Behavior Patterns Of Successful Weight Loss

This study conducted by researchers from Ohio State University and published in the Journal of the American Heart Association using Life's Essential 8 checklist analyzed data from over 20,000 American adults to link a healthier diet and increased exercise to weight loss that helps to reduce the risk of heart disease; and associated skipping meals and prescription diet pills with minimal weight loss, weight maintenance, and weight gain. 

AHA’s Life's Essential 8 checklist promotes heart disease risk reduction through the pursuit of the recommended metrics for BMI, blood pressure, cholesterol levels, blood sugar levels, sleep hygiene, physical activity, a nutritious diet, and making healthy choices like stopping smoking. 

Findings revealed that losing a clinically significant 5% of their body weight did not eliminate their risk factors for cardiovascular disease for many of the participants, and the average composite score on 8 risk factors was the same across the participants regardless of positive or negative weight changes.  Overall the participants had an average score of 60/100 on the eight measures. 17,465 participants lost less than 5% of their body weight, maintained their weight, or gained weight, and 2,840 had a loss of at least 5% of their body weight. 

"The Life's Essential 8 is a valuable tool that provides the core components for cardiovascular health, many of which are modifiable through behavior change," said senior study author Colleen Spees, associate professor of medical dietetics in the School of Health and Rehabilitation Sciences at Ohio State.

"Based on the findings in this study, we have a lot of work to do as a country," she said. "Even though there were significant differences on several parameters between the groups, the fact remains that as a whole, adults in this country are not adopting the Life's Essential 8 behaviors that are directly correlated with heart health."

The data came from 20,305 American adults, aged 19+ with an average age of 47 years old, who were enrolled in the National Health and Nutrition Examination Survey (NHANES) reporting their smoking status, physical activity, sleep habits, weight history, and what they had consumed in the previous 24 hours. The data was used to determine individual values for Life’s Essential 8 metrics and to assess their diet quality according to the Healthy Eating Index to gauge adherence to the Dietary Guidelines for Americans. 

"Clinically significant weight loss results in improvements in some health indices," Spees said. "People should feel hopeful in knowing that losing just 5% of their body weight is meaningful in terms of clinical improvements. This is not a huge weight loss. It's achievable for most, and I would hope that incentives people instead of being paralyzed with a fear of failure."

Those with clinically significant weight loss reported higher diet quality and had better scores for intake of protein, refined grains, and added sugars as well as more moderate to vigorous physical activity and lower LDL cholesterol levels than those without clinically significant weight loss. But the weight loss group had a higher average BMI, blood sugar levels, and fewer hours of sleep which all would lower their composite scoring on Life’s Essential 8.

According to the researchers the majority of those who did not lose at least 5% of their weight reported skipping meals, smoking, using prescription diet pills, using low-carb and liquid diets, taking laxatives, and vomiting as weight loss strategies. 

"We saw that people are still gravitating to non-evidence-based approaches for weight loss, which are not sustainable. What is sustainable is changing behaviors and eating patterns," Spees said.

"We absolutely need to be moving toward prevention of disease versus waiting until people are diagnosed with a disease. This becomes quite overwhelming, and individuals may feel it's too late at that point," she said.

"We have fantastic research, we have incredible educators," she said. "What we don't have is policy that promotes optimal health across the lifespan, from pregnancy through older adulthood."

Co-authors of the study included first author Emily Hill (supported by a National Center for Advancing Clinical Sciences fellowship), Lauren Cubellis, Randell Wexler and Christopher Taylor.