Regular Visits with Provider Key to Patients Maintaining Weight Loss from Lifestyle Modifications

The 2013 revision of guidelines on managing overweight and obesity in adults suggests that providers and patients set a goal of a sustained weight loss of 3-5% of baseline body weight to obtain improvements in triglycerides, blood glucose, HbA1c, and the risk of developing type 2 diabetes mellitus. Additionally, the US Preventive Services Task Force made a recent recommendation that physicians screen all adults for obesity and engage patients with a BMI over 30 kg/m² in intensive multicomponent interventions.

At the 2014 Cardiometabolic Health Congress, Thomas A. Wadden, PhD, Director of the Center for Weight and Eating Disorders at the University of Pennsylvania, discussed these new guidelines and the supporting data. According to the guidelines jointly set forth by the American Heart Association, the American College of Cardiology, and The Obesity Society, patients who need to lose weight should receive a comprehensive lifestyle intervention, including food intake, physical activity and behavior modification, lasting 6 months or more. The interventions should occur face-to-face, with at least 14 sessions in the first 6 months. With these comprehensive interventions, patients can expect to lose an average of 8 kg in 6 months.

An ongoing clinical study, the Look AHEAD study, is examining whether a weight loss of ≥7% of starting body weight, with increased activity, will reduce the risk of heart attack and stroke in obese patients with type 2 diabetes. The participants receive education on intensive lifestyle interventions for dietary intake and physical activity. Over the first 4 years of the study, patients receiving only diabetes support and education lost 1% of their starting weight. Patients receiving support for intensive lifestyle modification lost 4.7% of their starting weight.

At 9.6 years into the Look AHEAD study, patients in the intensive lifestyle intervention group improved their HbA1c levels and need for insulin, their systolic blood pressure and HDL cholesterol, their sleep apnea, and their risk of depression significantly more than patients who were assigned to the diabetes support and education group. However, the intensive lifestyle intervention did not meet any of the primary endpoints of the study, including reducing the risk of cardiovascular morbidity and mortality, reducing a composite measure of fatal and nonfatal myocardial infarction and stroke, or reducing hospitalization for angina.

Wadden also discussed efforts to educate a broader community about the intensive lifestyle interventions to lose weight. One partnership has been developed with the YMCA where wellness instructors are trained to deliver the type of information that was previously coming from health care providers. After 1 year of enrollment in the YMCA lifestyle intervention program, participants lost an average of 6% of their starting body weight. The cost of 1 year of treatment was $205 per participant when delivered trough the YMCA. If the same interventions were received through an academic medical center, the cost of treatment was $1476 per participant.

Participation in group programs seems to increase the amount of weight that participants lose. In a 1-year randomized study, participants receiving standard care had a mean weight loss of 1.8 kg and patients receiving support and education through a commercial weight loss program (eg, Weight Watchers) had a mean weight loss of 4.1 kg. Looking toward the future of behavioral modification strategies for weight loss, Wadden discussed the possibilities for Internet- and app-based interventions.