Early weight loss among patients with type 2 diabetes who are attending weight management programmes is a strong indicator of future success, according to UK researchers.
In contrast, they found that diabetes patients who fail to lose at least 0.5% of their body weight after the first three sessions of a programme are unlikely to succeed in reaching their weight loss goal.
“If we knew early on which participants were unlikely to succeed, we could switch them to other interventions”
Following this “simple rule of thumb” would allow those who are likely to struggle with weight loss to be identified early and offered alternative treatment, suggested the study authors.
The research was carried out by Lulwa Al-Abdullah, of the University of Glasgow, and Professor Jennifer Logue, from Lancaster University.
The pair noted that behavioural weight management programmes provided support on changing eating, physical activity and behavioural habits.
Such programmes are often run by commercial groups such as WW – formerly known as Weight Watchers – and Slimming World.
They typically aim to help participants lose more than 5% of their body weight over a period of around 12 weeks, with attendees also given advice on weight maintenance.
The researchers analysed the health records of adults with type 2 diabetes and obesity who were referred to the NHS Greater Glasgow and Clyde Weight Management Service from 2004-14.
The 1,658 participants had been diagnosed with type 2 diabetes for a median of 5.3 years and had a median body mass index of 40.2 kg/m2 and an average age of 57.8 years.
A successful short-term outcome was defined by the researchers as attending seven out of nine weight management sessions held over 16 weeks and losing over 5% body weight.
Participants who maintained weight loss of over 5% three years afterwards, and who also a successful short-term outcome, were classed as having a successful medium-term outcome.
The study found that 20% of participants had a successful short-term outcome and the only demographic or clinical factor associated with it was early weight loss.
Specifically, 90.4% of those who lost 0.5% of their weight after the first three sessions – held over four weeks – had a successful short-term outcome.
None of the other factors studied – including age, sex, socioeconomic status, ethnicity, diabetes medication and HbA1c – were found to be associated with short-term success.
For the 1,152 participants for which three-year data was available, 12.1% had a successful medium-term outcome. Again, early weight loss was the only factor associated with success.
For example, 89.9% of those who lost 0.5% of their weight after the first three sessions had a successful medium-term outcome at three years.
Overall, the threshold of failing to achieve 0.5% body weight loss in the first three sessions was 95% accurate at identifying participants who would not succeed in the programme.
“Early review is standard practice in our treatment of other conditions such as diabetes and high blood pressure”
As a result, the researchers concluded that early weight loss was strongly associated with short- and medium-term success and provided a simple way of identifying, early on, who was likely to struggle.
Ms Al-Abdullah said: “Such programmes help some, but not all, people living with obesity – around 40% do not achieve significant weight loss.
“If we knew early on which participants were unlikely to succeed, we could switch them to other interventions, including pharmacological options, when they are still highly motivated.
“It is likely the first few weeks are so important because this is the time when people are having to adapt their shopping, eating, cooking and physical activity behaviour to follow whatever the programme recommends,” she noted.
She added: “They will also need to understand the programme, have support from family and friends and be able to afford the food the diet plan suggests.
“This is a large behavioural change and also assumes that there are not underlying differences in appetite control and psychological conditions that will affect their ability to make these changes.”
Professor Logue, who led the research, noted that people were currently referred to programmes in a ‘one- size-fits-all’ model and had no alternative other than to drop out if they were struggling.
“This can have a wider health impact, as it may worsen self-stigma and feelings of failure and result in reluctance to visit healthcare professionals in future,” she said.
She added: “Early review is standard practice in our treatment of other conditions such as diabetes and high blood pressure, and our findings will allow it to become standard in treating obesity.”
The research is due to be presented at the annual meeting of the European Association for the Study of Diabetes in Stockholm later this month.