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Health Benefits Of Intentional Long-Term Weight Loss?



sharma-obesity-doctor-kidDespite the difficulties inherent in achieving AND maintaining long-term weight loss, the health benefits for those who manage to do so are widely believed to be substantial.

While the health benefits associated with intentional weight loss for some complications of obesity (such as elevated lipids and diabetes) are well documented, high-quality studies to back many other potential health benefits are harder to find.

Just how well (or poorly) the putative health benefits of long-term intentional weight loss are documented for each of the many conditions associated with obesity, is now detailed in a comprehensive review of the literature that we just published in the Annual Reviews of Nutrition.

The 40 page long review, which includes almost 250 relevant publications, supports the following main findings:

  1. Defining and assessing clinically relevant obesity and weight change are challenging  tasks. In a given individual, there is often little relationship between the magnitude of obesity and measures of health.
  2. Despite its modest effect on long-term weight loss, behavioral modifications thatimprove eating behaviors and increase physical activity constitute a cornerstone for integral and sustainable weight management.
  1. Intentional weight loss is associated with a clinically relevant reduction in blood pressure, improvement in cardiac function, and reduction in cardiovascular events. The duration and magnitude of weight change required to achieve a significant benefit are still unclear.
  2. In individuals with impaired glucose metabolism at any stage, intentional weight loss achieved by any means is associated with a proportional reduction in T2DM prevalence, severity, and progression.
  3. Intentional weight loss is consistently associated with a clinically relevant reduction in triglycerides and increase in HDL cholesterol. The effects of weight loss on LDL cholesterol are less consistent.
  4. Overall, nonalcoholic fatty liver disease is commonly associated with excess weight and can show marked improvement with behavioral, pharmacological, and/or surgical weight loss. Very rapid weight loss, however, may worsen liver histology in some patients. Simi- larly, gallbladder disease is not only common in patients presenting with obesity but also highly prevalent after intentional weight loss.
  5. Obesity is widely recognized as a key modifiable risk factor for osteoarthritis, with sig- nificant improvements in pain and function reported with weight loss.
  6. Obstructive sleep apnea and obesity hypoventilation syndrome tend to improve with moderate weight loss; however, complete resolution is not common and is related to very significant weight loss.
  7. Asthma and COPD are clearly associated with obesity. Sustained weight loss seems to be associated with a significant improvement in asthma symptoms. Data for COPD are rather limited.
  8. Pregnant women who under go bariatric surgery seem to be less likely to present obstetric complications such as gestational diabetes, preeclampsia, and macrosomia.
  9. Data on weight loss and suicide are controversial. Caution may be in order when con- sidering bariatric surgery in patients with a history of suicide ideation or attempt.
  10. Data suggest that long-term weight loss is associated with an improvement in health- related quality of life. The amount of weight loss required to achieve a significant change, however, remains controversial.

However, there are many other issues where putative benefits of intentional weight loss remain even less clear than with the above.

For many conditions we will likely not know the long-term benefits of obesity treatments till better treatments become available and are tested in affected individuals.

@DrSharma
Kananaskis,AB

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