New Harvard University study of nearly 200,000 people: People who are not overweight lose weight increase their risk of type II diabetes

This article is the original of the translational medicine network, please indicate the source when reprinting

Author: Jevin

Weight control is one
of the main and effective strategies for preventing and managing obesity and related chronic diseases.
Attempts to lose weight are common not only in overweight or obese individuals, but also in thinner individuals
.
In addition, there is currently insufficient
research on long-term weight changes and the risk of developing type II diabetes (T2D) after trying various weight loss strategies (WLS).
The researchers compared weight change of up to 10 years and 24 years of T2D risk
between individuals who lost 4.
5+kg through various WLS (a combination of low-calorie diet, exercise, low-calorie diet and exercise, fasting, commercial weight loss programs, diet pills, or the last 3 strategies collectively known as FCP).

A systematic review of eight weight loss trials showed that the trajectory of weight gain within 3 to 5 years of the intervention varied depending on the weight loss strategy and therefore may have a differential effect on
the risk of developing obesity-related diseases.
To fill the knowledge gap, a new study from Harvard University targeting nearly 200,000 people was published in PLOS MEDICINE
.

https://journals.
plos.
org/plosmedicine/article?id=10.
1371/journal.
pmed.
1004094

Obesity and type II diabetes

 01 

Obesity is one of the most common chronic diseases worldwide
.
Between 2017 and 2018, about 42.
4 percent of U.
S.
adults were obese, and obesity makes them more susceptible to multiple chronic diseases, especially type II diabetes
.
Therefore, weight control is one
of the main and effective strategies for preventing and managing chronic diseases associated with obesity.
It is estimated that in overweight/obese and pre-diabetic patients, the risk of diabetes can be reduced by 16%
for every kilogram of body weight lost on average.
Between 2013 and 2016, 49.
1 percent of U.
S.
adults reported attempting to lose weight through lifestyle changes, such as exercise (62.
9 percent) and dieting (62.
9 percent).

New research from nearly 200,000 people

 02

The Harvard researchers used data from the Health Professionals Follow-up Study, the Nurse Health Study, and the NHSII Study
.
HPFS began in 1986 and enrolls 51,529 male health professionals
between the ages of 40 and 76 from 50 U.
S.
states.
In 1976, the NHS recruited 121701 female nurses
between the ages of 30 and 55 from 11 states.
NHSII recruited in 1989 to include 116429 female nurses
between the ages of 24 and 42 from 14 states.
Since 1976, follow-up questionnaires have been mailed to participants every two years to update lifestyle and medical information
.
Thereafter, an additional validated semi-quantitative food frequency questionnaire is performed every 2 to 4 years to assess dietary intake
.
The reaction rate for each cycle of the 3 cohorts exceeded 90%.

Since the researchers did not know the exact time of weight loss during these 4 years, the 1988 year of NHS/HPFS and the 1989 year of NHSII were considered as the research baseline
.

For T2D results, participants were excluded if they skipped the WLS problem
.
If their weight loss is unintentional; Diabetes was reported before 1992; diagnosis or death of cardiovascular disease or cancer (NHS/HPFS)/1993(NHSII); Only the 1992/1993 questionnaire was completed; Lack of information on the date of diagnosis of T2D, age or baseline BMI; Or maybe they got pregnant at baseline (NHSII
only).
The investigators listed additional exclusions
related to specific WLS.
In the weight change analysis, the exclusion criteria were the same as those for T2D analysis, and participants who only answered the 1992/1993 questionnaire were retained
if a valid weight assessment was provided in that year.
Subjects who had not reported weight since 1992/1993 or who were over 65 years of age in 1992/1993 would be further excluded
.
After exclusion, the T2D analysis included 104180 subjects, and the weight change analysis considered 93110 subjects
.

Intentional weight loss with type II diabetes risk

 03 

About half of the participants reported deliberately losing 4.
5+kg of body weight using various strategies, from lifestyle changes (e.
g.
, LCD, exercise and combinations thereof) to fasting or other commercial interventions (e.
g.
, CWLP and pills
).
The main finding was that the association of various WLS with weight changes and T2D risk depended on the weight status
before weight loss.
Specifically, in obese individuals, those who lost 4.
5+ kg gained less weight and had a lower risk of T2D than those who did not attempt to lose weight, regardless of the WLS used to achieve weight loss
.
This pattern of favorable association is less pronounced in overweight individuals, and even in thinner individuals
.
Of all WLS, exercise was associated
with the lowest weight gain and the lowest risk of T2D in obese individuals.

Current research suggests that obese individuals trying to lose weight tend to gain less weight and have a lower risk
of diabetes, regardless of WLS use.
In contrast, thinner individuals who deliberately lose weight tend to gain more weight and have a higher risk of
diabetes.
These data suggest that intentional weight loss may not be beneficial for lean people, and that using WLS to achieve weight loss should be guided
only by medical indications.

Resources:

https://journals.
plos.
org/plosmedicine/article?id=10.
1371/journal.
pmed.
1004094

Note: This article is intended to introduce medical research advances and cannot be used as a reference for
treatment options.
For health guidance, please visit a regular hospital
.

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