Benefits of Modest Weight Loss in Improving Cardiovascular Risk Factors in Overweight and Obese Individuals With Type 2 Diabetes

Abstract

OBJECTIVEOverweight and obese individuals are encouraged to lose 5–10% of their body weight to improve cardiovascular disease (CVD) risk, but data supporting this recommendation are limited, particularly for individuals with type 2 diabetes.RESEARCH DESIGN AND METHODSWe conducted an observational analysis of participants in the Look AHEAD (Action For Health in Diabetes) study (n = 5,145, 40.5% male, 37% from ethnic/racial minorities) and examined the association between the magnitude of weight loss and changes in CVD risk factors at 1 year and the odds of meeting predefined criteria for clinically significant improvements in risk factors in individuals with type 2 diabetes.RESULTSThe magnitude of weight loss at 1 year was strongly (P < 0.0001) associated with improvements in glycemia, blood pressure, tryiglycerides, and HDL cholesterol but not with LDL cholesterol (P = 0.79). Compared with weight-stable participants, those who lost 5 to <10% ([means ± SD] 7.25 ± 2.1 kg) of their body weight had increased odds of achieving a 0.5% point reduction in HbA1c (odds ratio 3.52 [95% CI 2.81–4.40]), a 5-mmHg decrease in diastolic blood pressure (1.48 [1.20–1.82]), a 5-mmHg decrease in systolic blood pressure (1.56 [1.27–1.91]), a 5 mg/dL increase in HDL cholesterol (1.69 [1.37–2.07]), and a 40 mg/dL decrease in triglycerides (2.20 [1.71–2.83]). The odds of clinically significant improvements in most risk factors were even greater in those who lost 10–15% of their body weight.CONCLUSIONSModest weight losses of 5 to <10% were associated with significant improvements in CVD risk factors at 1 year, but larger weight losses had greater benefits.

Liraglutide reverses pronounced insulin-associated weight gain, improves glycaemic control and decreases insulin dose in patients with type 2 diabetes: a 26 week, randomised clinical trial (ELEGANT)

“…First, only patients with pronounced insulin-induced weight gain in the first 16 months of insulin therapy were included and therefore we cannot vouch for the efficacy of liraglutide in patients with less pronounced weight gain or weight gain on long-term insulin treatment. We defined 4% weight gain as pronounced, as this reflects the upper 50% of insulin-associated weight gain and a minimal weight reduction of 3-5% in obese participants is already associated with a clinically relevant reduction in health risk [6,36,37]. Second, as our study duration was 26 weeks, it cannot determine whether the effects of addition of liraglutide to insulin are sustained after this time period.…”

Assessing Baseline and Temporal Changes in Cardiometabolic Risk Using Metabolic Syndrome Severity and Common Risk Scores

“…The dramatic increase in CVD risk associated with development of T2DM, both because of shared cardiometabolic risk factors31 and additional effects of glycosylation,32 makes prediction of T2DM a relevant factor to consider for the clinical utility of cardiovascular risk scores. We found that both the ASCVD and FRS scores were associated with future T2DM, as evidenced by higher baseline scores and elevated ORs among those who went on to develop T2DM, whether they developed CVD afterward.…”

Results from the dissemination of an evidence-based telephone-delivered intervention for healthy lifestyle and weight loss: the Optimal Health Program

“…Almost half of participants who completed the program achieved at least 5 % weight loss, although it is important to note this was based on a small number of participants, given 44 % retention at 12 months. This magnitude of weight loss has been associated with beneficial health outcomes and is meaningful in terms of both individual and population health [59][60][61].…”