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University of Copenhagen - The Faculty of Health and Medical Sciences
The
condition is associated with increased risk for early death, as well as
sequelae such as Type 2 diabetes, cardiovascular diseases, cancer, and
infertility.
Weight
regain after an initial successful weight loss in people with obesity,
constitutes an important and unsolved problem. Until now, no well-documented
study on which treatment method is best for maintaining a healthy weight loss has
been available.
Researchers at University of Copenhagen and Hvidovre Hospital have completed a new, sensational study, which is being published in the world's most quoted medical journal, The New England Journal of Medicine.
By testing four
different types of treatment following a diet-induced weight loss, the
researchers demonstrate for the first time how it is possible for people with
obesity to maintain long-term weight loss, says Professor Signe Torekov at the
Department of Biomedical Sciences.
In
a randomized clinical trial, the group of researchers has demonstrated a highly
effective treatment after a diet-induced weight loss, by combining moderate to
vigorous-intensive exercise with appetite-inhibiting obesity medication, an
analogue to the appetite-inhibiting hormone GLP-1.
"This is new knowledge for doctors, dietitians and physical therapists to use in practice. This is evidence that we have been missing," explains Signe Torekov, who has been heading the study.
"The
problem is that people are fighting against strong biological forces when
losing weight. The appetite increases simultaneously with decreased energy
consumption, and this counteracts weight loss maintenance. We have an
appetite-stimulating hormone, which increases dramatically when we lose weight,
and simultaneously the level of appetite-suppressing hormones drops
dramatically. In addition, a weight loss can provoke loss of muscle mass, while
the body reduces the energy consumption. Thus, when the focus in obesity
treatment has been on how to obtain a weight loss -- rather than how to
maintain a weight loss -- it is really difficult to do something about your
situation," says Signe Torekov.
Highly
efficient when combining treatments
215
Danes with obesity and low fitness ratings participated in the study. The
participants initially followed a low calorie diet over eight weeks, where they
each lost approximately 13 kg, which brought significant improvements to their
health with a drop in blood sugar level and blood pressure.
The participants were then randomly divided into four groups. Two of the groups received placebo medication, while the two other groups received obesity medication. Among the two placebo groups, one group followed an exercise program of minimum 150 minutes of physical activity at moderate intensity or 75 minutes at vigorous-intensity during the week or a combination of the two, while the other group maintained their current level of physical activity.
The
two groups receiving obesity medication were similarly divided into one group
with and one group without an exercise program.
All
participants in the study were weighed monthly and received nutritional and
diet counseling with the focus on healthy weight loss according to the
guidelines from the Danish health and food administrations.
After
one year, the group with exercise alone and the group with obesity medication
alone maintained the weight loss of 13 kg and health improvements. The placebo
group gained half of the weight back with deterioration of all risk factors,
for example for development of Type 2 diabetes and cardiovascular disease.
The
most dramatic improvements occurred in the combination group, which followed
the exercise program and received obesity medication. The researchers observed
additional weight loss in this group, and the total weight loss was
approximately 16 kg over one year. The health benefits were also double that of
each of the single treatments, i.e., twice the loss of fat mass while
preserving muscle mass, higher fitness ratings, reduced blood sugar and
improved quality of life.
The
two groups that exercised increased their fitness rating, lost fat mass, and
gained muscle mass. This could indicate a healthier weight loss than for
people, who had only lost fat mass without increasing the fitness rating.
"It
is an important aspect to highlight, as you do not necessarily get a healthier
body from losing weight if, at the same time, you lose a lot of muscle
mass," says Signe Torekov.
"It
is great news for public health that a significant weight loss can be
maintained with exercise for approximately 115 minute per week performed mostly
at vigorous-intensity, such as cycling. And that by combining exercise with
obesity medication, the effect is twice as good as each of the individual
treatments." "
With
the study, the researchers now hope people with obesity, together with their
care provider, can create a useful framework for maintaining the weight loss.
Fundamental
lifestyle change
Signe
Torekov points out that many people with obesity have tried to lose weight
before, only to regain the weight. This happens, because the general advice is
to eat healthier and exercise more.
"Without
a follow-up on whether people actually have support to perform exercise, the
treatment will not be enough. Therefore, we also followed up with the
participants on an ongoing basis to ensure that they received the support they
needed in order to exercise. That is necessary, because maintaining weight loss
is extremely hard. People need to understand this. Once you have lost weight,
you are not 'cured.' The ongoing exercise and effort will
likely need to continue for many years," says Signe Torekov.
"Our
study also demonstrates that without a structured treatment plan, there is a
high risk of gaining the weight back. There were 12 individual consultations
over the course of a year, including weighing and diet advice from Danish
authorities according to guidelines for healthy weight maintenance. This was
just not enough for the placebo group without exercise program, in this group
all health benefits gained by weight loss during the eight week program were
gone after one year, despite frequent weighing and diet and nutritional
counseling based on official guidelines." Torekov says.
According
to Signe Torekov, this underscores the importance of participating in a mutual
weight maintenance program based on feedback when starting a weight loss
programme.
"Therefore,
it is important that there is a system for supporting people with obesity in
maintaining the lifestyle change. Our study can help with this, because we can
say this actually works to doctors, dietitians and municipalities, if they
create a structured, joint treatment plan with the individual using ongoing
follow-ups," says Torekov.
