Long-Term Effect of Weight Regain Following Behavioral Weight Management Programs on Cardiometabolic Disease Incidence and Risk: Systematic Review and Meta-Analysis

Abstract

BACKGROUND: Behavioral weight management programs (BWMPs) enhance weight loss in the short term, but longer term cardiometabolic effects are uncertain as weight is commonly regained. We assessed the impact of weight regain after BWMPs on cardiovascular risk factors, diabetes, and cardiovascular disease. METHODS: Trial registries, 11 databases, and forward-citation searching (latest search, December 19) were used to identify articles published in English, from any geographical region. Randomized trials of BWMPs in adults with overweight/obesity reporting cardiometabolic outcomes at ≥12 months at and after program end were included. Differences between more intensive interventions and comparator groups were synthesized using mixed-effects, meta-regression, and time-to-event models to assess the impact of weight regain on cardiovascular disease incidence and risk. RESULTS: One hundred twenty-four trials reporting on ≥1 cardiometabolic outcomes with a median follow-up of 28 (range, 11–360) months after program end were included. Median baseline participant body mass index was 33 kg/m 2 ; median age was 51 years. Eight and 15 study arms (7889 and 4202 participants, respectively) examined the incidence of cardiovascular disease and type 2 diabetes, respectively, with imprecise evidence of a lower incidence for at least 5 years. Weight regain in BWMPs relative to comparators reduced these differences. One and 5 years after program end, total cholesterol/HDL (high-density lipoprotein) ratio was 1.5 points lower at both times (82 studies; 19 003 participants), systolic blood pressure was 1.5 mm mercury and 0.4 mm lower (84 studies; 30 836 participants), and HbA1c (%) 0.38 lower at both times (94 studies; 28 083 participants). Of the included studies, 22% were judged at high risk of bias; removing these did not meaningfully change results. CONCLUSIONS: Despite weight regain, BWMPs reduce cardiometabolic risk factors with effects lasting at least 5 years after program end and dwindling with weight regain. Evidence that they reduce the incidence of cardiovascular disease or diabetes is less certain. Few studies followed participants for ≥5 years. REGISTRATION: URL: https://www.crd.york.ac.uk/PROSPERO/ ; Unique identifier: CRD42018105744.

Text Messages With Financial Incentives for Men With Obesity

“…Although 5% weight loss is typically considered clinically meaningful, some evidence has suggested that weight loss of less than 5% may be clinically important . Providing participants with cash that they could retain if they met study goals may have facilitated enrollment of participants with lower incomes, in contrast to deposit contract financial incentives where participants risk losing their own money .…”

Long-Term Outcomes Following Behavioral Weight Management Programs: Worth the Weight

“…In this issue of Circulation: Cardiovascular Quality and Outcomes, Hartmann-Boyce et al 7 examined the extensive body of literature on weight regain following BWMPs to characterize the impact of initial weight loss and then weight regain on cardiometabolic risk factors (blood pressure, glycemic control, and cholesterol) and on incident cardiovascular disease and T2DM. Among over 17 000 studies, they found only 124 randomized control trials which reported on ≥1 cardiometabolic outcome with at least 12 months of follow-up.…”

“…In this study, weight loss following BWMP and subsequent regain are associated with favorable, although modest changes in cardiometabolic risk factors, yet, long-term data are insufficient in characterizing the association between weight changes and cardiovascular death, myocardial infarction, or stroke. 7 Understanding long-term clinical outcomes is important because BWMPs are often resource intensive, and the emerging pharmacologic therapies are expensive. On a population level, it is critical to fully evaluate the economic impact of these weight loss strategies, especially in a condition that leads to high health care costs.…”

The association of body mass index variability with cardiovascular disease and mortality: a mediation analysis of pooled cohorts

“…The obesity paradox refers to the seemingly counterintuitive notion that body mass index (BMI) is not a consistent cardiovascular risk factor in overweight and obese individuals ( 7 , 8 ), and questions the cardiovascular health benefits of weight loss in the long term ( 9 – 11 ). Body weight variability has been examined as an additional risk factor to explain the controversial findings on the effect of weight loss on CVD and mortality ( 12 , 13 ).…”