the topic and for its long-term analysis. He, however, was not part of the study.
“For weight loss studies it is unusual to have data for more than six months to a year,” he said. “What is unusual and very helpful about this study is the focus on results five years out.”
Dr. Gardner also said that the results support the idea that “it’s better to have lost weight and regained it than never to have lost it at all.”
Another question that arises is whether the positive outcomes of these weight loss programs endure beyond a period of five years. The authors of the study emphasized the need for additional information to ascertain whether this potential benefit continues to exist over an extended duration.
In Some Cases, Regain Could Show Downside
Researchers have noted that these findings contradict previous evidence suggesting that weight regain increases the risks to heart health.
For instance, a study published in the New England Journal of Medicine in April 2017 demonstrated that individuals with heart conditions who experienced repeated fluctuations in weight were at a considerably higher risk of negative outcomes. Another study, featured in the journal Obesity, examined participants of the television show “The Biggest Loser” who had lost substantial amounts of weight. The findings revealed that several contestants experienced significant weight regain and ended up in a less healthy state compared to their pre-weight loss condition.
Gardner explains that intensive weight loss programs can involve extreme measures, leading to short-term weight loss exceeding 2 pounds per week.
“In order to maintain that, drastic dietary changes and high intensity and frequent physical activity is usually required,” said Gardner. “These [measures] usually have good short-term results, but due to the extreme nature, most people can’t maintain them. When they stop, the weight regain can be rapid.”
He also recommended to go for diets that have goals of losing 1 to 2 pounds per week at most may be a better way to go.
“An individual doing this might be frustrated with the slow pace, but if this less-intensive program fits more easily into their lifestyle, and is less extreme, it could be something they are more successful in maintaining, and in the long run they lose more weight and keep it off,” said Gardner.
However, should weight be regained, this study suggests that the initial weight loss can still offer substantial long-term health benefits.
“Even if all weight is regained, the health benefits in reduced cardiovascular disease should persist through life,” said Aveyard. “If blood pressure, cholesterol, and blood sugar are lower, then the arteries [get blocked] less, reducing the risk of these problems over a lifetime.”
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