This content originally appeared on Everyday Health. Republished with permission.
By Don Rauf
Weight loss is already known to boost heart health and cut diabetes risk. But once you’ve shed the pounds, it can be a challenge to keep them off.
A new study has found that people who followed an intensive behavioral weight loss program lowered their systolic blood pressure levels, their ratio of total cholesterol to good cholesterol, and their diabetes biomarkers for at least five years compared with people who did not participate in a program or who participated in a lower-intensity behavioral program.
Significantly, these benefits were maintained even when participants put pounds back on.
“Even if weight is regained — which most people do — the health benefits persist,” says Paul Aveyard, PhD, one of the study’s authors and a professor of behavioral medicine at the University of Oxford in England. “This should serve as encouragement for people to try to lose weight and do so in the most effective way, by joining a behavioral weight loss program.”
Participants Received Intensive, Little, or No Behavioral Support
Published March 28 in the American Heart Association journal Circulation: Cardiovascular Quality and Outcomes, the analysis was based on a comprehensive review of 124 controlled trials, which involved more than 50,000 participants randomly assigned to a behavioral weight management program or to a control group where they received minimal or no weight loss support.
These types of programs promote losing pounds without drugs or surgery; WW (formerly Weight Watchers) is a well-known example. The programs usually feature weekly meetings with a leader who aims to motivate, support, advise, and monitor progress, according to the researchers. Interventions may encourage weight loss through exercise, healthy foods, partial or total meal replacement, intermittent fasting, or financial incentives for losing weight.
Participants in this analysis were an average age of 51 and had a body mass index (BMI) of 33, which is considered obese. The World Health Organization has declared obesity an epidemic, with at least 2.8 million people dying each year because of factors related to excess weight. Obesity contributes directly to cardiovascular risk factors, including high cholesterol, type 2 diabetes, high blood pressure, and sleep disorders, according to the American Heart Association (AHA).
Behavioral Support for Weight Loss Decreased the Risk Factors for Heart Disease and Diabetes
Across the different studies in this research, average weight loss ranged from 5 to 10 pounds. After the weight loss program ended, the people who were randomized to get support regained 0.26 to 0.7 pounds per year more than people who received little or no support, according to Dr. Aveyard. On the other hand, because the weight loss was about 5 pounds more at the end of the program for people offered support, they were still lighter than those in the control group.
Aveyard notes that people’s “unguided weight loss efforts” did result in weight loss, but scientists observed several advantages for those in the weight management group over those in the control group.
“The control group had reductions in risk factors, but the intervention group experienced a benefit over and above that,” he says.
For those who received behavioral support, average systolic blood pressure (the top number in a blood pressure reading) was 1.5 millimeters of mercury (mmHg) lower at one year and 0.4 mmHg lower at five years.
At both one and five years, their percentage of HbA1c, a protein in red blood cells used to test for diabetes, was lower by 0.26, and their ratio of total cholesterol to “good” (HDL) cholesterol was 1.5 points lower. (Higher numbers mean a higher risk of heart disease, according to the Mayo Clinic.)
Researchers also observed that the risk of a cardiovascular disease or type 2 diabetes diagnosis appeared to remain lower even after weight regain.
Lasting Outcomes — Even When Weight Returned
Christopher Gardner, PhD, a nutrition scientist and a professor of medicine at Stanford School of Medicine in California, who was not involved in the study, praised the research for its comprehensiveness and long-term analysis.
“For weight loss studies it is unusual to have data for more than six months to a year,” he says. “What is unusual and very helpful about this study is the focus on results five years out.”
Dr. Gardner adds that the results support the notion that “it’s better to have lost weight and regained it than never to have lost it at all.”
Whether positive outcomes from such weight loss programs persist beyond five years is another question. Study authors said that more information is needed to confirm whether this potential benefit persists.
In Some Cases, Weight Regain May Have a Downside
These results contradict some previous evidence that weight regain increases heart health risks, researchers pointed out.
For example, an analysis published in the April 2017 New England Journal of Medicine showed that heart patients whose weight repeatedly fluctuated were at a significantly greater risk of poor outcomes. A study in the journal Obesity looked at contestants who lost large amounts of weight on the television show The Biggest Loser, and found that several competitors regained significant weight and ended up less healthy than before their weight loss.
According to Gardner, intensive weight loss programs can involve extreme measures that lead to short-term weight loss of more than 2 pounds per week.
“In order to maintain that, drastic dietary changes and high intensity and frequent physical activity is usually required,” says Gardner. “These [measures] usually have good short-term results, but due to the extreme nature, most people can’t maintain them. When they stop, the weight regain can be rapid.”
He suggests that diets with goals of losing no more than 1 to 2 pounds per week may be more practical.
“An individual doing this might be frustrated with the slow pace, but if this less-intensive program fits more easily into their lifestyle, and is less extreme, it could be something they are more successful in maintaining, and in the long run they lose more weight and keep it off,” says Gardner.
Still, if weight does come back, this study indicates that the initial weight loss may provide some significant health payoffs in the long run.
“Even if all weight is regained, the health benefits in reduced cardiovascular disease should persist through life,” says Aveyard. “If blood pressure, cholesterol, and blood sugar are lower, then the arteries [get blocked] less, reducing the risk of these problems over a lifetime.”