Long-term impact of the metabolic status on weight loss-induced health benefits

Abstract

Background: While short-term effects of weight loss on quality of life and metabolic aspects appear to be different in metabolically healthy (MHO) and metabolically unhealthy obese (MUO), respective long-term data is still missing. Given the high relevance of long-term changes, we aimed to address these in this post-hoc analysis of the MAINTAIN trial.

Methods: We analyzed 143 overweight/obese subjects (BMI ≥ 27 kg/m2, age ≥ 18 years) before and after a 3-month weight loss program (≥ 8% weight loss), after a 12-month period of a randomized weight maintenance intervention (n = 121), and after another 6 months without intervention (n = 112). Subjects were retrospectively grouped into MHO and MUO by the presence of metabolic syndrome and secondarily by estimates of insulin sensitivity (HOMA-IR and ISIClamp). Quality of life (QoL), blood pressure, lipids, HOMA-IR, and ISIClamp were assessed and evaluated using mixed model analyses.

Results: Despite similar short- and long-term weight loss, weight loss-induced improvement of HOMA-IR was more pronounced in MUO than MHO after 3 months (MHO: 2.4[95%-CI: 1.9-2.9] vs. 1.6[1.1-2.1], p = 0.004; MUO: 3.6[3.2-4.0] vs. 2.0[1.6-2.4], p < 0.001; p = 0.03 for inter-group comparison). After 21 months, the beneficial effect was no longer seen in MHO (2.0[1.5-2.6], p = 1.0), while it remained partially preserved in MUO (2.9[2.4-3.3], p = 0.002). QueryShort-term improvements of lipid parameters were similar in both groups. However, long-term improvements of HDL-cholesterol and triglycerides were only seen in MUO (44.4[41.5-47.4] vs. 49.3[46.2, 52.3] mg/dl, p < 0.001; 176.8[158.9-194.8] vs. 138.8[119.4-158.3] mg/dl, p < 0.001, respectively) but not in MHO. Weight loss-induced improvements in the QoL and particularly the physical health status were maintained in MUO until the end of the trial, while benefits disappeared over time in MHO. Group allocation by HOMA-IR and ISIClamp revealed higher benefits for MUO mainly in parameters of the glucose metabolism and QoL.

Conclusions: Our data demonstrates stronger and longer-lasting improvements of metabolism and QoL in MUO after weight loss. Trial registration (ClinicalTrials.gov): NCT00850629. Registered 25 February 2009, https://ichgcp.net/clinical-trials-registry/NCT00850629 .

Keywords: Healthy obesity; Insulin sensitivity; Quality of life; Weight loss.

Conflict of interest statement

We declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

© 2022. The Author(s).

Figures

Fig. 1

Effect of weight loss and maintenance on patient-reported quality of life in MHO/MUO. A, B MHO + MUO were assigned following the IDF criteria for metabolic syndrome. C, D MHO + MUO were assigned on the basis of HOMA-IR. E, F MHO + MUO were assigned on the basis of ISIClamp. Values represent estimated marginal means with 95% confidence intervals from model with adjustment to sex, age, and randomization. *p < 0.05, **p < 0.01, ***p < 0.001 vs. T-3 in respective group. Where indicated, †/††/††† describe between-group comparisons, respectively. SF-36 Short Form (36) Health Survey, PCS physical component summary score, MCS mental component summary score

Fig. 2

Effect of weight loss and maintenance on insulin resistance (adjusted for BMI) in MHO/MUO. MHO + MUO were assigned following the IDF criteria for metabolic syndrome. Values represent estimated marginal means with 95% confidence intervals from model with adjustment to sex, age, randomization, and BMI at all time-points. * p < 0.05, ** p < 0.01, *** p < 0.001 vs. T-3 in respective group