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Sustained weight loss reduces risk of adverse cardiometabolic outcomes

3rd November 2021

Sustained weight loss over 6 years delays the onset of the adverse cardiometabolic outcomes type 2 diabetes, hypertension and hyperlipidaemia.

A sustained weight loss over several years, not only delays but reduces the overall incidence of adverse cardiometabolic outcomes including type 2 diabetes, hypertension and hyperlipidaemia. This was the conclusion of a retrospective analysis of nearly 50,0000 patients by researchers from Geisinger Health, Pennsylvania, US. According to the world Health Organisation (WHO), worldwide levels of obesity have tripled since 1975 and in 2016, more than 1.9 billion adults, 18 years and older, were overweight and of these over 650 million were obese. However, obesity is not limited to adults and WHO data also suggests that in 2020, 39 million children under the age of 5 were overweight or obese. In a 2017 article, the World Obesity Federation issued a position statement, arguing that obesity should be perceived as a chronic relapsing disease process in which an abundance of food, coupled with low levels of physical activity, various environmental factors and genetic susceptibilities, all interact to create a positive energy balance. Increased weight and obesity are linked to a higher incidence of cardiovascular diseases, musculoskeletal disorders and some cancers. Nevertheless, even a 5% sustained weight loss improves metabolic function in multiple organs although longer term maintenance of weight loss is challenging, with one meta-analysis of 29 weight loss studies concluding that “weight-loss maintenance 4 or 5 y after a structured weight-loss program averages 3.0 kg or 23% of initial weight loss.”

However, what remains unclear is the impact of sustained weight loss on the development of cardiometabolic diseases and for the present study, researchers turned to in data held the Geisinger Health System, which represents one of the largest healthcare organisations in the US. The team looked at adult patients for whom there were 3 or more electronic health record entries for weight measurements within a 2-year period. Individuals were then categorised as obesity maintainers (OM), i.e., those with a history of obesity and who maintained their weight within 3% of their baseline levels; weight loss rebounders (WLRs) who had lost > 5% body weight but had regained > 20% of their 1-year loss and finally weight loss maintainers (WLMs), who again loss > 5% of their body weight but maintained > 80% of their 1-year weight loss. The outcomes of interest were the development of type 2 diabetes, hypertension and hyperlipidaemia, all of which were extracted from the electronic health records. In their analysis, researchers adjusted for several factors such as age, gender and various co-morbidities.

Findings

The sample contained 49,327 individuals with a mean age of 50.4 years (60.2% female) with the majority classed as OM (the reference group) and the whole sample were followed-up for a mean period of 6.6 years. After 5 years, 11.1% of the OM, 9.1% of the WLR and 6.5% of the WLM had developed type 2 diabetes and those in the sustained weight loss group (WLM) had a 33% lower risk of developing incident type 2 diabetes (adjusted hazard ratio, aHR = 0.68, 95% CI 0.62 – 0.74, p < 0.0001). Similarly, the WLM had a reduced risk of developing hypertension (aHR = 0.72) and hyperlipidaemia (aHR = 0.86).

Based on these findings, the authors concluded that sustained weight loss was associated with a delayed onset of cardiometabolic diseases and that these associations are enhanced in those with the greatest weight loss.

Citation

Bailey-Davis L et al. Impact of Sustained Weight Loss on Cardiometabolic Outcomes. Am J Cardiol 2021

Hypertension self-management successful with mobile technology

21st October 2021

Hypertension self-management can be successfully achieved over a three year period through harnessing the support of mobile technology

The use of mobile technology can support hypertension self-management in patients with the condition, according to the findings of a three-year study by a group from the Department of Epidemiology & Biostatistics, University of California, California, US. Hypertension is a global problem with the World Health Organisation (WHO) estimating that it affects 1.28 billion adults aged 30-79 years. However, perhaps of greater concern, is the WHO statistic that only 1 in 5 adults (21%) with hypertension have their condition under control.

Although self-monitoring can lead to reductions in blood pressure (BP) over and above usual care, a 2017 systematic review concluded that self-monitoring alone is not associated with lower BP or better control but that it requires co-interventions such as education or lifestyle counselling, to achieve clinically significant reductions which persist for at least 12 months. The use of mobile technology in the form of smartphone health apps, have been suggested a method to enable effective self-management of hypertension. Yet despite this potential role, a 2018 review of such apps concluded that although available studies do suggest a reduction in blood pressure among those using health apps, the conclusion should be interpreted with caution, since many studies were at high risk of bias.

Given the high risk of bias and the importance of co-interventions, the Californian team used a smartphone app in conjunction with BP monitoring that included digital-based coaching to help support hypertension self-management. Participants were US adults with elevated BP recruited through an employer-based health plan. Blood pressure was measured using an FDA approved Bluetooth-enabled monitor paired with the smartphone app which also allowed participants to track their weight and levels of physical activity. The app included medication reminders and coaching to drive lifestyle changes based on usage patterns to personalise the advice. At baseline, participants were categorised in terms of their systolic BP as: normal and < 120 mmHg; systolic between 120 and 129 mmHg; systolic between 130 and 139 (stage 1 hypertension) and finally a systolic > 140 mmHg (stage 2 hypertension). Blood pressure measurements (both systolic and diastolic) were evaluated in the first week (week 0) and then several times up to weeks 148 to 163.

Findings

A total of 28,189 individuals with a median age of 51 years (59.6% male) were included in the hypertension self-management study. After 3 years, median systolic blood pressure was reduced in 53.7% of those with a systolic BP between 120 and 129 mmHg, 75.3% of those with stage 1 hypertension and in 84.4% of those with stage 2 hypertension. Similarly, after 3 years, the mean reductions in diastolic BP were -4.4 mmHg, -6.8 mmHg and -11.6 mmHg respectively.

A subgroup of 3,229 participants recorded their body mass index (BMI) and for each unit reduction in BMI, there was a 0.74 mmHg decrease in systolic BP. Similarly, among 590 individuals who recorded their physical activity, for each 1000-step increase per day, there was a 0.8 mmHg lower systolic BP (P = 0.03).

The authors concluded that their hypertension self-management program supported by mobile technology, achieved long-term control of BP, suggesting that this approach may be useful for BP monitoring and control.

Citation

Gazit T et al. Assessment of Hypertension Control Among Adults Participating in a Mobile Technology Blood Pressure Self-management Program. JAMA Netw Open 2021