Health at Every Size®-Based Interventions May Improve Cardiometabolic Risk and Quality of Life Even in the Absence of Weight Loss: An Ancillary, Exploratory Analysis of the Health and Wellness in Obesity Study

Abstract

We examined whether weight loss following HAES®-based interventions associates with changes in cardiometabolic risk factors and quality of life of women with obesity. This was an exploratory, ancillary analysis of a 7-month, mixed-method, randomized controlled trial. Fifty-five women (age: 33.0 ± 7.2; BMI: 30–39.9 kg/m2) were included in this study. Body weight, cardiovascular risk factors, clustered cardiometabolic risk, and quality of life were assessed before (Pre) and after HAES®-based interventions (Post). Delta scores (Post-Pre) were calculated for each outcome and used in linear regression models. After adjusting by potential confounders, weight loss was associated with improvements in waist circumference (β = 0.83, p <0.001), fasting glycemia (β = 0.45, p = 0.036), total cholesterol (β = 1.48, p = 0.024), LDL (β = 1.33, p = 0.012), clustered cardiometabolic risk (β = 0.18, p = 0.006), and quality of life (β = −1.05, p = 0.007). All participants but one who reduced body weight (n = 11) improved clustered cardiometabolic risk and quality of life. Of relevance, 34% and 73% of the participants who maintained or gained weight improved clustered cardiometabolic risk and quality of life, respectively, although the magnitude of improvements was lower than that among those who lose weight. Improvements in cardiovascular risk factors and quality of life following HAES®-based interventions associated with weight loss as expected. However, most of the participants who maintained or even gained weight experienced benefits to some extent. This suggests that weight-neutral, lifestyle-modification interventions may improve wellness and health-related outcomes, even in the absence of weight loss.

Revisiting the impact of Health at Every Size® interventions on health and cardiometabolic related outcomes: An updated systematic review with meta‐analysis

“…Of 128 records identified in the updated literature search, six additional articles were included. [19][20][21][22][23][24] Combining results of these new studies with data from the original review 13 led to a total of 19 full-text articles (10 unique studies) included in the current review. One of the articles in the original review was excluded as it only presented qualitative findings and did not meet inclusion criteria.…”

“…Thirteen papers (eight original studies) reported anthropometric measures such as body weight, BMI, hip and waist circumference (Table 1). 19,20,22,23,[26][27][28][29][30][31][32]35,36 Eleven papers investigated differences between a HAES ® intervention group and a control group. Regarding this outcome, control groups varied between studies, the most commonly reported comparator was 'wait-list' followed by us of 'social support' or weight loss program.…”

“…Regarding this outcome, control groups varied between studies, the most commonly reported comparator was 'wait-list' followed by us of 'social support' or weight loss program. The other two papers, Ulian et al, 22 Mensinger et al, 24 combined anthropometric results for both the control and intervention groups and evaluated pre-and posttreatment differences across the total sample as a pre-post analysis only. Data from seven studies 19,20,23,[26][27][28][29] were eligible for inclusion in a meta-analysis, with results indicating no statistically significant difference between HAES ® and control groups in terms of BMI or body weight (Figures S2A and S3A).…”

“…It is worth noting that this paper 29 did not report a p-value for the post-hoc test, and discrepancies were observed between the results presented in the relevant figure compared with results presented in the table. Seven papers 20,22,26,27,29,32,35 reported on cardiometabolic outcomes including Total-Cholesterol (TC), HDLcholesterol (HDL-C), LDL-cholesterol (LDL-C), plasma TG and blood pressure (BP) reported as both systolic (SBP) and diastolic blood pressure (DBP) measures (Table 1). These measures were from results of six original studies, of which one study only reported baseline results.…”

“…Other cardiometabolic outcomes, including fasting glucose, insulin, HbA1c, HOMA-IR, arterial pressure and cardiovascular risk were assessed in only one study. 22 In addition, when reported these results were combined with control group data and reported as a pre-post analysis for the entire sample, and therefore between group data to specifically evaluate between group differences could not be extracted. Two studies measured LDL-C, 20,27 of which one 27 reported a significant between-group improvement in LDL-C concentrations in the HAES ® intervention compared with the control group post-intervention (at 6-months), although this effect was not maintained at the 24-month follow up.…”