Weight Drops, Muscle Mass Stays: 5-Year 'Why WAIT' Success

Marlene Busko

June 08, 2015

BOSTON — Researchers report encouraging 5-year findings from a real-world study of obese patients with type 2 diabetes who took part in an initial 12-week, intensive lifestyle intervention to lose weight — the Weight Achievement and Intensive Treatment (Why WAIT) program, which emphasizes the preservation of muscle mass.

The 53% of participants who lost at least 7% of their weight (about 23 pounds) with the program and kept it off for a year maintained this weight loss long term and saw improvements in certain cardiovascular risk factors in the 5-year follow-up.

Dr Osama Hamdy (Joslin Diabetes Center, Boston, Massachusetts) reported these findings here at the American Diabetes Association (ADA) 2015 Scientific Sessions, and the study was awarded the Michaela Modan Memorial Award for its major contribution to the understanding of type 2 diabetes.

The trial showed that "significant weight loss can be achieved and maintained for up to 5 years in real-world clinical practice, and to our knowledge, [is] the longest duration of weight loss in real-world clinical practice," Dr Hamdy said.

"Interestingly, people who continue to maintain a good level of exercise, especially strength-[training] exercise, are the patients who maintained the weight loss for a longer duration," he said in reply to a question from the audience. "We know for sure that this is the parameter that helps you to maintain the weight loss.

Losing Weight, Preserving Muscle

When patients follow an intensive lifestyle intervention to lose weight, they typically regain most of the pounds shed within a year, Dr Hamdy explained. The current study was designed to evaluate the long-term impact of sustained weight loss vs weight regain on cardiovascular risk factors in a clinical-practice setting as opposed to a clinical trial.

The researchers analyzed data from 129 obese patients with type 2 diabetes who took part in the Why WAIT program at their center.

"I would like to remind you that this [intervention] is more intensive than the Look AHEAD study," Dr Hamdy emphasized.

In Why WAIT, participants were provided with structured menus of 1500 calories/day for women and 1800 calories/per day for men. Carbohydrates were limited to 40% to 45% of the diet, which emphasized more protein (1.5 to 2 g/day), fiber, and monounsaturated fatty acids and less saturated fat and sodium. As in Look AHEAD, participants had liquid meals and snacks, but they were transitioned to normal eating at 10 weeks instead of 20 weeks.

The participants were also given a progressive, gradual, balanced, individualized exercise plan that was designed to improve flexibility (stretching and yoga), aerobic capacity (walking, swimming, cycling, dancing) and, importantly, strength (weight lifting, yoga, exercises with resistance tubing).

The participants increased their exercise time from 20 to 40 minutes 4 days a week for the first month to 50 to 60 minutes 6 days a week for the third month. In Look AHEAD, participants did 175 minutes a week of aerobic exercise only.

And in Why WAIT, endocrinologists switched the patients' antihyperglycemic medications to those that cause weight loss or do not affect weight.

The patients had cognitive behavioral modification modeled after the Diabetes Prevention Program. They also attended weekly, 30-minute group educational sessions about diabetes for 12 weeks.

At the end of the 12-week program, the patients had lost an average of 9.7% of their initial weight (23.8 pounds). Their average HbA1c levels dropped from 7.5% to 6.5%, and their medication use fell by 50% to 60%, Dr Hamdy noted

Does Initial Success Last 5 Years ?

After 1 year, the patients were divided into two groups, based on their weight loss:

  • Group A consisted of 61 patients (47%) who had not maintained a weight loss of at least 7% of their initial weight.

  • Group B consisted of 68 patients (53%) who had maintained this level of weight loss.

The two groups were followed prospectively for 5 years.

On average, the patients who did not maintain a weight loss of at least 7% at one year nevertheless maintained a weight loss of 3.5% (8.3 pounds) at 5 years.

However, the other patients who had been successful in maintaining a weight loss of 7% or more at 1 year had lost 9.0% of their initial weight (23 pounds) at 5 years. "This is again a significant weight loss and it occurred in 53% of patients," Dr Hamdy pointed out.

In patients who were not successful in maintaining a 7% weight loss at 1 year, mean HbA1c levels decreased to 6.7% at 12 weeks and then increased to 7.7% at 1 year and 8.0% at 5 years.

These patients still maintained significant improvements in LDL and HDL cholesterol, with no change in blood pressure but with worsening serum triglycerides.

So patients' HbA1c and triglyceride levels were the first risk factors to deteriorate with weight regain, while other lipid improvements were maintained, Dr Hamdy noted.

However, in the other "successful" patients, mean HbA1c levels decreased to 6.49% at 12 weeks, and increased, but to a lesser extent, to 6.8% at 1 year and 7.3% at 5 years. They had significant improvements in lipid profiles for 5 years and also had lower blood-pressure levels for the first 18 months.

Thus "significant weight reduction in patients with diabetes can be maintained for 5 years in a real-world clinical practice and is predicted by the ability to maintain >7% weight loss at 1 year," Dr Hamdy summarized.

Dr Hamdy is on the advisory panel for Metagenics and receives research support from Metagenics and Neurometrix; he is also a consultant for Abbott Nutrition and Merck. Disclosures for the coauthors are listed in the abstract.

American Diabetes Association 2015 Scientific Sessions; June 6, 2015; Boston, MA. Abstract 58-OR

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