Submitted to: Obesity
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: January 9, 2012
Publication Date: March 15, 2012
Citation: Raatz, S.K. 2012. Patterns of weight change associated with long-term weight change and cardiovascular disease risk factors in the look AHEAD study. Obesity. 20(10):2045-2056. Interpretive Summary: The association of weight-loss patterns during the first year of an intensive lifestyle intervention was evaluated to assess 4-year weight maintenance and health outcomes. Two specific patterns described weight change during the first year of intervention: one reflected the typical pattern of weight loss over the 12 months, but distinguished those who lost larger amounts across the monthly intervals from those who lost less. The second component distinguished a pattern of initial weight loss followed by regain vs. a more sustained pattern of weight loss. 2438 individuals aged 45–76 years with type 2 diabetes mellitus were assigned scores according to how their weight losses reflected these patterns. Relationships these scores had with weight losses and health outcomes over 4 years were described. When compared to those with lower scores on the two components, both individuals who had larger month-to-month weight losses in year 1 and whose weight loss was more sustained during the first year had better maintenance of weight loss over 4 years. The pattern of larger monthly weight loss during year 1 was also independently predictive of year 4 levels of HbA1c, HDL-cholesterol, and systolic blood pressure.
Technical Abstract: Although lifestyle modification of diet, physical activity and behavior is a proven methodology for weight loss and health improvement it is typically resource intensive, particularly when administered in a medical setting. We examined a locally designed, community-based lifestyle intervention program administered by a certified personal trainer (CPT) and registered dietitian (RD) at a local fitness center. Assessment of anthropometric, fitness and metabolic outcomes in 41 (2 men, 39 women) overweight and obese (BMI = 32.0 ± 0.5 kg/m2) adults (age 49.3 ± 1.9 years) were made at baseline, the end of treatment (8 weeks) and follow-up (20 weeks). We hypothesized that the intervention would improve weight loss, body composition, fitness parameters, and cardiometabolic risk biomarkers. Participants were randomly assigned to an 8 week intervention (n=23) or to a control (n=18) group which received one educational session at baseline. At 8 weeks, participants in the intervention group had greater weight loss (p<0.05), total fat loss (p<0.05), trunkal fat loss (p<0.05) compared to controls. Participants in both groups reported improved Weight Efficacy Life-Style Questionnaire (WEL) scores. At 20 weeks, intervention participants maintained their weight loss, particularly reduction in total (p<0.05) and trunkal fat (p<0.05). No changes were observed in SBP, DBP, TG or hsCRP while significant time related changes were observed in both groups for glucose, insulin, cholesterol, LDL and HDL. A local community-based lifestyle intervention presented by an RD and a CPT is an effective format for a weight management intervention.