Abstract
The majority of people with type 2 diabetes are overweight or obese, and weight loss
is a recommended treatment strategy. A systematic review and meta-analysis was undertaken
to answer the following primary question: In overweight or obese adults with type
2 diabetes, what are the outcomes on hemoglobin A1c (HbA1c) from lifestyle weight-loss
interventions resulting in weight losses greater than or less than 5% at 12 months?
Secondary questions are: What are the lipid (total cholesterol, low-density lipoprotein
cholesterol, high-density lipoprotein cholesterol, and triglycerides) and blood pressure
(systolic and diastolic) outcomes from lifestyle weight-loss interventions resulting
in weight losses greater than or less than 5% at 12 months? And, what are the weight
and metabolic outcomes from differing amounts of macronutrients in weight-loss interventions?
Inclusion criteria included randomized clinical trial implementing weight-loss interventions
in overweight or obese adults with type 2 diabetes, minimum 12-month study duration,
a 70% completion rate, and an HbA1c value reported at 12 months. Eleven trials (eight
compared two weight-loss interventions and three compared a weight-loss intervention
group with a usual care/control group) with 6,754 participants met study criteria.
At 12 months, 17 study groups (8 categories of weight-loss intervention) reported
weight loss <5% of initial weight (−3.2 kg [95% CI: −5.9, −0.6]). A meta-analysis
of the weight-loss interventions reported nonsignificant beneficial effects on HbA1c,
lipids, or blood pressure. Two study groups reported a weight loss of ≥5%: a Mediterranean-style
diet implemented in newly diagnosed adults with type 2 diabetes and an intensive lifestyle
intervention implemented in the Look AHEAD (Action for Health in Diabetes) trial.
Both included regular physical activity and frequent contact with health professionals
and reported significant beneficial effects on HbA1c, lipids, and blood pressure.
Five trials (10 study groups) compared weight-loss interventions of differing amounts
of macronutrients and reported nonsignificant differences in weight loss, HbA1c, lipids,
and blood pressure. The majority of lifestyle weight-loss interventions in overweight
or obese adults with type 2 diabetes resulted in weight loss <5% and did not result
in beneficial metabolic outcomes. A weight loss of >5% appears necessary for beneficial
effects on HbA1c, lipids, and blood pressure. Achieving this level of weight loss
requires intense interventions, including energy restriction, regular physical activity,
and frequent contact with health professionals. Weight loss for many overweight or
obese individuals with type 2 diabetes might not be a realistic primary treatment
strategy for improved glycemic control. Nutrition therapy for individuals with type
2 diabetes should encourage a healthful eating pattern, a reduced energy intake, regular
physical activity, education, and support as primary treatment strategies.
Keywords
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Biography
M. J. Franz is a nutrition/health consultant, Nutrition Concepts by Franz, Inc, Minneapolis, MN.
Biography
J. L. Boucher is senior vice president and chief operating officer, Minneapolis Heart Foundation, Minneapolis MN.
Biography
S. Rutten-Ramos is a statistician, Minneapolis Heart Foundation, Minneapolis MN.
Biography
J. J. VanWormer is an associate research scientist, Marshfield Clinic Research Foundation, Center for Clinical Epidemiology and Population Health, Marshfield, WI.
Article info
Publication history
Published online: April 29, 2015
Accepted:
February 24,
2015
Received:
September 15,
2014
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT There is no funding to disclose.
Identification
Copyright
© 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
