Long-term Effects Of Weight Loss Research Articles

Does Successful Weight Loss in an Internet-Based Worksite Weight Loss Program Improve Employee Presenteeism and Absenteeism?

Certain risk factors associated with overweight and obesity may lead to reduced productivity in the workforce (i.e., increased absenteeism and presenteeism). Participants in a large, Internet-based worksite weight loss intervention, who were present at follow-up (N = 1,030), completed a self-reported productivity measure (World Health Organization's Health and Work Performance Questionnaire) at baseline and postintervention. Twenty-two percent of the participants lost a clinically meaningful amount of weight (≥5% weight loss). There were no statistically significant (p < .05) relationships between weight change from baseline to 12 months and change scores of absolute or relative absenteeism or for absolute or relative presenteeism. Within a modestly successful Internet-based, worksite weight loss intervention, weight loss did not improve self-reported absenteeism or presenteeism. Further studies are needed to explore the sensitivity of the World Health Organization's Health and Work Performance Questionnaire and the long-term effects of weight loss on productivity.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Dietetic treatment lowers body mass index in overweight patients: an observational study in primary health care

Greater insight into the effectiveness of usual dietetic care will contribute to the ongoing development of dietetic services. The present study examined the change in body mass index (BMI) in overweight patients after dietetic treatment in primary care, the sources of variability and factors associated with BMI change. This population-based observational study was based on data from a Dutch registration network of dietitians in primary health care. Data were derived from electronic medical records concerning 3960 overweight adult patients (BMI ≥ 25 kg m⁻²) who received usual care from 32 registered dietitians between 2006 and 2012. Multilevel linear regression analyses were conducted. Patients' BMI significantly (P < 0.001) decreased by 0.94 kg m⁻² on average during treatment. An additional reduction of 0.8 kg m⁻² was observed in patients treated for longer than 6 months. BMI decreased by 0.06 kg m⁻² for each additional unit in initial BMI above 31.6. Most (97%) variability in BMI change was attributed to patients and 3% to dietitians. Part of the variance between patients (11%) and dietitians (30%) was explained by patient sociodemographic characteristics, nutrition-related health aspects, initial body weight and treatment duration. Dietetic treatment in primary care lowers BMI in overweight patients. Patients' change in BMI was rather similar between dietitians. Greater BMI reductions were observed in those with a high initial BMI and those treated for at least 6 months. Future research is necessary to study the long-term effects of weight loss after treatment by primary healthcare dietitians, especially because many patients drop out of treatment prematurely.

Is Mortality Risk Reduced in Overweight or Obese Diabetics?

Is Mortality Risk Reduced in Overweight or Obese Diabetics?

Long-Term Effect of Weight Loss on Obstructive Sleep Apnea Severity in Obese Patients with Type 2 Diabetes

To examine whether the initial benefit of weight loss on obstructive sleep apnea (OSA) severity at 1 year is maintained at 4 years. Randomized controlled trial with follow-up at 1, 2, and 4 years. 4 Look AHEAD clinical centers. Two hundred sixty-four obese adults with type 2 diabetes and OSA. Intensive lifestyle intervention with a behavioral weight loss program or diabetes support and education. Change in apnea-hypopnea index on polysomnogram. The intensive lifestyle intervention group's mean weight loss was 10.7 ± 0.7 (standard error), 7.4 ± 0.7, and 5.2 ± 0.7 kg at 1, 2, and 4 years respectively, compared to a less than 1-kg weight loss for the control group at each time (P < 0.001). Apnea-hypopnea index difference between groups was 9.7 ± 2.0, 8.0 ± 2.0, and 7.7 ± 2.3 events/h at 1, 2 and 4 years respectively (P < 0.001). Change in apnea-hypopnea index over time was related to the amount of weight loss (P < 0.0001) and intervention, independent of weight loss (P = 0.001). Remission of OSA at 4 years was 5 times more common with intensive lifestyle intervention (20.7%) than diabetes support and education (3.6%). Among obese adults with type 2 diabetes and OSA, intensive lifestyle intervention produced greater reductions in weight and apnea-hypopnea index over a 4 year period than did diabetes support and education. Beneficial effects of intensive lifestyle intervention on apneahypopnea index at 1 year persisted at 4 years, despite an almost 50% weight regain. Effect of intensive lifestyle intervention on apnea-hypopnea index was largely, but not entirely, due to weight loss.

Restoring ATBF: Dreaming the impossible dream?

Dear Sir: Knowledge of the longterm effect of weight loss on adipose tissue blood flow (ATBF) is scarce. We read with great interest the paper by Rossi et al. [3], reporting the results of a study using laser-Doppler flowmetry (LDF), where baseline thigh ATBF was lower in morbidly obese subjects compared to ageand sex-matched controls (4.8 vs. 79.9 perfusion units /PU). These results confirm several previous studies [4]. After one-year follow-up subsequent to Roux-en Y gastric bypass (RYGB) in obese patients, they observed a meaningful weight loss (−40 kg, e.g.−28%). This weight loss was associated with a slight but nevertheless significant increase in ATBF (up to 10.0 PU) although patients remained obese. The main limitations of the Rossi et al. study are linked to the inherent drawbacks of the LDF method, relating mainly to calibration, multiple Doppler shifts, tissue optical properties, motion artefacts, biological zero and impossibility to express the results in absolute values [2]. The gold-standard for ATBF measurement is the 133 xenon wash-out method, which should be combined with LDF in order to validate data obtained therewith [1]. Anemia, a frequent complication of RYGB, and antihypertensive drugs, which may influence adipose tissue perfusion [4], could also interfere with LDF measurements. However, no indication relating to these specific issues was provided in the paper. Additionally, the chosen site of measurement stands out as another scientific issue, because subcutaneous adipose tissue in the thigh is known to be much less active than in abdomen [4]. Rossi et al.’s conclusion to the effect that the slight increase in ATBF, observed one year after RYGB, is rather negligible, is sustained by another study [5] reporting on ATBF following a very low-calorie diet

Sex hormone changes during weight loss and maintenance in overweight and obese postmenopausal African-American and non-African-American women

IntroductionChanges in sex hormones with weight loss might have implications for breast cancer prevention but have not been examined extensively, particularly in African-American (AA) women.MethodsWe conducted a prospective study of 278 overweight/obese postmenopausal women (38% AA) not taking hormone therapy within the Weight Loss Maintenance Trial. All participants lost at least 4 kg after a 6-month weight-loss phase and attempted to maintain weight loss during the subsequent 12 months. We evaluated the percentage changes in estrone, estradiol, free estradiol, testosterone, free testosterone, androstenedione, dehydroepiandrosterone sulfate and sex hormone-binding globulin (SHBG) using generalized estimating equations.ResultsIn all study phases, AA women had higher levels of estrogen and testosterone concentrations, independent of adiposity. On average, participants lost 7.7 kg during the weight-loss phase, and concentrations of estrone (-5.7%, P = 0.006), estradiol (-9.9%, P <0.001), free estradiol (-13.4%, P <0.0001), and free testosterone (-9.9%, P <0.0001) decreased, while the SHBG concentration (16.2%, P <0.001) increased. Weight change did not significantly affect total testosterone or other androgen concentrations. Compared with non-AA women, AA women experienced less change in estrogens per kilogram of weight change (that is, per 1 kg weight loss: estrone, -0.6% vs. -1.2%, P-interaction = 0.10; estradiol, -1.1% vs. -1.9%, P-interaction = 0.04; SHBG, 0.9% vs. 1.6%, P-interaction = 0.006; free estradiol, -1.4% vs. -2.1%, P-interaction = 0.01).ConclusionTo the best of our knowledge this is the first study to examine and compare the effects of intentional weight loss and maintenance on a panel of sex hormones in AA women and non-AA women. Although speculative, these data suggest hormonal differences may contribute to different racial patterns of breast cancer incidence and mortality and encourage further investigations to understand the long-term effects of weight loss on sex hormones in obese postmenopausal women.Trial RegistrationClinicalTrials.gov: NCT00054925

Effect of weight loss on metabolic control in people with type 2 diabetes mellitus: systematic review.

The aim of this systematic review was to examine randomized clinical trials (RCT) regarding long-term effects of weight loss (WL) on biological markers in people with type 2 diabetes mellitus (T2DM). We searched for articles published in English and Spanish recorded in the databases of Pubmed and Cochrane , and the journal collections platforms of Ebsco and Scielo between January 1, 2000 and January 1, 2010. Inclusion criteria included RCT with follow-up ≥ 12 months. A total of 842 articles were identified, 95 of them contained information on the effect of WL on biological markers. Twenty studies fulfilled the inclusion criteria. WL percentage ranged from 0.8 to 20%. A reduction of A1C was observed in nine studies, blood glucose in seven, of total cholesterol and LDL in four, systolic and diastolic blood pressure in three, and the use of hypoglycemic drugs in four; an increase of HDL was observed in seven studies. Remission of T2DM was reported in only one study, which included surgical treatment. The quality of the studies ranged from very low to high; however, the study with the longest follow-up that did not involve surgical treatment, was 52 months. The evidence of the beneficial effect of WL on biological markers on long-term studies in people with T2DM is inconclusive. These results warrant longer and better designed studies.

Long-Term Effect of Weight Loss on Body Composition and Performance in Elite Athletes

When weight loss (WL) is needed, it is recommended that athletes do it gradually by 0.5-1 kg/wk through moderate energy restriction. However, the effect of WL rate on long-term changes in body composition (BC) and performance has not been investigated in elite athletes. To compare changes in body mass (BM), fat mass (FM), lean body mass (LBM), and performance 6 and 12 mo after 2 different WL interventions promoting loss of 0.7% vs. 1.4% of body weight per wk in elite athletes. Twenty-three athletes completed 6- and 12-mo postintervention testing (slow rate [SR] n = 14, 23.5 ± 3.3 yr, 72.2 ± 12.2 kg; fast rate [FR] n = 9, 21.4 ± 4.0 yr, 71.6 ± 12.0 kg). The athletes had individualized diet plans promoting the predetermined weekly WL during intervention, and 4 strength-training sessions per wk were included. BM, BC, and strength (1-repetition maximum) were tested at baseline, postintervention, and 6 and 12 mo after the intervention. BM decreased by ~6% in both groups during the intervention but was not different from baseline values after 12 mo. FM decreased in SR and FR during the intervention by 31% ± 3% vs. 23% ± 4%, respectively, but was not different from baseline after 12 mo. LBM and upper body strength increased more in SR than in FR (2.0% ± 1.3% vs. 0.8% ± 1.1% and 12% ± 2% vs. 6% ± 2%) during the intervention, but after 12 mo there were no significant differences between groups in BC or performance. There were no significant differences between groups after 12 mo, suggesting that WL rate is not the most important factor in maintaining BC and performance after WL in elite athletes.

Comparative study of laparoscopic sleeve gastrectomy with and without partial enterectomy and omentectomy

BackgroundLaparoscopic sleeve gastrectomy (LSG) is a novel bariatric surgical procedure that constitutes the first-stage procedure of laparoscopic Roux-en-Y gastric bypass in high-risk patients, the long-term results of which are unknown. Our objective was to establish whether partial enterectomy and omentectomy are necessary in addition to LSG to achieve weight loss in obese patients. The setting was a case series in a provincial hospital. MethodsA total of 40 obese patients (29 women and 11 men) were separated into 2 equal groups according to patient choice. Group 1 underwent LSG alone, and group 2 underwent LSG plus partial enterectomy and omentectomy. The partial enterectomy left the first 100 cm of the jejunum and the last 200 cm of the ileum. The data were collected during the follow-up examinations, performed at 1, 3, 6, and 12 months postoperatively. ResultsThe body mass index loss (BMIL) was 3.9 ± .5 kg/m2 and 9.4 ± 1.3 kg/m2 at 1 and 12 months in group 1, respectively. The BMIL was 4.5 ± .9 kg/m2 and 10.4 ± 1.9 kg/m2 at 1 and 12 months in group 2, respectively. At 1 and 12 months postoperatively, the percentage of excess body weight loss was 32.2% ± 12.6% and 81.5% ± 20.4% in group 1 and 35.5% ± 10.5% and 83.8% ± 24.5% in group 2, respectively. Except for the BMIL at 1 month after surgery, no significant differences were found in the BMIL or percentage of excess body weight loss. ConclusionLSG with and without partial enterectomy and omentectomy in our study was an effective method of bariatric surgery, but they did not differ in their effect on weight loss. However, the long-term effect of weight loss with LSG alone or combined with partial enterectomy and omentectomy needs additional study.

One day of moderate energy deficit reduces fasting and postprandial triacylglycerolemia in women: The role of calorie restriction and exercise

Fasting and postprandial hypertriacylglycerolemia are important cardiovascular risk factors in women. We sought to examine the effects of acute (1 day), moderate ( approximately 2 MJ) energy deficit induced by calorie restriction, exercise, or combination of both on fasting and postprandial triacylglycerol (TAG) metabolism in women. Six healthy premenopausal women performed four oral fat tolerance tests in the morning after a day of a) rest (control), b) calorie restriction ( approximately 2 MJ), c) exercise (net deficit of approximately 2 MJ) and d) calorie restriction-plus-exercise (total energy deficit of approximately 2 MJ). All energy deficit trials significantly reduced fasting and postprandial total plasma TAG concentrations by 15-23% and 12-23%, respectively, and triacylglycerol-rich lipoprotein TAG concentrations by 37-43% and 25-39%, respectively, compared with the control condition (P<0.05). Postprandial, but not fasting, total TAG concentrations were approximately 12% lower after exercise compared with diet-induced energy deficit (P=0.05). Acute, moderate energy deficit independently of its origin (i.e. diet or exercise or combination of both) reduces fasting and postprandial triacylglycerolemia in women. Exercise elicits a somewhat greater effect than calorie restriction in the postprandial state. The acute effect of diet and exercise should be taken into account when studying the long-term effects of weight loss and exercise training on TAG metabolism.

Understanding Long-term Effects of Weight Loss

The majority of Americans enter midlife overweight or obese. With this excess weight come other cardiometabolic risk factors, and an inc easing propor ion of adults are living with chronic disease. For the growing segment of the middle-aged and older population who are overweight or mildly obese, the question might reasonably be asked, Does losing weight improve longevity? Conversely, Is it harmful for persons who are already overweight to continue gaining weight into old age? In this issue of Epidemiology, Myrskyla and Chang1 report that large weight loss was related to elevated mortality, with a much stronger association in persons with low body mass index (BMI) at baseline. Large weight gain was associated with mortality, but only in persons who were initially obese. No data were available to indicate whether subjects intended to lose weight. Although the authors do not state explicitly that they were evaluating the effects of purposeful or intentional weight loss, their extensive efforts to exclude the influence of disease-related weight loss in their analyses suggest that this was their aim. They concluded that they found no benefits to mortality from weight loss, whereas weight gain seemed to be harmless except in very obese persons. Can observational studies, using only observed body weight change and limited behavioral and health data, answer questions about the long-term benefits and harms of weight loss? Many previous studies have reported elevated risk of death in persons who have lost weight. Problems with interpreting these studies have been well described.2-7 The fundamental issue is that unintentional weight loss is common in older people8'9 and often caused by underlying disease or psychosocial problems that are themselves associ ated with increased mortality. If these conditions are undetected (or if necessary data are not available to the researcher), it is difficult to account for their effects. More recent studies have asked subjects whether they intended to lose weight. This strategy represents an advance, but it only partially disentangles intentional from unintentional weight loss7: among persons expressing the intent to lose weight, a substantial proportion of actual weight loss is likely the result of other causes such as stress or disease.7'10 To move the field forward, it will be necessary to collect much richer, denser, and more biologically relevant data. Others have already described the data and design elements needed to advance our understanding of the long-term harms and benefits of weight change.3'6'7'11 I will highlight 3 of these elements. In a commentary in Epidemiology 10 years ago, Tim Byers stated that epidemiol ogists had reached the limits of what could be learned in observational studies that simply estimate associations between undifferentiated weight loss and mortality.11 Byers called on epidemiologists to engage a major effort to uncover the specific reasons for weight change. Similar comments have been made by others.3 Byers noted that episodes of substantial weight loss, including unintentional weight loss, are common but poorly understood. He suggested the possibility of unintentional weight loss syndromes that could be precursors to chronic disease. Researchers now recognize and are beginning to understand several weight loss syndromes in older persons and in those with disease.12-14

¿Es sano perder peso?

This study was aimed at analysing the long-term effects of weight-loss on mortality. Studies available in the Pubmed database regarding the effect of weight-loss on mortality were analysed. Possible causes for inconsistencies amongst different studies and the biological rationale for the available evidence were studied. Most studies have suggested that being overweight and obesity are common risk factors for chronic diseases. However, most studies have also suggested that, independently of weight, a change in weight (increase or reduction) increases the risk of mortality when compared to maintaining a stable weight. The beneficial or adverse effect of weight-loss on mortality could depend on individuals' genetic characteristics, pre- and post-natal background, initial weight, the amount of weight lost, the time taken to lose weight and the strategies used for reducing weight.

Long-Term Weight Loss From Lifestyle Intervention Benefits Blood Pressure?

Weight gain may increase blood pressure. Weight loss may reduce this. Reviews have considered the long-term effects of weight loss but are related mainly to more obese participants often on obesity medication and/or undergoing obesity surgery. This systematic review, based on lifestyle interventions for adults (18 to 65 years) with mean baseline BMI of <35 kg/m(2), links weight change to blood pressure difference. A systematic review of studies reporting weight differences and blood pressure outcomes, published between 1990 and 2008 with follow-up of > or =2 years identified 8 clinical trials or controlled before and after studies (represented by 9 articles) and 8 cohort studies. Differences ranged from -11 to +4kg for weight, -7 to +2.2 mm Hg for diastolic blood pressure and -13 to +6.1 mm Hg for systolic blood pressure. For this population group, no quantifiable relationship between weight and diastolic blood pressure difference was found, possibly because of small weight losses, differing weight status responses, or because pharmacologically controlled hypertension masked weight loss influences. Systolic differences were in line with previous reviews of 1 kg:1 mm Hg relationship, but only for follow-up periods of 2 to 3 years, possibly reflecting the fact that regardless of maintained weight loss, blood pressure often reverts back to higher levels. Lifestyle interventions for weight and blood pressure are limited in this target group, and there has been no exploration of successful intervention components. An individual patient data analysis may uncover baseline and medication effects, explore differences between weight groups, and may identify successful components. Such an analysis would enable effective development of preventative interventions for both hypertension and obesity.

Long-Term Effects of Caloric Restriction or Exercise on DNA and RNA Oxidation Levels in White Blood Cells and Urine in Humans

Excessive adiposity is associated with increased oxidative stress and accelerated aging. Weight loss induced by negative energy balance reduces markers of oxidation in experimental animals and humans. The long-term effects of weight loss induced by calorie restriction or increased energy expenditure induced by exercise on measures of oxidative stress and damage have not been studied in humans. The objective of the present study was to compare the effects of 20% caloric restriction or 20% exercise alone over 1 year on oxidative damage to DNA and RNA, as assessed through white blood cell and urine analyses. Eighteen men and women aged 50 to 60 years with a body mass index (BMI) between 23.5 to 29.9 kg/m(2) were assigned to one of two conditions--20% CR (n = 9) or 20% EX (n = 9)--which was designed to produce an identical energy deficit through increased energy expenditure. Compared to baseline, both interventions significantly reduced oxidative damage to both DNA (48.5% and 49.6% reduction for the CR and EX groups, respectively) and RNA (35.7% and 52.1% reduction for the CR and EX groups, respectively) measured in white blood cells. However, urinary levels of DNA and RNA oxidation products did not differ from baseline values following either 12-month intervention program. Data from the present study provide evidence that negative energy balances induced through either CR or EX result in substantial and similar improvements in markers of DNA and RNA damage to white blood cells, potentially by reducing systemic oxidative stress.

Long-term effect of bariatric surgery on respiratory function in severe uncomplicated obesity

Background: Obesity can have profound adverse effects on the respiratory system. The long-term effects of weight loss attained by bariatric surgery on pulmonary function tests (PFT) are not well known. The aim of the study was to find out whether weight reduction induced by laparoscopic adjustable gastric banding is associated with a sustained improvement of the pulmonary functional parameters in the severely obese. Materials & methods: A consecutive series of 32 obese patients who had laparoscopic adjustable gastric banding were studied. BMI, walking distance, dyspnea and PFT were evaluated at baseline and after 12, 24 and 30 months after surgery. Results: 32 patients (24 females, age mean 36 ± 11 years) were evaluated. Mean BMI (kg/m2) decreased from 43 ± 6 before to 35 ± 5 12 months postoperatively. The BMI remained decreased 24 and 30 months after surgery. In obese PFT increased 12 months postoperatively and it remained increased 24 and 30 months after bariatric surgery. Similarly, the distance walked...

Weight Loss in Overweight Adults and the Long-term Risk of Hypertension

Few studies address long-term effects of weight loss on risk of incident hypertension among overweight adults. We evaluated weight loss among 623 overweight (body mass index [calculated as weight in kilograms divided by the square of height in meters] >/=25) middle-aged (aged 30-49 years) and 605 overweight older (aged 50-65 years) adults in Framingham, Mass. Subjects were classified first according to amount of weight lost over 4 years: (1) weight changed by less than 1.8 kg (stable weight), (2) lost 1.8 to less than 3.6 kg, (3) lost 3.6 to less than 6.8 kg, and (4) lost 6.8 kg or more. We also classified weight loss according to whether it was sustained during the next 4 years. After adjusting for age, sex, education, baseline body mass index, height, activity, smoking, and alcohol intake, weight loss of 6.8 kg or more led to a 21% to 29% reduction in long-term hypertension risk. After adjusting for cancer or cardiovascular disease occurring during follow-up, weight loss of 6.8 kg or more led to a 28% reduction in risk (relative risk [95% confidence interval], 0.72 [0.49-1.05]) for middle-aged adults and a 37% reduction (0.63 [0.42-0.95]) for older adults. Sustained weight loss led to a 22% reduction in hypertension risk (0.78 [0.60-1.03]) among middle-aged and a 26% reduction (0.74 [0.56-0.97]) in older adults. This risk reduction was strengthened by adjustment for prevalent cancer or cardiovascular disease during follow-up. A modest weight loss, particularly when sustained, substantially lowers the long-term risk of hypertension in overweight adults.

Intention to Lose Weight, Weight Changes, and 18-y Mortality in Overweight Individuals without Co-Morbidities

BackgroundWeight loss in the obese improves risk factors for cardiovascular diseases and diabetes. However, several studies have shown inconsistent long-term effects of weight loss on mortality. We investigated the influence on mortality of intention to lose weight and subsequent weight changes among overweight individuals without known co-morbidities.Methods and FindingsIn 1975, a cohort of individuals reported height, weight, and current attempts (defined as “intention”) to lose weight, and in 1981, they reported current weight. Mortality of the 2,957 participants with body mass index ≥ 25 kg/m2 in 1975 and without pre-existing or current diseases was followed from 1982 through 1999, and 268 participants died. The association of intention to lose weight in 1975 and actual weight change until 1981 with mortality was analysed while controlling for behavioural and psychosocial risk factors and hypertension as possible confounders. Compared with the group not intending to lose and able to maintain stable weight, the hazard ratios (with 95% confidence intervals) in the group intending to lose weight were 0.84 (0.49–1.48) for those with stable weight, 1.86 (1.22–2.87) for those losing weight, and 0.93 (0.55–1.56) for those gaining weight. In the group not intending to lose weight, hazard ratios were 1.17 (0.82–1.66) for those who did lose weight, and 1.57 (1.08–2.30) for those gaining weight.ConclusionDeliberate weight loss in overweight individuals without known co-morbidities may be hazardous in the long term. The health effects of weight loss are complex, possibly composed of oppositely acting processes, and need more research.

Long-Term Effects of Low-Calorie Diet on the Metabolic Syndrome in Obese Nondiabetic Patients

The prevalence of obesity is increasing among western populations, bringing about a parallel rise in the prevalence of the metabolic syndrome (1), which is strictly related to overweight (2). There is full agreement that lifestyle changes primarily focused on weight reduction are the first-line approach to patients with the metabolic syndrome (3). In short-term trials, even a modest weight reduction has been shown to favorably affect the components of the metabolic syndrome such as hypertension, lipid abnormalities, and glycemic control (4–8). The long-term effects of weight loss on the cluster of factors that comprise the metabolic syndrome have been studied in both overweight (9) and mildly obese (10) patients. We report here the extent to which a 2-year treatment program with a low-calorie, low-fat diet altered components of the metabolic syndrome in obese, nondiabetic patients presenting with the syndrome. The local ethics committee reviewed and approved the study, and each eligible participant gave written informed consent. We enrolled 41 patients (30 women and 11 men, age 58.7 ± 11.27 years [means ± SD]) with the metabolic syndrome as diagnosed according to the criteria of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATPIII) (2). The inclusion criteria were age >18 years, BMI ≥30 kg/m2, and a willingness to adhere to the prescribed diet. The exclusion criteria …

Effects of Weight Loss in Overweight/Obese Individuals and Long-Term Hypertension Outcomes

Many studies have assessed short-term effects of weight loss on blood pressure, whereas little attention has been paid to long-term effects. We conducted a systematic review to evaluate the long-term effects of weight loss on hypertension outcome measures in adults using literature published from 1966 to 2001. All prospective studies and trials, performed on participants with body mass index of > or =28 kg/m2 with a follow-up of >2 years and weight changes recorded, were included. The data from these studies were used to model the long-term effects on blood pressure. Previous reviews on shorter-term studies indicate a 1:1 drop in blood pressure (mm Hg) with weight loss (kilograms). Our findings, based on studies with follow-up of > or =2 years, demonstrate blood pressure decreases less than this after weight loss. The surgical intervention studies exhibited huge weight losses with undramatic blood pressures changes. When surgical interventions are excluded, the models suggest that for 10 kg weight loss, decreases of 4.6 mm Hg and 6.0 mm Hg in diastolic and systolic blood pressure, respectively, may be expected, about half of that predicted from the short-term trials. Initial blood pressure, the length of follow-up, medication changes, and physiological restrictions may contribute to this reduced effect in the long-term studies. Extrapolation of short-term blood pressure changes with weight loss to the longer term is potentially misleading. The weight/hypertension relationship is complex and needs well-conducted studies with long-term follow-up to examine the effects of weight loss on hypertension outcomes.