Comparison among criteria to define successful weight-loss maintainers and regainers in the Action for Health in Diabetes (Look AHEAD) and Diabetes Prevention Program trials

Abstract

Background: Given the low rates of successful weight maintenance after lifestyle-induced weight loss, it is critical to develop approaches that distinguish successful weight-loss maintainers from regainers. Objective: The aim of this study was to compare published categorization criteria that differentiate maintainers and regainers via quantitative agreement. Design: The study used publicly available data from Look AHEAD (Action for Health in Diabetes; n = 1791) and Diabetes Prevention Program (DPP; n = 613) participants with $3% initial weight loss after lifestyle interventions and 4-y follow-up data. Eight previously published criteria defining maintainers and regainers were compared with respect to number of participants and concordance via agreement statistics. Criteria were assessed separately among those with 3-9% and $10% initial weight loss. Results: Regainers had higher body weight at year 4 than did maintainers (mean difference range: 6.6-11.9 kg in Look AHEAD; 11.5-14.6 kg in DPP; P , 0.0001). Assessing concordance among criteria, agreement was dependent on initial weight loss. Among those with 3-9% initial weight loss in both cohorts, 9 of 28 comparisons were concordant (agreement $80%). Among those with $10% initial weight loss, 7 of 28 comparisons in Look AHEAD and 13 of 28 in the DPP were in high agreement. The definition of successful weight-loss maintenance "regaining #25% of initial weight loss during maintenance" showed high agreement with the most commonly used definition of "staying $10% below initial weight" among those with $10% initial weight loss (agreement: 85.0% in Look AHEAD; 87.4% in DPP). The same definition of #25% regain showed high agreement with the definition of staying $5% below initial weight among those with 3-9% initial weight loss (agreement: 91.6% in Look AHEAD; 90.5% in DPP). Conclusions: Although all of the criteria discriminated on the basis of weight loss, many showed low agreement, which limited crossstudy comparisons. Among criteria with high agreement, the definition of successful weight maintenance "regaining #25% of initial weight loss during maintenance" is a preferred definition of success, given the realistic challenges of maintaining 100% weight loss and flexible application in populations with high initial weight-loss variations. This trial was registered at clinicaltrials.gov as NCT00017953 (Look AHEAD) and NCT00004992 (DPP). Am J Clin Nutr 2017;106:1337-46.

Lifestyle Intervention With or Without Lay Volunteers to Prevent Type 2 Diabetes in People With Impaired Fasting Glucose and/or Nondiabetic Hyperglycemia

“…The longer term legacy effect of the NDPS intervention on Type 2 diabetes incidence and maintained weight loss is of course unknown, but some short term regain of lost weight after an intensive lifestyle intervention is a common observation in people with obesity, Type 2 diabetes, or high risk glycemic categories, particularly in those with least initial weight loss. [49][50][51][52] We also observed a significant increase in energy expenditure in the intervention groups (e Supplementary material Table 3 -7). There is a direct consistent association between reduced Type 2 diabetes risk and an increase in almost all type of physical activity and energy expenditure, which is only in part mediated through changes in adiposity.…”

“…44,45 Our full within -trial economic analysis will be published separately, and the high costs of the intense interventions in the early landmark research trials are well recognised 46 , although intervention models translated into clinical settings may be deliverable at lower cost. 45,[47][48][49] The combined intervention group at 12 months had a significantly lower mean weight (-1.76kg), waist circumference (-2.48 cm) and body mass index. Despite relatively low levels of weight loss, compared with the landmark studies in the field, the maintenance of behaviour changes or "area under the curve" generated may be partly responsible for the high level of impact on diabetes incidence.…”

Beyond weight loss: Impact of a weight management programme for mid‐older Australians in private health insurance

“…Although small average weight increases were observed among our sample, weight‐loss maintenance patterns show that after 3 months, three‐quarters of participants and after 6 months, approximately two‐thirds of participants successfully maintained their weight loss . The proportion of those achieving weight‐loss maintenance seemed to stabilize between 9 and 12 months (at around 55%), suggesting that the extended‐contact LTMP can assist participants continuing in the programme to maintain weight loss.…”

“…Considering the real‐world setting of the LTMP, a strength of our study is that we used the evidence‐based definition of weight‐loss maintenance which accounts for variations in initial weight loss and the fluctuations in maintaining weight loss . Our study examined the pattern of weight‐loss maintenance at shorter time intervals than most other studies, identifying changes within time intervals pertinent to targeting service delivery change.…”

“…Using anthropometric data from all participants, average within‐individual change in weight, waist circumference and BMI were determined from HWFL baseline (0 weeks) to 18 weeks (ie, initial weight loss) and from LTMP baseline (0 months) to 6 and 12 months. The primary outcome of weight loss maintenance was defined as <25% of initial weight loss and weight regain as ≥25% of initial weight loss, which allowed for non‐clinically important fluctuations in weight . Weight‐loss maintenance for LTMP participants who had lost a health‐enhancing amount of weight (ie, ≥2% of their initial weight) during the HWFL programme, was calculated at 3, 6, 9 and 12 months.…”