Stockholm, Sweden, Sept. 19, 2022 – For people with type 2 diabetes, the success of long-term weight loss plans may depend on how well a short-term diet plan works first.

The findings come from new research among people with type 2 diabetes in a weight-loss program that found if they haven't lost 0.5% of their body weight within the first 4 weeks, their chance of long-term success is less likely and a change of plan may be best.

The data, from a weight management service in Scotland that is part of the U.K.’s National Health Service  is to be presented Thursday at a diabetes conference in Europe.

The Glasgow weight management service -- like others throughout the NHS -- emphasizes behavioral changes to change diet and improve physical activity, with sessions delivered every 1 to 2 weeks. Participants are typically asked to follow the program for 3 to 4 months, with the aim of losing at least 5% of their body weight and to maintain the weight loss says,

Lulwa Al-Abdullah, a fourth-year PhD student at the University of Glasgow,  who was to present the findings this week. 

While the program has shown success, Al-Abdullah says people often find it difficult to lose that amount of weight and to keep it off because many drop out or don’t follow the program closely enough. “In this project, we wanted to identify demographic, clinical, and process factors that are associated with and predictive of short and medium-term successful weight loss,” she says.

As it turned out, early weight loss was the the measurement that mattered most.

No other factor the investigators looked at, including type of diabetes medication, made a difference. This suggests that simply referring patients to weight loss programs without assessing their early progress is insufficient, says researcher Jennifer Logue, MD, PhD, who was professor of metabolic medicine at Lancaster University in the U.K., at the time of the study.

Most People Just Drop Out

“It’s not that people get to the end and say, ‘Oh I haven’t been successful.’ They don’t get to the end,” she says. “They just drop out. And when they drop out that can be worse for them, because we know that people with obesity have a lot of not just external stigma but internalized self-stigma…and that makes matters even worse.”

“You don’t want to go back and tell your [doctor] that you failed…We need to concentrate our efforts on those people who aren’t reaching that threshold early, before we lose them and before we cause harm,” says Logue, who this month went to work for the pharmaceutical company straZeneca.

And for those who haven’t lost half a percent of body weight at 1 month, “We should be saying why is this not working, and what do we need to change for that individual?” she says.

The problem may be something that can be changed, like they simply didn’t understand the diet. Or they have problems regulating appetitethat can be overcome with appropriate medication or bariatric surgery.

Or, they may need a waiting period.

“It might be that some people have something else going on in their life and this may not be the time for behavior change. They may have some other stresses that make it impossible, so they should deal with those things and come back when they’re ready,” Logue advised.

Asked to comment, Amy E. Rothberg, MD, says, “Although I am surprised that 0.5% was the threshold, my group at Michigan and other investigators have shown that early weight loss is a predictor of both short and long-term weight loss success.”

Unlike the U.K. program, her center uses total diet replacement, which typically leads to a 5% weight loss in the first 4 weeks.

Rothberg, director of the Michigan Medicine Weight Management Program in Ann Arbor, says, “Four weeks is adequate time, although there may be some extenuating factors and so a short period of re-intensification with the intervention, of about 2 weeks, might be justified before referring to alternative treatments.”

As for people with type 2 diabetes in particular, she says, “I think those who have diabetes and are taking … medications such as insulin may have a slightly harder time losing as much weight, but nevertheless can lose weight. I don’t think that diabetes versus no diabetes would make any difference in achieving 0.5% weight reduction at 4 weeks. This is a low bar.”

'It’s Not Fun Living With Obesity'

Researchers looked at data for 1,658 patients with type 2 diabetes who were referred to the Glasgow weight loss center. Of those, 20% successfully lost at least 5% of their body weight within 16 weeks and attended seven of nine weight management sessions. The other 1,325 didn’t lose the weight and/or dropped out.

Of those who lost 0.5% in the first three sessions over 4 weeks, 90.4% had a successful short-term outcome.

Aftger 3 years, 8% had successfully maintained the 5% or greater weight loss. And a higher early weight loss of at least 2.5% in the first month increased the chance of success even further, Al-Abdullah says.

Logue told Medscape Medical News: “It’s not fun living with obesity. It’s a horrible stigmatized disease and [people who have it] are treated appallingly even by health care professionals. I think people think that they’re doing duty by referring to these programs and it’s great that we have them…but we may be making things worse if we’re setting them up to fail.”

“That doesn’t mean don’t send them at all, but we’re seeing there’s an answer here. You can intervene. It's not just about changing diet. There are other factors that affect it. Not everything works for every person, and we need to get it right for them,” she says.