Patterns of weight change associated with long-term weight change and cardiovascular disease risk factors in the Look AHEAD Study

Abstract

This article provides an assessment of the associations that weight-loss patterns during the first year of an intensive lifestyle intervention have with 4-year maintenance and health outcomes. Two components described patterns of 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 reflected the weight change trajectory, and distinguished a pattern of initial weight loss followed by regain vs. a more sustained pattern of weight loss. Two thousand four hundred and thirty eight individuals aged 45-76 years with type 2 diabetes mellitus, who enrolled in the weight-loss intervention of a randomized clinical trial, were assigned scores according to how their weight losses reflected these patterns. Relationships these scores had with weight losses and health outcomes (glycosolated hemoglobin--hemoglobin A1c (HbA1c); systolic blood pressure, high-density lipoprotein (HDL)-cholesterol, and triglycerides) 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, independent of characteristics traditionally linked to weight loss success (P < 0.001). While relationships with year 4 weight loss were stronger, 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.

Figure 1

Figures 1a–1b: Patterns of weight loss during the first year of an intervention associated with the tertiles of principal component scores for month-to-month weight losses and linear versus curvilinear trajectory of weight loss. Curves were computed by adding to each principal component the mean levels of the other component.

Figure 1

Figures 1a–1b: Patterns of weight loss during the first year of an intervention associated with the tertiles of principal component scores for month-to-month weight losses and linear versus curvilinear trajectory of weight loss. Curves were computed by adding to each principal component the mean levels of the other component.

Figure 2

Figure 2a–b: Mean percent changes in weight from baseline across four years for individuals grouped by tertile of component scores from the first year of the intervention. The time scales for the means have been perturbed slightly to reduce overlap in the figures.

Figure 2

Figure 2a–b: Mean percent changes in weight from baseline across four years for individuals grouped by tertile of component scores from the first year of the intervention. The time scales for the means have been perturbed slightly to reduce overlap in the figures.

Figure 3

Figure 3a: Mean changes in HbA1c (%) for participants grouped (tertile) according to the relative magnitude of month-to-month weight losses during year 1 with covariate adjustment for all factors in Table 1 and weight loss from baseline measured at the same time as the HbA1c measures. Figure 3b: Mean increases in HDL-cholesterol (mg/dl) for participants grouped (tertile) according to the relative magnitudes of month-to-month weight losses during year 1 with covariate adjustment for all factors in Table 1 and change in weight at the time of HCL-cholesterol measures.

Figure 3

Figure 3a: Mean changes in HbA1c (%) for participants grouped (tertile) according to the relative magnitude of month-to-month weight losses during year 1 with covariate adjustment for all factors in Table 1 and weight loss from baseline measured at the same time as the HbA1c measures. Figure 3b: Mean increases in HDL-cholesterol (mg/dl) for participants grouped (tertile) according to the relative magnitudes of month-to-month weight losses during year 1 with covariate adjustment for all factors in Table 1 and change in weight at the time of HCL-cholesterol measures.