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New research being presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Stockholm, Sweden (19-23 Sept), has found that early weight loss in people with type 2 diabetes (T2D) attending weight management programs is a strong indicator of future success.
In contrast, people with T2D who fail to lose at least 0.5% of their body weight after the first three sessions of a weight management program are unlikely to succeed in reaching their weight loss goal, according to the research from Ms. Lulwa Al-Abdullah, of the University of Glasgow, Glasgow, UK; Professor Jennifer Logue, of Lancaster University, Lancaster, UK; and colleagues. Behavioral weight management programs provide support on changing eating, physical activity and behavioral habits. They are often run by commercial groups such as WW (formerly known as Weight Watchers) and Slimming World, and typically aim to help participants lose greater than 5% of their body weight over a period of around 12 weeks. Attendees are also given advice on weight maintenance.
"Such programs help some, but not all, people living with obesity—around 40% do not achieve significant weight loss," says Ms Al-Abdullah. "If we knew early on which participants were unlikely to succeed, we could switch them to other interventions, including pharmacological options, when they are still highly motivated."
To find out more, the researchers carried out a longitudinal analysis of the electronic health records of adults living with T2D and obesity referred to the NHS Greater Glasgow and Clyde Weight Management Service from 2004-2014.
They looked for demographic and clinical factors that predicted successful weight loss.
The 1,658 participants (60% female) had been diagnosed with T2D for a median of 5.3 years. They had a median BMI of 40.2 kg/m2 and an average age of 57.8 years.
A successful short-term outcome was defined as attending seven out of nine weight management sessions held over 16 weeks and losing more than 5% of their body weight.
Participants who maintained weight loss of more than 5% three years on, and who had also achieved a successful short-term outcome, were classed as having a successful medium-term outcome.
A total of 333 (20%) of participants had a successful short-term outcome. The only demographic or clinical factor associated with a successful short-term outcome was early weight loss.
Furthermore, 90.4% of those who lost 0.5% of their weight after the first three sessions (held over four weeks) had a successful short-term outcome.
None of the other factors studied, including age, sex, socioeconomic status, ethnicity, diabetes medication, HbA1c (average blood sugar level), were associated with short-term success.
Three-year data was available on 1,152 participants and 12.1% (139) of these had a successful medium-term outcome.
As before, early weight loss was on the only factor associated with success.
Of those who lost 0.5% of their weight after the first three sessions, 89.9% had a successful medium-term outcome at three years.
Overall, the threshold of failing to achieve 0.5% body weight loss in the first three sessions was 95% accurate at identifying participants who wouldn't succeed in the program.
The researchers conclude that early weight loss is strongly associated with short and medium-term success and so provides a simple way of identifying, early on, who is likely to struggle to lose weight.
They add that the NHS-run scheme they studied is similar to other programs in the UK.
Professor Logue, who led the research, says, "Currently, people are referred to weight management programs in a 'one- size-fits-all' model, and if they are struggling, they have no alternative other than to drop out.
"This can have a wider health impact, as it may worsen self-stigma and feelings of failure and result in reluctance to visit healthcare professionals in future.
"By identifying those individuals for whom a program is not working early in the process, you can provide support and possibly alternative therapies before the person disengages from treatment.
"Early review is standard practice in our treatment of other conditions such as diabetes and high blood pressure and our findings will allow it to become standard in the treatment of obesity."
Ms Al-Abdullah adds, "It is likely the first few weeks are so important because this is the time when people are having to adapt their shopping, eating, cooking and physical activity behavior to follow whatever the program recommends.
"They will also need to understand the program, have support from family and friends and be able to afford the food the diet plan suggests.
"This is a large behavioral change and also assumes that there are not underlying differences in appetite control and psychological conditions that will affect their ability to make these changes."