Differences in weight change trajectory patterns in a publicly funded adult weight management centre

Abstract

SummaryObjectiveTo describe differences in weight loss (WL) trajectory patterns at a publicly funded clinical weight management centre.MethodsGroups with differences in the attainment of a 5% total body WL and percentage WL patterns over time were identified in 7,121 patients who attended a physician lead multi‐disciplinary clinical lifestyle weight management that predominantly focused on education and diet counselling. Resultant health differences were examined.ResultsPatients had 3.2 ± 6.3%WL with 35% of patients achieving and maintaining a 5%WL. Half of these patients achieved the 5%WL within 6 months, while the other half had a more gradual approach. Another 10% achieved 5%WL, but regained weight after 6 months. There were seven distinct WL patterns identified: LargeWL (Mean WL: 21.2 ± 8.1%; Probability of group membership (PGM): 2.4%), ModerateWL (15.1 ± 5.1%WL; 5.4%PGM), SlowWL (6.7 ± 3.2%WL; 20.1%PGM) and MinimalWL (2.4 ± 2.2%WL; 34.6%PGM), WL Regain (9.4 ± 3.5%WL; 8.2%PGM), Weight Stable (1.2 ± 3.2%WL; 28.5%PGM) and Weight Gain (18.4 ± 11.2%WG; 0.8%PGM) groups. Improvements in blood pressure, lipids and glucose were generally related to the magnitude of WL achieved more than the pattern or speed of WL.ConclusionsThere are large differences in the absolute WL attained and the pattern of WL during a publicly funded weight management program. Changes in clinical health markers appear to be more strongly related with the absolute WL attained as opposed to patterns of weight change. © 2016 The Authors. Obesity Science & Practice published by John Wiley & Sons Ltd, World Obesity and The Obesity Society.

Absolute Weight Loss, and Not Weight Loss Rate, Is Associated with Better Improvements in Metabolic Health

“…However, this recommended WLR is for reducing the risk for gallstone formation [4] and was not created based on associations with obesity or cardiometabolic health outcomes. In accordance with previous observations [7, 16], faster WLR is associated with greater WL overall as compared to slower WLR. We extend these findings to show that there is also a greater reduction in waist circumference with faster WLR.…”

“…Three studies in smaller cohorts report that there are no differences in health changes between fast and slow WL [13–15]. Using a substantively larger sample, we demonstrate that WLR faster than the recommended 1-2 lb/wk is associated with greater improvements in BP [16]. However, after adjustment for the differences in absolute WL, there were minimal differences in the metabolic risk factor changes, with the differences tending to be worse in the Fast WLR as compared with the Rec WLR group.…”

“…As described previously [16–18], WMC is a physician referral-based clinic designed to educate and enable patients to implement strategies to manage their weight and improve their health. Patients attend the clinic on a monthly basis or as needed to have individual meetings with bariatric educators (with a university degree in nutrition) to discuss personalized weight management strategies, dietary plans, and physical activity options.…”

“…These intervention studies designed the WL to be similar between groups and did not observe any differences in BP or lipid changes between fast and slow WL but may have been underpowered. We have previously shown that faster WL is associated with greater WL and reductions in BP, but after adjustment for overall WL, there were no significant differences in BP reduction between fast and slow WL [16]. However, these studies did not directly examine whether WLR faster than the commonly recommended 1-2 lb/wk results in differential effects on health independent of the absolute WL and thus warrants further investigation.…”

Individuals with obesity but no other metabolic risk factors are not at significantly elevated all‐cause mortality risk in men and women

“…Thus, it is unclear whether these individuals with metabolically healthy obesity would benefit from weight loss. Furthermore, given the low success rates for obesity reduction and the stigma and bias experienced by those struggling with obesity , it may be particularly important to confirm whether obesity itself is associated with increased morbidity and mortality risk or reduced quality of life outcomes. Furthermore, whether metabolically healthy individuals with obesity benefit from weight loss in terms of physical, functional, psychological and metabolic outcomes needs to be confirmed in future research.…”