Two recent studies focus on the cardiovascular benefits of weight loss in middle age and the importance of effective weight loss maintenance (WLM).

In the first study, published in JAMA Network Open, investigators found that sustained weight loss in middle age compared to persistent overweight led to a long-term decreased risk of chronic disease, including type 2 diabetes, myocardial infarction, stroke, cancer, asthma or chronic obstructive pulmonary disease, and all-cause mortality.

Timo E. Strandberg, MD, PhD, et al., analyzed data from 23,149 participants from three separate studies: the Whitehall II (WHII) study (4,118 participants, median age 39, 28% women, baseline 1985-1988), the Helsinki Businessmen (HBS) study (2,335 participants, median age 42, all men, baseline 1964-1973) and the Finnish Public Sector (FPS) study (16,696 participants, median age 39, 83% women, baseline 2000).

Results at a median follow-up of 23 and 12 years, respectively, showed that participants in the WHII study (after adjusting for smoking, systolic blood pressure and serum cholesterol at first evaluation) and in the FPS study who lost weight (from BMI ≥25 to <25) had a decreased risk of developing chronic disease compared to those with persistent overweight (BMI ≥25; hazard rate [HR], 0.52 and 0.43, respectively). In the WHII study, the outcome was similar when excluding for diabetes (HR, 0.58).

In the HBS, during a median follow-up of 35 years, weight loss was associated with decreased mortality compared to persistent overweight (HR, 0.81).

Investigators note that at the time of the studies, there were few surgical and pharmacological weight-loss interventions available, and that, "Although correcting midlife overweight without surgical or pharmacological treatment is challenging, our results suggest that it is feasible."

In an accompanying editorial comment, Ga Eun Nam, MD, PhD, and Yong-Moon Mark Park, MD, PhD, write that "these results highlight midlife as a potentially critical window for weight management and reinforce the importance of sustained weight management in chronic disease prevention and longevity." They add that, "From a public health perspective, these results highlight the need for sustained support systems to help individuals maintain a healthy weight over time."

The CHAMPS trial, published in JAMA Internal Medicine, is one piece of research that could contribute to these public health discussions about sustained support systems, finding that patient-to-patient lifestyle interventions led to better WLM and cardiovascular outcomes compared to professional-led standard of care (SOC).

Tricia M. Leahey, PhD, et al., first enrolled participants into a four-month online obesity lifestyle intervention. Those who lost ≥5% of their body weight (287 participants, 54 years old, 84% women, mean BMI following initial intervention 30.9, mean weight 84.0 kg) were then randomized to either SOC delivered by a professional (n=134) or mentor-led interventions and peer support (n=153). Mentors had no previous health care experience but had successfully lost ≥7% of their body weight in a previous weight loss trial and maintained the loss for one year or more.

Interventions were completed in group settings with participants keeping in contact with their professional or mentor during the 18 months of treatment. Participants were also randomly paired into peer dyads who were asked to exchange weekly progress reports and provide helpful feedback.

Results showed that patient-to-patient treatment compared to SOC had a significant difference in weight change: more weight loss at six months (mean weight change –1.44 kg vs. –0.16 kg), and less weight regain at 12 months (0.04 kg vs. 0.77 kg) and 18 months (0.77 kg vs. 2.37 kg). Patient-to-patient treatment also resulted in better cardiovascular risk outcomes, including lower diastolic blood pressure, lower heart rate, increased physical activity and reduced sedentary time.

Leahey, et al., note that mentor- and peer-led interventions deliver "a unique sense of empathy not duplicated by professionals." While professional interventions can be costly and unsustainable over longer periods of time, patient-to-patient support may prove to "be a sustainable, cost-effective add-on to existing [diabetes prevention programs] currently being delivered in YMCAs, pharmacies, or faith-based organizations, providing continuous care for successful weight loss maintenance in community settings."

In an accompanying editorial comment, Kathryn M. Ross, PhD, MPH, calls the results, "exciting, as they offer new hope for researchers and clinicians aiming to identify effective methods of promoting long-term weight loss maintenance, underscoring the potential for future development of novel and sustainable treatment approaches that could improve the health of millions of U.S. adults."