Lancaster University: Weight loss in first three sessions of weight management programmes predicts success

Early weight loss in people with type 2 diabetes attending weight management programmes is a strong indicator of future success say researchers led by Lancaster University.

In contrast, people with type two diabetes who fail to lose at least 0.5% of their body weight after the first three sessions of a weight management programme are unlikely to succeed in reaching their weight loss goal.

The research was led by Professor Jennifer Logue, of Lancaster Medical School, with Lulwa Al-Abdullah of the University of Glasgow and colleagues.

They found that behavioural weight management programmes provide support on changing eating, physical activity and behavioural habits. They are often run by commercial groups such as WW (formerly known as Weight Watchers) and Slimming World and typically aim to help participants lose more than 5% of their body weight over a period of around 12 weeks. Attendees are also given advice on weight maintenance.

Professor Logue, who led the research, says: “Currently, people are referred to weight management programmes in a ‘one- size-fits-all’ model and, if they are struggling, they have no alternative other than to drop out.

“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.

“By identifying those individuals for whom a programme is not working early in the process, you can provide support and possibly alternative therapies before the person disengages from treatment.

“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 the treatment of obesity.”

The research was presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Stockholm, Sweden.

Ms Al-Abdullah from the University of Glasgow 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.”

To find out more, the researchers carried out a longitudinal analysis of the electronic health records of adults living with type two diabetes and obesity referred to the NHS Greater Glasgow and Clyde Weight Management Service from 2004-2014.

They looked for demographic and clinical factors which predicted successful weight loss.

The 1,658 participants (60% female) had been diagnosed with type two diabetes for a median of 5.3 years. They had a median BMI of 40.2 kg/m2 and an average age of 57.8 years.

A successful short-term outcome was defined as attending seven out of nine weight management sessions held over 16 weeks and losing more than 5% body weight.

Participants who maintained weight loss of more than 5% three years on, and who also had a successful short-term outcome, were classed as having a successful medium-term outcome.

333 (20%) of participants had a successful short-term outcome. The only demographic or clinical factor associated with a successful short-term outcome was early weight loss.

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, HbA1c (average blood sugar level), were associated with short-term success.

Three-year data was available on 1,152 participants and 12.1% (139) of these had a successful medium-term outcome.

As before, early weight loss was on the only factor associated with success.

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 wouldn’t succeed in the programme.

The researchers conclude that early weight loss is strongly associated with short and medium-term success and so provides a simple way of identifying, early on, who is likely to struggle to lose weight.

They add that the NHS-run scheme they studied is similar to other programmes in the UK.

Ms Al-Abdullah said: “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.

“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.”