Weight regain after an initial successful weight loss in people with obesity, is an important and unsolved problem. Until now, no well-documented study on which treatment method is best for maintaining a healthy weight loss has been available.
Researchers at University of Copenhagen and Hvidovre Hospital have completed such a study, published in The New England Journal of Medicine. By testing four different types of treatment following a diet-induced weight loss, the researchers demonstrated for the first time how it is possible for people with obesity to maintain a weight loss over the long-term.
In a randomized clinical trial, the research group demonstrated an effective treatment after a diet-induced weight loss by combining moderate to vigorous-intensive exercise with an appetite-inhibiting obesity medication (liraglutide), an analogue to GLP-1, a hormone produced in the gut that reduces appetite.
The fight to maintain a weight loss
The problem is that people are fighting against strong biological forces when losing weight. Appetite increases as calorie consumption decreases, counteracting the ability to maintain a weight loss. An appetite-stimulating hormone increases dramatically when we lose weight and, at the same time, the level of appetite-suppressing hormones drops dramatically. What’s more, a weight loss can result in a loss of muscle mass, which reduces the body’s calorie-burning.
About the study
The study involved 215 participants in Denmark with obesity and low fitness ratings. Participants initially followed a low-calorie diet over eight weeks, where they each lost approximately 13 kg (28.6 lbs), which resulted in significant improvements to their blood sugar level and blood pressure.
The participants were then randomly divided into four groups.
Two of the groups received placebo medication, while the two other groups received obesity medication.
Among the two placebo groups, one group followed an exercise program of minimum 150 minutes of physical activity at moderate-intensity or 75 minutes at vigorous-intensity during the week or a combination of the two, while the other group maintained their current level of physical activity.
The two groups receiving obesity medication were similarly divided into one group with and one group without an exercise program.
All participants in the study were weighed monthly and received nutrition and diet counseling with the focus on healthy weight loss according to the guidelines from the Danish health and food administrations.
Highly efficient when combining treatments
After one year, the group with exercise alone and the group with obesity medication alone maintained the weight loss of 13 kg and health improvements. The placebo group gained half of the weight back with deterioration of all risk factors for development of Type 2 diabetes and cardiovascular disease.
The most dramatic improvements occurred in the combination group, which followed the exercise program and received obesity medication. The researchers observed additional weight loss in this group, and the total weight loss was approximately 16 kg over one year. The health benefits were also double that of each of the single treatments, i.e., twice the loss of fat mass while preserving muscle mass, higher fitness ratings, reduced blood sugar and improved quality of life.
The two groups that exercised increased their fitness rating, lost body fat and gained muscle mass. This could indicate a healthier weight loss than for people, who had only lost fat mass without increasing the fitness rating.
Fundamental lifestyle change
The lead researcher points out that many people with obesity have tried to lose weight before, only to regain the weight.
“This happens because the general advice is to eat healthier and exercise more. Without follow-up on whether people actually have support to perform exercise, the treatment will not be enough. Therefore, we followed up with the participants on an ongoing basis to ensure that they received the support they needed in order to exercise. That is necessary, because maintaining weight loss is extremely hard. People need to understand this. Once you have lost weight, you are not cured”.
He says, “The ongoing exercise and effort will likely need to continue for many years.”
The study also demonstrates that without a structured treatment plan, there is a high risk of gaining the weight back. There were 12 individual consultations over the course of a year, including weighing and diet advice from experts.
Source: New England Journal of Medicine, May 6, 2021.
All research on this web site is the property of Leslie Beck Nutrition Consulting Inc. and is protected by copyright. Keep in mind that research on these matters continues daily and is subject to change. The information presented is not intended as a substitute for medical treatment. It is intended to provide ongoing support of your healthy lifestyle practices.