This study used data from the UK Clinical Practice Research Database to assess the effects of different degrees of weight loss or gain (10% or 20%), as related to baseline BMI, and the risk of complications in people with obesity. The 13 obesity-related comorbidities were:
- Endocrine/metabolic: Type 2 diabetes, hypertension, dyslipidaemia and polycystic ovary syndrome (PCOS).
- Biomechanical: Sleep apnoea, asthma and hip/knee osteoarthritis.
- Cardiovascular: Heart failure, chronic kidney disease (CKD), atrial fibrillation, venous thromboembolism (VTE) and unstable angina/myocardial infarction (MI).
- Mental health: Depression.
Weight was compared between baseline and 2–4 years later, and obesity complications were recorded over a median follow-up of 7.3 years thereafter. A total of 418 774 participants with a BMI between 30 and 50 kg/m2 were analysed. The median weight change over the initial 4-year follow-up was +0.9%.
The impact of weight change on obesity complications was generally dependent on baseline BMI, with four distinct patterns identified:
- Type 2 diabetes, sleep apnoea, hypertension and dyslipidaemia benefited from weight loss in all baseline BMI categories, but the greatest benefits were seen in those with a lower baseline BMI.
- Asthma, hip/knee osteoarthritis and PCOS showed a weight loss benefit at a lower baseline BMI but not benefit in those with higher baseline BMI.
- CKD, heart failure, atrial fibrillation and VTE showed benefit with weight loss up to 10% but no further benefit from greater weight loss.
- Angina/MI and depression showed no clear relationship with weight change.
Similar but opposite patterns were observed with weight gain.
The authors conclude that benefits on obesity-related complications are dependent on weight loss magnitude and initial BMI, while weight gain is associated with similar risk increases. The four distinct patterns may support clinicians in taking a more individualised approach for obesity management.
Attempts to achieve remission, or at least a substantial improvement in glycaemic control, should be the initial focus at type 2 diabetes diagnosis.
9 May 2024