What Works for Weight Loss Maintenance?

Highlight from ObesityWeek 2015

Commentary by Donna Ryan, MD and Carel le Roux, PhD, MBChB

Weight loss concept woman smilingEven as experts continue to wrestle with the optimal methods of weight loss, whether surgical or nonsurgical, they're also focusing on the best ways to maintain the weight loss. They don't have all the answers, but they have more clues, according to researchers who reviewed the data at ObesityWeek 2015 in Los Angeles.

“The Look AHEAD Lifestyle Intervention Study can teach us a lot about weight maintenance,” said Donna Ryan, MD, Professor Emeritus at Pennington Biomedical Research Center, Baton Rouge, who is a long-time obesity researcher. She cited its size and follow-up. Over 10 years, the researchers looked at 5,145 adults with type 2 diabetes. "It has more than 140 publications," she said. Less than 4% were lost to follow up. All had type 2 diabetes; they were given equivalent medical care.1

The participants were randomized to lifestyle intervention or to the support condition. The intervention included group and individual visits, in person, other contact, use of meal replacements and a ''toolbox'' approach to individualize treatment. The researchers also identified lapses early and made corrections.

  • At one year, the mean weight loss was 8.6% for the intervention group versus .7% in the control group.

Among its biggest lessons? "One of the biggest predictors of long-term weight loss loss is that initial weight loss," Ryan said. "Weight loss in year one predicts weight loss at year 4."

''Even the weight loss in the first and second month was predictive," she said. That initial weight loss effect seems to endure. "Initial weight loss was a very strong predictor over the long-term, at year 8, in Look AHEAD," Ryan said.

Older adults in the study tended to lose more. "Those 65 and older lost more than those 45 to 54 and 55 to 64," she said. "What is going on here is entirely explained by adherence."

The better the diabetes was in control, the more success in weight loss, Ryan said.

NWCR: More Clues
“Another source of good information on weight loss maintenance comes from the National Weight Control Registry (NWCR),” Ryan said. It is tracking more than 10,000 people who have lost significant amounts of weight and kept it off.

Among the measures, they report:

  • High levels of physical activity, about 300 minutes a week
  • Eating a low-calorie, low-fat diet
  • Eating breakfast
  • Maintaining a consistent eating pattern
  • Self-monitoring weight regularly
  • Catching ''slips'' before they become larger regains

Self-monitoring becomes easier with what Ryan calls ''wearables." Among the devices that can help people track activity are:

  • Nike Fuel
  • Jawbone
  • Fitbit
  • Apple Smart Watch

Diversity, Individualization Key
“Another large study providing rich information is the SCALE study,” said Carel le Roux, PhD, MBChB, a researcher at the University College Dublin in Ireland. "It allows us to see how things can be put together," he said. In the study, 3,700 adults who were overweight or obese were randomized 2:1 to inject 3.0milligrams of liraglutide (Saxenda) or placebo. None had diabetes at the study start. Both groups were given diet and exercise instructions.2

After 56 weeks, the liraglutide group averaged an 8.4 kilogram (kg) loss, compared to 2.8 kg in the placebo group (a difference of -5.6 kg; 95% CI, -6.0 to -5.1, P<0.001). While 33% of the liraglutide group lost more than 10% of their body weight; 10.6% of the placebo group did (P=<0.001).

“Just as patients with other chronic conditions such as hypertension need a variety of treatments, physicians who treat patients with obesity should have a toolbox to pick from,” le Roux said. "Not everyone will respond to every treatment. So we need diverse treatment. We're not smart enough at the moment to [always] get the right treatment to the right patient at the right time. We will be."

Take-Homes
Focusing on the intensity of the weight loss treatment initially bodes well long term, Ryan said.  "Adherence is the thing that predicts initial success, and early success is the greatest predictor of long-term weight loss."

"Weight loss maintenance is going to require continued intervention," Ryan said. "We have a lot to learn, but I do see progress."

Disclosure: Donna Ryan, MD reported serving as a paid advisor for Novo Nordisk, Vivus, Eisai, Takeda, Janssen, Pfizer, Amgen and Real Appeal. Dr. Ryan holds an equity position in Scientific Intake and Tulip.

November 20, 2015

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