To Lose Weight and Keep It Off

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New research finds lifestyle changes combined with weight loss drugs enabled people with obesity and overweight to maintain a weight loss of nearly 11 percent for up to five years.

Weight loss greater than 10 percent offers significant health benefits, according to researchers.

“If weight loss can be sustained, metabolic abnormalities can be reversed with meaningful benefits in patients with type 2 diabetes, cardiovascular disease, and many other diseases where obesity is the root cause,” lead study author Michael A. Weintraub, MD, lead author and fellow in the Division of Endocrinology, Diabetes & Metabolism at Weill Cornell Medicine, told Healthline.

Weintraub and the team presented their findings on June 12 at ENDO 2022, the Endocrine Society’s annual meeting in Atlanta, Georgia.
Research could help guide obesity treatment regimens
“Our real-world study,” said Weintraub. “Demonstrates that anti-obesity medications along with lifestyle changes can achieve significant weight loss of 10 percent body weight and that loss is maintained over the long-term.”

The study analyzed data from 428 patients at an academic weight management center.
“This research can help guide medical practitioners toward designing personalized, accessible treatment regimens to aid patients in long-term weight loss,” he said.

All patients received counseling on following a low-glycemic diet and exercise by the obesity medicine specialist during their office visits and were offered additional counseling with a registered dietitian.
Medical intervention included FDA-approved and off-label weight-loss medications that included metformin, phentermine, and topiramate.
By their final visit, patients were using an average of two medications for weight management.

Followed for about 5 years, participants maintained an average weight loss of 10.7 percent.

A third of patients maintained 15% weight loss
“In our study, we were surprised at the magnitude of weight loss achieved and maintained,” said Weintraub. “By adding anti-obesity medications, patients lost and maintained on average 10 percent of their body weight, which in this cohort was 23 pounds.”
He added that a third of patients could maintain 15 percent or more long-term weight loss.

“If weight loss can be sustained, metabolic abnormalities can be reversed with meaningful benefits in patients with type 2 diabetes, cardiovascular disease, and many other diseases where obesity is the root cause,” Weintraub said.

Brian Quebbemann, MD, FACS, bariatric surgeon, and founder of The N.E.W. Program in Orange County, California, said for many people with overweight or obesity, a 10 percent weight loss would not mean they end up with moderate weight.

“Yes, a weight loss of 10 percent provides some health benefits,” said Quebbemann.

He compared it to a person with a blood pressure of 200 over 140 who is better off if they’re given medications that lower their blood pressure to 180 over 120. At that level, they still would be considered to have high blood pressure.

“Yes, they are better off, but they are still a long way from achieving a healthy blood pressure,” said Quebbemann.

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How safe are weight loss drugs?

Suchitra Rao, MD, bariatric physician at O’Connor Hospital in San Jose, California, said that when used appropriately, weight loss drugs can help people reach their weight loss goals in a safe manner.
“However obesity being a chronic, complex, and relapsing disease,” she noted. “It may be necessary to continue them long term for maintenance of weight loss and prevent weight regain.”
Rao added that beneficial lifestyle interventions to promote and maintain weight loss include behavioral modifications for adapting our lifestyle to eat a healthy diet, learning to stay active regardless of age, stress management, and getting adequate sleep.

According to Minisha Sood, MD, an endocrinologist at Lenox Hill Hospital in New York, while all medications have potential side effects, the real issue is whether the benefits of a medication outweigh its risks.
“In the case of obesity, oftentimes the benefits do outweigh the risks,” she said. “Metformin, topiramate, and phentermine have been used for many years with success in a safe manner.”

Sood pointed out that these medications have manageable side effects and can be easily discontinued if someone experiences intolerable adverse effects.

However, when the medication is discontinued, weight can increase.
Lifestyle changes alone don’t work for some people
According to Weintraub, his findings show its possible to achieve “significant” long-term weight loss in overweight and obese people without surgery.

“Although it will require lifelong medications, the side effects of the weight loss medications used in this study are relatively mild,” he said.
Weintraub added that the health benefits of weight loss could result in a decrease in serious weight-related disease, and therefore a decrease in cost of medications as well as a decrease in disability and future complications of these medical problems.

“The result will be a measurable improvement in the quality of life of those people that take the necessary lifestyle changes to heart,” he concluded.

The bottom line
New research finds a combination of weight-loss drugs and lifestyle changes can result in significant long-term weight loss.

Experts say that once the medications are stopped, weight may return.
They also encourage people trying to lose weight to thoroughly assess their lifestyle to make healthy changes that encourage weight loss.