Weight loss in the first three sessions of weight management programs predicts success

New research presented at the European Association for the Study of Diabetes (EASD) annual meeting in Stockholm, Sweden (Sep 19-23) found that people with type 2 diabetes (T2D) who participating in weight management programs, losing weight early is a strong predictor of future success.

In contrast, people with T2D who do not lose at least 0.5% of their body weight after the first three sessions of a weight management program are unlikely to achieve their weight loss goal, according to the study by Ms Lulwa Al-Abdullah, University of Glasgow, Glasgow. United Kingdom; Professor Jennifer Logue from Lancaster University, Lancaster, UK; and colleagues. Behavioral weight management programs help change eating, exercise and behavioral habits. Often run by commercial groups such as WW (formerly known as Weight Watchers) and Slimming World, they typically aim to help participants lose more than 5% of their body weight over a period of around 12 weeks. Participants will also receive advice on weight maintenance.

“Such programs help some, but not all people living with obesity – about 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 conducted a longitudinal analysis of the electronic health records of adults with T2D and obesity who were referred to the NHS Greater Glasgow and Clyde Weight Management Service from 2004 to 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 mean 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 over 16 weeks and losing more than 5% of body weight.

Participants who maintained a weight loss greater than 5% after three years and who had also achieved a successful short-term outcome were classified as having a successful mid-term outcome.

A total of 333 (20%) participants had a successful short-term outcome. The only demographic or clinical factor associated with a successful short-term outcome was early weight loss.

Additionally, 90.4% of those who lost 0.5% of their weight after the first three sessions (which took place over four weeks) had a short-term result.

None of the other factors examined such as age, gender, socioeconomic status, ethnicity, diabetes medication, HbA1c (mean blood glucose level) were associated with short-term success.

Three-year data from 1,152 participants were available and 12.1% (139) of these had a successful mid-term outcome.

As before, early weight loss was the only factor linked to success.

Of those who lost 0.5% of their weight after the first three sessions, 89.9% had a successful mid-term result after three years.

Overall, the threshold of not achieving 0.5% body weight loss in the first three sessions was 95% accurate for identifying participants who would not successfully complete the program.

The researchers conclude that early weight loss is strongly associated with short- and medium-term success, providing an easy way to identify early on who is likely to be struggling to lose weight.

They add that the NHS program 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 on a one-size-fits-all model and if they have problems, they have no choice but to drop out.

“This may have broader health implications as it can exacerbate self-stigma and feelings of failure and make it more reluctant to see healthcare professionals in the future.

“By identifying early on those individuals for whom a program is not working, you can offer support and possibly alternative therapies before the individual walks away from treatment.

“Early screening is standard practice in our management of other conditions, such as diabetes and hypertension, and our results will allow it to become standard in the management of obesity.”

Ms Al-Abdullah added: “Perhaps the first few weeks are so important because this is the time when people need to adjust their shopping, eating, cooking and exercise behaviors to follow the program’s recommendations.

“You also need to understand the program, have support from family and friends, and be able to afford the food that the meal plan suggests.

“This is a major behavior change and also assumes there are no underlying differences in appetite control and psychological conditions that impair their ability to make these changes.”