Elizabeth Morris1, Susan A Jebb1, Jason Oke1, Alecia Nickless2, Amy Ahern3, Emma Boyland4, Ian D Caterson5, Jason Halford6, Hans Hauner7, Paul Aveyard1. 1. Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road; NIHR Oxford Biomedical Research Centre, Oxford, UK. 2. Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford; Exploristics Ltd., Belfast, UK. 3. MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK. 4. Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK. 5. SoLES, University of Sydney, Boden Collaboration, Charles Perkins Centre, University of Sydney, Australia. 6. Psychology, University of Leeds, Leeds, UK; president of the European Association for the Study of Obesity. 7. Chair of nutritional medicine and director of the Else Kröner-Fresenius-Centre of Nutritional Medicine, Technical University of Munich, Munich, Germany.
Abstract
BACKGROUND: Guidelines recommend that clinicians identify individuals at high cardiometabolic risk and support weight loss in those with overweight or obesity. However, we lack individual level data quantifying the benefits of weight change for individuals to guide consultations in primary care. AIM: To examine how weight change affects cardiometabolic risk factors, and to facilitate shared decision making between patients and clinicians regarding weight loss. DESIGN AND SETTING: Observational analysis using data from two trials of referral of individuals with overweight or obesity in primary care to community weight-loss groups. METHOD: Linear mixed effects regression modelling examining the association between weight change and change in systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose, glycated haemoglobin (HbA1c), and lipid profile across multiple timepoints (baseline to 24 months). Subgroup analyses examined changes in individuals with hypertension, diabetes, and hyperlipidaemia. RESULTS: In total, 2041 participants had a mean (standard deviation) age of 50 (SD 13.5) years, mean baseline weight of 90.6 (14.8) kg and mean body mass index (BMI) of 32.7 (SD 4.1) kg/m2. Mean (SD) weight change was -4.3 (SD 6.0) kg. All outcome measures showed statistically significant improvements. Each 1 kg weight loss was associated with 0.4 mmHg reduction in SBP and 0.3 mmHg reduction in DBP, or 0.5 mmHg and 0.4 mmHg/kg respectively in people with hypertension. Each 1 kg weight loss was associated with 0.2 mmol/mol reduction in HbA1c, or 0.6 mmol/mol in people with diabetes. Effects on plasma lipids were negligible. CONCLUSION: Weight loss achieved through referral to community weight-loss programmes, which are commonly accessible in primary care, can lead to clinically relevant reductions in BP and glucose regulation, especially in those at highest risk.
BACKGROUND: Guidelines recommend that clinicians identify individuals at high cardiometabolic risk and support weight loss in those with overweight or obesity. However, we lack individual level data quantifying the benefits of weight change for individuals to guide consultations in primary care. AIM: To examine how weight change affects cardiometabolic risk factors, and to facilitate shared decision making between patients and clinicians regarding weight loss. DESIGN AND SETTING: Observational analysis using data from two trials of referral of individuals with overweight or obesity in primary care to community weight-loss groups. METHOD: Linear mixed effects regression modelling examining the association between weight change and change in systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting glucose, glycated haemoglobin (HbA1c), and lipid profile across multiple timepoints (baseline to 24 months). Subgroup analyses examined changes in individuals with hypertension, diabetes, and hyperlipidaemia. RESULTS: In total, 2041 participants had a mean (standard deviation) age of 50 (SD 13.5) years, mean baseline weight of 90.6 (14.8) kg and mean body mass index (BMI) of 32.7 (SD 4.1) kg/m2. Mean (SD) weight change was -4.3 (SD 6.0) kg. All outcome measures showed statistically significant improvements. Each 1 kg weight loss was associated with 0.4 mmHg reduction in SBP and 0.3 mmHg reduction in DBP, or 0.5 mmHg and 0.4 mmHg/kg respectively in people with hypertension. Each 1 kg weight loss was associated with 0.2 mmol/mol reduction in HbA1c, or 0.6 mmol/mol in people with diabetes. Effects on plasma lipids were negligible. CONCLUSION: Weight loss achieved through referral to community weight-loss programmes, which are commonly accessible in primary care, can lead to clinically relevant reductions in BP and glucose regulation, especially in those at highest risk.
Authors: Douglas G Manuel; Jenny Lim; Peter Tanuseputro; Geoffrey M Anderson; David A Alter; Andreas Laupacis; Cameron A Mustard Journal: BMJ Date: 2006-03-18
Authors: Judith E Neter; Bianca E Stam; Frans J Kok; Diederick E Grobbee; Johanna M Geleijnse Journal: Hypertension Date: 2003-09-15 Impact factor: 10.190
Authors: Amy L Ahern; Graham M Wheeler; Paul Aveyard; Emma J Boyland; Jason C G Halford; Adrian P Mander; Jennifer Woolston; Ann M Thomson; Melina Tsiountsioura; Darren Cole; Bethan R Mead; Lisa Irvine; David Turner; Marc Suhrcke; Laura Pimpin; Lise Retat; Abbygail Jaccard; Laura Webber; Simon R Cohn; Susan A Jebb Journal: Lancet Date: 2017-05-03 Impact factor: 79.321