Abstract
High body mass index (BMI) is known to be associated with various conditions, including type 2 diabetes (T2D), osteoarthritis, cardiovascular disease (CVD) and sleep apnoea; however, the impact of intentional weight loss on the risk of these and other outcomes is not well quantified. We examined the effect of weight loss on ten selected outcomes in a population from the UK Clinical Practice Research Datalink (CPRD) GOLD database. Included individuals were >18 years old at the index date (first BMI value between January 2001 and December 2010). They were categorised by their weight pattern between year 1 post-index and year 4 post-index (baseline period) as having stable weight (−5% to +5%) or weight loss (−25% to −10%, plus evidence of intervention or dietary advice to confirm intention to lose weight). For inclusion, individuals also required a BMI of 25.0–50.0 kg/m2 at the start of the follow-up period, during which the occurrence of ten obesity-related outcomes was recorded. Cox proportional hazard models adjusted for BMI, comorbidities, age, sex and smoking status were used to estimate relative risks for weight loss compared with stable weight. Individuals in the weight-loss cohort had median 13% weight loss. Assuming a BMI of 40 kg/m2 before weight loss, this resulted in risk reductions for T2D (41%), sleep apnoea (40%), hypertension (22%), dyslipidaemia (19%) and asthma (18%). Furthermore, weight loss was associated with additional benefits, with lower risk of T2D, chronic kidney disease, hypertension and dyslipidaemia compared with maintaining the corresponding stable lower BMI throughout the study. This study provides objective, real-world quantification of the effects of weight loss on selected outcomes, with the greatest benefits observed for the established CVD risk factors T2D, hypertension and dyslipidaemia.
Highlights
Many of the clinical and economic [1] impacts of obesity are contributed by the presence of various chronic comorbidities, and the association between increasing body mass index (BMI) and the risk of these obesity-related outcomes has been extensively characterised
The greatest benefits of weight loss were observed for outcomes known to be strongly associated with BMI: type 2 diabetes (T2D), sleep apnoea, hypertension and dyslipidaemia [25]
These results support the findings of previous studies showing that moderate weight loss can reduce blood pressure, T2D biomarkers, circulating lipids and other cardiovascular disease (CVD) risk biomarkers [18, 30,31,32,33,34,35]
Summary
Many of the clinical and economic [1] impacts of obesity are contributed by the presence of various chronic comorbidities, and the association between increasing body mass index (BMI) and the risk of these obesity-related outcomes has been extensively characterised. Both the degree of overweight or obesity and the presence of comorbidities should be considered when identifying the best weight-management approach for each individual. Treatment approaches to achieve this include: dietary and lifestyle changes, such as increased physical activity; pharmacological intervention; and bariatric surgery for patients with severe obesity and comorbidities [12, 13]. Data from randomised controlled trials have demonstrated that weight-loss interventions, such as pharmacotherapy and lifestyle changes, can reduce the risk of obesity-related conditions including sleep apnoea [15,16,17] and delay the onset of T2D [18, 19]. Previous studies have not investigated how the risk of obesity-related outcomes changes with intentional weight loss, in comparison with maintaining baseline weight. (2) How does the risk of outcomes differ after weight loss compared with maintaining the corresponding stable lower BMI? (Objective 2)
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