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Can initial weight loss predict long-term success?

Study could help identify ILI non-responders early on so they can be supported with other evidence-based treatment options to achieve success over the long-term

Recent data from the Look AHEAD study suggests doctors may want to look at results from a patient's first two months of intensive lifestyle intervention (ILI) to help predict his or her long-term success. These secondary analyses conducted by Dr Jessica L Unick of the Weight Control and Diabetes Research Center, The Miriam Hospital and Brown Medical School, Providence, RI and colleagues were published in Obesity, the scientific journal of The Obesity Society (TOS) and examined the association between initial weight loss (first two months of treatment) and long-term weight loss (eight years after initial treatment).

"This is the first study of its kind to show that if patients enrolled in intensive lifestyle intervention treatments aren't successful in losing weight after the first two months of treatment, they aren't likely to be successful using this approach alone long-term," said Unick. "The results imply that clinicians should evaluate ILI patients after the first two months and make a determination about the trajectory of the patient's treatment. This is a key time to determine whether additional treatment options may be necessary."

Jessica L Unick

Look AHEAD is the largest United States weight-loss study using diet and exercise alone and has previously shown that long-term weight loss is possible through ILI for weight management. These new findings add to the current body of research by helping clinicians identify ILI non-responders early on so they can be supported with other evidence-based treatment options to achieve success over the long-term.

To conduct the study, Unick and her colleagues examined 2,290 participants from the Look AHEAD trial who had type 2 diabetes, a BMI>25kg and 45-76 years of age. All participants were enrolled in an intensive behavioural lifestyle intervention that included frequent treatment meetings and a prescription for specific physical activity and dietary goals, including the use of meal replacements. Treatment was provided on a frequent basis throughout the first year and significantly reduced in years two through eight. The researchers found that greater weight loss at month one or two was associated with greater weight loss at any given year over the eight-year period (p's<0.001), as shown in Figure 1.

Figure 1: Weight change trajectories over an 8-year period, based on (A) 1-month and (B) 2-month weight change

More specifically, month one, participants losing 2-4% and >4% had 1.62 (95% CI: 1.32, 1.98) and 2.79 (95% CI: 2.21, 3.52) times higher odds of achieving ≥5% WL at year four and 1.28 (95% CI: 1.05,1.58) and 1.77 (95% CI: 1.40, 2.24) times higher odds of achieving ≥5% WL at year eight, compared to those losing <2% initially. At month two, 3-6% WL resulted in greater odds of achieving ≥5% WL at year four (OR = 1.85; CI: 1.48, 2.32), and >6% WL resulted in the greatest odds of achieving ≥5% WL at Year 4 (OR = 3.85; CI: 3.05, 4.88) and year eight (OR = 2.28; CI: 1.81, 2.89), compared to those losing <3%. Differences in adherence between WL categories were observed as early as month 2.

"Based on our findings, clinicians should watch closely for early reductions in adherence and low initial weight loss," added Unick. "Continued participation for patients not finding success in an ILI program alone may lead to frustration and decreased interest in future weight control efforts."

The study was conducted using correlative data, so results may not be causal. Additionally, the research was limited to participants with diabetes who received an ILI that used meal replacement products. Future studies should examine whether using initial weight loss as a criterion for changing a treatment plan has a greater benefit for patients.

"We know that a one-size-fits-all approach to obesity is not the solution," said Dr Tim Church, TOS member and Professor at Pennington Biomedical Research Center. "This new data helps us to better understand the various steps to evaluate the success of an ILI programme and a key point in time to consider supplementary treatment options, such as pharmacotherapy and surgery."

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