Influencers of weight re-gain following intensive weight loss in overweight and obese pre-diabetic adults: An investigation into long-term weight re-gain and weight loss maintenance after a 2-month Low Energy Diet induced weight loss period

Abstract

Background: Obesity and overweight are fundamental risk factors for the development of chronic diseases such as type-2 diabetes mellitus. Body weight loss in obese and overweight individuals of 5-10% is proven to reduce the risk of development and progression to such chronic illness. However, long-term weight loss maintenance, lasting >6 months, is often not achieved by individuals and consequential weight re-gain occurs. Aim: The aim of this study was to identify variables which are correlated with long-term weight re-gain, following a 2-month Low Energy Diet (LED) weight loss intervention. Methods: Methodology followed protocol set by the overarching ‘Prevention of diabetes through lifestyle intervention in New Zealand and around the world’ (PREVIEW) 3-year trial. Forty-nine obese and overweight pre-diabetic adults undertook phase 1: 2-month Low Energy Diet intervention (LED), losing ≥8% of baseline body weight. Followed by phase 2: 16-month weight loss maintenance period, supported by dietary changes and group education sessions. Anthropometry, dietary composition, perceived stress, and group education attendance data were recorded. Participants were followed up at 12-month and 18-month timepoints. Results: At 18-month follow-up, 35% of participants maintained ≥8% weight loss, and the remaining 65% re-gained lost body weight. Mean rate of weight loss during the LED period was not significantly different between maintainers and re-gainers (P=0.8266). Similarly, quantity of weight loss was not significant between groups in both absolute (P=0.833) and relative (P=0.177) terms. Mean (SD) percentage energy from carbohydrates was significantly (P=0.024) greater in re-gainers compared with maintainers; 41.6%(1.4) and 35.5%(2.5) respectively. Maintainers attended a significantly (P=0.015) greater percentage of group education sessions compared with re-gainers. Conclusions: Long-term weight loss maintenance was not correlated with rate and quantity of weight loss during the 2-month LED period. However, a greater rate and quantity of weight loss was linked with greater body weight re-gain in the 16-month maintenance period following the LED phase. Carbohydrate intake, presented as en%, was significantly greater in long-term re-gainers, compared with maintainers. Additionally, appointment attendance to group counselling sessions throughout the trial period from base line to 18-month follow-up, was significantly greater in maintainer participants.