Behavior patterns of people who achieve clinically significant weight loss

A new study analyzing data on over 20,000 U.S. adults links a healthier diet and increased exercise to weight loss that reduces heart disease risk – while associating skipping meals and taking prescription diet pills with minimal weight loss, weight maintenance or weight gain.

For many in the study sample, however, losing a “clinically significant” 5% of their body weight did not eliminate their risk factors for cardiovascular disease, results showed. In fact, the average composite score on eight risk factors for heart disease was the same across the entirety of the study population – regardless of reported weight changes, up or down.

The study is the first to compare weight-loss strategies and results in the context of the American Heart Association’s “Life’s Essential 8,” a checklist promoting heart disease risk reduction through the pursuit of recommended metrics for body weight, blood pressure, cholesterol, blood sugar, smoking, physical activity, diet and sleep. The AHA first defined a construct of cardiovascular health with “Life’s Simple 7” metrics in 2010, and updated the recommendations to the “Life’s Essential 8” in June 2022.

The Ohio State University researchers found that overall, U.S. adults had an average score of 60 out of 100 on the eight measures – suggesting there is plenty of room for improvement even among those whose diet and exercise behaviors helped move the needle on some metrics.

“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 research was published recently in the Journal of the American Heart Association.

Data for the analysis came from 20,305 U.S. adults aged 19 or older (average age of 47) who participated in the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2016. Participants reported their smoking status, physical activity, average hours of sleep per night, weight history and weight loss strategy, and what they had eaten in the previous 24 hours. Health exams and lab tests measured their body mass index, blood pressure, LDL (bad) cholesterol and blood glucose.

The Ohio State researchers used the data to determine individuals’ values for Life’s Essential 8 metrics and assessed their diet quality according to the Healthy Eating Index, which gauges adherence to U.S. Dietary Guidelines for Americans.

Within the sample, 17,465 individuals had lost less than 5% of their body weight, maintained their weight or gained weight in the past year. The other 2,840 reported intentional loss of at least 5% of their body weight in the same time frame.

“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.”

In this study, adults with clinically significant weight loss reported higher diet quality, particularly with better scores on intakes of protein, refined grains and added sugar, as well as more moderate and vigorous physical activity and lower LDL cholesterol than the group without clinically significant weight loss. On the other hand, the weight-loss group also had a higher average BMI and HbA1c blood sugar measure and fewer hours of sleep – all metrics that would bring down their composite Life’s Essential 8 score.

A greater proportion of people who did not lose at least 5% of their weight reported skipping meals or using prescription diet pills as weight-loss strategies. Additional strategies reported by this group included low-carb and liquid diets, taking laxatives or vomiting, and smoking.

“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.

With federal data estimating that more than 85% of the adult U.S. population will be overweight or obese by 2030 (compared to the current rate of 73%), Spees said that to fend off related increases in heart disease and other health problems, a paradigm shift toward prevention is in order.

“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.

One idea to consider, she said, would be prescriptions for regular visits with registered dietitians trained in behavior change, complete with insurance reimbursement – similar to physical therapy.

“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.