Intake: Gewichtsverlust

DiRECT randomized 49 UK primary-care practices to a structured weight-management program (a total-diet-replacement formula phase of about 850 kcal/day for 12 to 20 weeks, then stepped food reintroduction and maintenance support) or usual care, in 298 adults with type 2 diabetes of up to six years and not on insulin. At 12 months, 46% of the intervention group versus 4% of controls were in remission, defined as HbA1c under 6.5% off all glucose-lowering medication. Remission rose with weight loss: 34% at 5 to 10 kg, 57% at 10 to 15 kg, and 86% at 15 kg or more. The trial was open-label, and because remission depends on keeping the weight off, regain reverses it.

The Diabetes Prevention Program randomized 3,234 adults with impaired glucose tolerance to intensive lifestyle change (goal: at least 7% weight loss and 150 minutes/week of moderate activity), metformin, or placebo. Over a mean 2.8 years the lifestyle group's incidence of type 2 diabetes fell 58% (95% CI 48 to 66) versus placebo; metformin cut it 31%. Lifestyle worked across ages, sexes, and ethnic groups, and best in older participants. The intervention used one-to-one case managers, so the supported result is stronger than an unsupported attempt, and it measures prevention over about three years, not for life.

Look AHEAD randomized 5,145 overweight or obese adults with type 2 diabetes to an intensive lifestyle intervention or diabetes support and education. The intervention produced greater weight loss and fitness at every year, but over a median 9.6 years it did not reduce the primary composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or hospitalization for angina, and the trial was halted early for futility. Both arms had aggressive statin, blood-pressure, and glucose management that lowered event rates and shrank the detectable difference, and controls also lost modest weight. Secondary outcomes favored the intervention: better glycemic control, blood pressure, sleep apnea, mobility, quality of life, and less medication.

This meta-analysis of 25 randomized trials (4,874 adults) found blood-pressure reductions of 1.05 mmHg systolic and 0.92 mmHg diastolic per kilogram of weight lost. In the subset of trials where average weight loss exceeded 5 kg, systolic pressure fell about 6.6 mmHg and diastolic about 5.1 mmHg, versus roughly 2.7 and 2.0 mmHg where less was lost. The per-kilogram estimate averages across diverse trials, some using weight-loss medication, and the drop is larger in people who begin hypertensive and smaller in those near normal.

The IDEA trial randomized 454 overweight or obese adults aged 55+ with knee osteoarthritis to diet, exercise, or both for 18 months. The diet-plus-exercise group lost a mean 10.6 kg (about 11%) and had the lowest WOMAC pain (3.6 versus 4.7 to 4.8), best function, greatest reduction in IL-6, and a large drop in knee compressive force. Diet groups reduced joint load more than exercise alone. Because the best arm combined weight loss with exercise, it does not isolate weight loss by itself, though the diet-only arm shows load and inflammation fall with weight regardless.

DIETFITS randomized 609 overweight adults without diabetes to a healthy low-fat or healthy low-carbohydrate diet for 12 months, both centered on vegetables and whole foods with minimal added sugar and refined grains, with 22 support sessions. Weight change was -5.3 kg (low-fat) versus -6.0 kg (low-carb), not a significant difference. Pre-specified tests found no interaction with a three-SNP genotype pattern (P=.20) or with baseline insulin secretion (P=.47), so neither predicted the better diet for an individual. Because food quality and support were matched, the result isolates macronutrient ratio as the variable that did not matter.

POUNDS Lost randomized 811 overweight adults to one of four diets crossing higher and lower fat with higher and lower protein, all reduced-calorie, for two years. Weight loss was similar across every combination (for example 3.0 versus 3.6 kg for 15% versus 25% protein), with no significant macronutrient effect. Session attendance was strongly associated with loss, about 0.2 kg per session attended. That attendance link is observational, so it cannot separate showing up from succeeding, and average loss was modest with regain toward baseline underway by year two.

Sumithran measured appetite hormones and hunger in 50 adults before a 10-week very-low-calorie diet (mean loss about 13 kg), just after, and at one year. At 12 months, despite some regain, ghrelin remained above baseline and leptin, peptide YY, cholecystokinin, insulin, and amylin remained below it, with subjective appetite still elevated. This is a single-arm study without a control group, so it characterizes the appetite biology after weight loss, not proving these shifts cause regain in a given person, and it does not mean maintenance is impossible, only that the body's drive to eat works against it and must be planned around.

Vilar-Gomez followed 293 adults with biopsy-proven non-alcoholic steatohepatitis through 52 weeks of diet and activity change, with paired liver biopsies. Improvement was dose-dependent on weight loss: at 5% or more lost, 58% had NASH resolution and 82% had a 2-point drop in the NAFLD activity score; at 10% or more, 90% had resolution, all had a lower activity score, and 45% had fibrosis regression. It is a single-arm study without a control group, so year-long spontaneous change cannot be fully separated out, and only about 30% of participants reached the 10% threshold.

The Sleep AHEAD substudy randomized 264 obese adults with type 2 diabetes and obstructive sleep apnea to an intensive lifestyle intervention or diabetes support and education. At one year the intervention lowered the apnea-hypopnea index by an adjusted 9.7 events/hour more than control (P<.001), about a halving of severity, with the largest gains in those losing 10 kg or more, and roughly three times the rate of complete OSA remission. Participants had diabetes, so magnitude may vary in non-diabetic apnea, and improvement scaled with weight lost, not resolving apnea in everyone.

Longland randomized 40 resistance-trained young men to 2.4 or 1.2 g protein/kg/day during a four-week 40% energy deficit with six days a week of resistance, sprint, and circuit training. The higher-protein group gained 1.2 kg lean mass and lost 4.8 kg fat; the lower-protein group gained 0.1 kg lean and lost 3.5 kg fat. It is a short, supervised study in young men under a severe deficit, so the specific numbers do not transfer directly to women, older adults, or an ordinary unsupervised deficit, but the principle that adequate protein and resistance training spare muscle during weight loss is well supported.

This review synthesizes the National Weight Control Registry, thousands of adults who lost a mean 33 kg and maintained it for a mean 5.7 years, plus related maintenance research. Successful maintainers report about an hour a day of activity, a consistent lower-calorie, lower-fat diet with little weekday-to-weekend variation, regular breakfast, and frequent self-weighing, and their risk of regain drops after two to five years of successful maintenance. About 20% of people who intentionally lose 10% keep it off for at least a year. Because the registry enrolls people who already succeeded and skews about 80% female, it describes maintainer behavior, not proving cause.

This systematic review gathered 10 longitudinal studies of weight loss (3 to 34 kg, achieved by diet, bariatric surgery, or medication) in people with gout or hyperuricemia. Serum urate fell and, in 6 of the 8 studies that tracked it, gout flare frequency dropped. The authors graded the body of evidence low to moderate: designs were mostly observational and heterogeneous. A known caveat is that rapid weight loss, particularly in the early weeks after bariatric surgery, can transiently raise urate and precipitate flares before the sustained benefit appears.