Early weight-loss success identifies nonresponders after a lifestyle intervention in a worksite diabetes prevention trial

Abstract

Background: People with prediabetes are at increased risk for developing type 2 diabetes mellitus. Weight reduction through lifestyle modification can significantly reduce diabetes risk. Yet, weight loss varies among individuals and some people do not achieve clinically meaningful weight loss after treatment.

Objective: Our aim was to evaluate the time point and threshold for achieving ≥5% weight loss after completion of a 16-week worksite, lifestyle intervention for diabetes prevention.

Design: Weight change before and after the behavioral intervention among participants randomized to the experimental group was examined.

Participants/setting: Individuals with prediabetes aged 18 to 65 years with a body mass index (calculated as kg/m(2)) of 25 to 50 at Ohio State University were eligible.

Intervention: The 16-week, group-based intervention, adapted from the Diabetes Prevention Program, was delivered to 32 participants in the experimental group.

Main outcome measures: Percent weight loss was assessed weekly during the intervention and at 4- and 7-month follow-up.

Statistical analyses performed: Linear regression modeled the relationship between percent weight loss during month 1 of the intervention and percent weight loss at 4 and 7 months. Logistic regression modeled failure to lose ≥5% weight loss at 4 and 7 months using weekly weight change during the first month of intervention.

Results: Percent weight loss at intervention week 5 was significantly associated with percent weight loss at 4 and 7 months (all P<0.001). Only 11.1% and 12.5% of participants who failed to achieve a 2.5% weight-loss threshold during month 1 achieved ≥5% weight loss at months 4 and 7, respectively.

Conclusions: The first month of lifestyle treatment is a critical period for helping participants achieve weight loss. Otherwise, individuals who fail to achieve at least 2.5% weight loss may benefit from more intensive rescue efforts or stepped-care interventions.

Trial registration: ClinicalTrials.gov NCT01682954.

Keywords: Diabetes prevention; Predictive value; Sensitivity; Specificity; Weight-loss success.

Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

The relationship between percent weight change at week 5 of the intervention and percent weight change at 4-month follow-up among employees enrolled in a worksite lifestyle intervention (n=31)

Figure 2

The relationship between percent weight change at week 5 of the intervention and percent weight change at 7-month follow-up among employees enrolled in a worksite lifestyle intervention (n=31)