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Cardiovascular Benefits of Losing Weight and Keeping It Off

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The tremendous health benefits of not regaining weight after a reduction in body weight should be considered as important as losing weight in the first place for overall health, according to a session on diabetes management and cardiovascular health at the 2023 EASD conference.

The impact of weight loss on effective diabetes management has gotten a great deal of well-deserved attention recently, noted Dr. Antonio Ceriello, of the RCCS MultiMedica Hospital in Milan, Italy. 

The past few years have produced continued evidence of the astounding metabolic, cardiovascular, and glucose benefits of the new drugs designed to lower body weight in people with type 2 diabetes.   

The success of these therapies in lowering weight has led some researchers to ask whether the new crop of incretin-based therapies has made focusing on controlling weight a more effective approach than blood glucose management for improving the health of people with type 2 diabetes. 

At the 2023 EASD conference in Hamburg, Germany, during an expert symposium on type 2 diabetes and cardiovascular risk, Ceriello introduced an extra consideration to complicate this question: What is the harm of fluctuating weight in the development of diabetes complications? Does the so-called “yo-yo effect” of weight loss do harm to those trying, and failing, to maintain a lower body weight?

Ceriello discussed his 2021 research showing that people who fluctuate in weight are at a higher risk for cardiovascular complications

“What this means is that any human being, with or without diabetes, who goes up and down in weight is at a higher risk for cardiovascular complications,” he said.

People who rebound after weight loss can also be at higher risk for developing obesity, he added. “What we know is that when we have obesity, it plays a large role in cardiovascular events.”

Given that most people who lose weight tend to gain it back over time, and sometimes in excess of what they had lost, he posed the question of what can be done to prevent the all-too-common, often excruciating experience of rebound weight gain for those who succeed, for a time, in shedding body weight but eventually gain it back.

“When we speak of weight control, it’s not enough to talk only about ways to lose weight,” Ceriello said.

Following recommendations to manage type 2 diabetes through lifestyle modification – including diet and exercise – is not always easy to sustain, he cautioned. Taking diabetes medications consistently also requires considerable effort and can pose a burden for people with diabetes.  

Ceriello said that the current conversation about weight loss and effective diabetes and cardiovascular management must go beyond the mantra that less weight is the only goal. It must be tempered, he said, with a greater understanding of why and how fluctuating weight, or in his words “body weight variability,” is to be avoided.

“We have to help people lose weight,” Ceriello said. “But we also have to convince them of the importance of keeping a stable weight.” 

The message is not new, he reminded those in attendance. The idea that high body weight variability leads to increased mortality from coronary heart disease, independent of existing cardiovascular risk factors, was established by the Framingham Heart Study more than 30 years ago.

Further research showed that “body weight variability is associated with an increased risk of cardiovascular diseases regardless of ethnicity or diabetes status,” Ceriello added. But even though the knowledge is not new, the recent focus on weight loss as a first focus in diabetes management brings the findings into sharper focus.

After his presentation to the symposium, Ceriello said that he knows firsthand how hard it is to lose weight and keep it off.

“I was able to do it because I was strongly supported by my wife,” he said. “The idea is family support is very important because it’s complicated. What’s important is to have continued support, psychological support, from somebody who is close to you to help you to keep the diet.” 

With the new generation of drugs offering 15-25% weight loss, the problem has shifted, Ceriello emphasized. The key now is making the new weight sustainable with diet and exercise. 

“You can take drugs to lose weight, but if you want to keep the weight off, you need to take the drugs for life and I don’t know if that's very practical,” Ceriello said. “I think people have to change their minds and attitude, which is the most difficult thing in life.”

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