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Lifestyle Management of Adult Obesity

Health Benefits of Intentional Weight Loss

Prospective epidemiological studies have shown that weight loss, weight gain, and weight cycling (frequent episodes of weight loss and regain) are all related to increased mortality compared with a stable weight. [24] Since unintentional weight loss is often associated with symptomatic disease, it is apparent why mortality might be increased. Weight gain clearly increases the prevalence of several risk factors for chronic disease and, thereby, would be expected to increase morbidity and mortality. Recent studies also have demonstrated that weight cycling is associated with increased health risks. [25] [26] [27] Many epidemiological studies of weight loss have not adequately addressed these issues creating confusion among the public. It is the author's perspective that the evidence regarding sustained weight loss in adulthood clearly supports the health benefits of intentional weight loss and maintenance.

Numerous studies show that weight loss, even if only 5-10%, significantly improves lipoproteins, [28] [29] hypertension, [30] DM and insulin resistance, [31] risk for osteoarthritis and it's symptoms, [32] risk for selected cancers, [33] and other risk factors for chronic diseases. [34]

A recent study from Finland of nearly 500 men and women at risk for type 2 DM who were randomized to intensive lifestyle modifications or standard care found a 58% reduction in new cases of DM over three years. [35] None of the subjects who achieved all five study goals (weight loss of 5-10%, 30-45 minutes of physical activity, 4-5 days per week, < 30% fat calorie intake, < 10% saturated fat calorie intake, and 15 grams of fiber per 1000 calories) developed DM. This study was a multifactorial design, but included common lifestyle changes (i.e., increased physical activity and a 30% or less fat diet with increased fiber) aimed at weight loss. Clearly even small amounts of weight loss can significantly improve risk factors for CVD and other chronic diseases. However, it is not clear whether the benefits of moderate weight loss are sustained long term. One basic problem has been the inability to successfully maintain significant long-term weight loss. The Finnish study which was the first published randomized clinical trial of diabetes prevention through lifestyle changes suggests that sustained modest weight losses of 5% of bodyweight can indeed reduce the risk of developing a chronic disease. [35]

Several recent large prospective studies suggest that intentional weight loss is associated with decreased mortality. [33] [36] [37] One study of 43,457 women found that any amount of intentional weight loss resulted in health benefits. [33] In this study, women who intentionally lost weight had a 40-50% decrease in deaths from obesity-related cancers and a 30-40% decrease in death from type 2 DM. Another study of 49,337 men reported a 32-36% decline in death from DM among men with health problems who intentionally lost weight. [37]

It is beyond the scope of this case to thoroughly review and discuss the benefits of intentional weight loss. However, it seems clear that numerous health benefits are potentially derived from weight loss, particularly when it is intentional and sustained over the long term. Throughout the management plan for the case study presented in this paper, additional evidence will be provided for the health benefits associated with intentional weight loss.