….serving residents of southwest sydney since 1990

Lost weight but found it again – does the body remember the good times?

Dr Chee L Khoo, 14th June 2019

We all know how frustrating it is regaining the weight that you have lost. All those hard earned efforts down the drain. You often wonder why it happens to you. Well, you are not alone. “Most” people who successfully lose weight regain them over months and sometimes years.
You sometimes wonder whether it is all worth it.

Of course it’s worth it. All the effort actually brings benefits even years later. This is especially true in patients newly diagnosed with diabetes. Significant weight loss at the beginning translate to reduction in heart disease rates years later. It’s as if the body remembers the good times!

The Anglo–Danish–Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION)–Cambridge trial had a fresh look at the association of weight change in the year following diabetes diagnosis and 10-year CVD and mortality incidence (9).  24,654 patients from 49 practices in England participated in a diabetes screening program between 2002-2006. 867 participants were diagnosed with type 2 diabetes (T2DM) and were cluster randomised to either intensive treatment or usual care (according to UK diabetes management guidelines).

Intensive treatment included more frequent consultations, provision of educational materials and GP-based academic-detailing sessions encouraging earlier use of medication to improve control of risk factors. The outcomes of interest were CVD events and all-cause mortality. The composite CVD outcome included cardiovascular mortality, non-fatal myocardial infarction, non-fatal stroke, non-traumatic amputation, and revascularisation. They excluded deaths occurring in the year following the assessment of weight change, to reduce the likelihood that weight loss in our study was caused by disease.

Compared with participants who maintained weight, those who lost ≥5% body weight had lower HbA1c, diastolic BP and triacylglycerols at 1 year. At 5 years, these improvements were only apparent among those who had lost ≥10% weight. Losing ≥5% of body weight was associated with a lower hazard of 10-year CVD events compared with maintaining weight (HR 0.52). There were no associations between weight loss and all-cause mortality.

Most patients diagnosed with T2DM are diagnosed in primary care these days. There is no such thing as mild diabetes. Most with diabetes starts mild and invariably will deteriorate over time and the risk of complications starts to accumulate over that time. Moderate weight loss may translate to substantial long-term CVD reduction and may be an achievable target in primary care.

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