Can Weight Loss (and its benefits) be Maintained?

Overweight and obesity are strong risk factors for type 2 diabetes (T2D). Excess body weight is strongly associated with insulin resistance and hyperglycemia. Weight loss plays a central role in efforts to prevent or delay T2D. In persons with overweight or obesity improved glycemia is readily noticeable with weight loss. However the health benefits of weight loss may last only when the initial weight loss persists over the long term.

The Diabetes Prevention Program (DPP) was a randomized controlled trial (RCT) that ran from July 1996 to July 2001. The DPP compared the efficacy of intensive lifestyle intervention (ILS), metformin, and placebo in prevention of T2D in 3234 participants with elevated glucose levels and overweight or obesity. Its Outcomes Study (DPPOS) began in September 2002 and examined 2779 (88.5%) of the remaining DPP participants.

A recent study analyzed the data from the DPPOS with the primary objective to identify some predictors of long-term weight loss (LTWL). It compared the differences in LTWL maintenance in the original intervention group among those who achieved at least 5% weight loss at 1 year and examined the baseline factors that predicted maintenance of weight loss for up to 15 years.

Three key findings emerged:

• Although twice as many participants in the ILS group versus the metformin group lost at least 5% of their weight in the first year, those who were originally assigned to metformin had greater success in maintaining LTWL.
• Other independent characteristics of LTWL identified were a greater 1-year weight loss in all the groups; older age and the prior use of metformin in the metformin group; older age and absence of either diabetes or a family history of diabetes in the ILS group; and a lower baseline fasting plasma glucose in the placebo group.
• Cumulative diabetes incidence rates over 15 years were lower among those who lost at least 5% of their weight in the first year.

Long-Term Weight Loss With Metformin or Lifestyle Intervention in the Diabetes Prevention Program Outcomes Study

John W. Apolzan, PhD; Elizabeth M. Venditti, PhD; Sharon L. Edelstein, ScM; William C. Knowler, MD, DrPH; Dana Dabelea, MD; Edward J. Book, MD; Xavier Pi-Sunyer, MD; Rita R. Kalyani, MD; Paul W. Franks, PhD; Preethi Srikanthan, MD; and Kishore M. Gadde, MD; for the Diabetes Prevention Program Research Group

Ann Intern Med. doi: 10.7326/M18-1605

This article was published at annals.org on 23 April 2019.