Metabolic Health and Long-term Weight Loss Maintenance: Results from the EU Horizon 2020 NoHoW Trial

Background/Objectives: Long-term weight loss maintenance is a major challenge in the treatment of overweight and obesity. Metabolic and hormonal signalling systems are believed to influence weight trajectories during weight management attempts. However, very limited research has previously been conducted in this area. The aim of the present analysis was to investigate the relationship between metabolic health and weight changes at 18-months in adults who had achieved clinically significant (≥ 5%) initial weight loss. Subjects/Methods: This post-hoc analysis used 18-month follow-up data from 879 participants from the Navigating to a Healthy Weight (NoHoW) trial. Participants were categorised at baseline into metabolic health subgroups according to BMI (kg/m2) and the presence of cardiometabolic risk factors for metabolic syndrome, defined according to the NCEP-ATP III criteria. These subgroups were: 1) metabolically healthy overweight or obesity (n = 568), 2) metabolically unhealthy overweight or obesity (n = 151), 3) normal weight and zero risk factors for metabolic syndrome (n = 104), and 4) normal weight and ≥1 risk factors for metabolic syndrome (n = 56). The primary outcome was 18-month changes in body weight (kg and %). Secondary outcomes were 18-month changes in waist circumference (cm), fat mass (kg and %) and fat-free mass (kg and %). Multiple linear regression models were used to examine the relationship between outcomes and metabolic health subgroup in those with overweight and obesity and those with normal weight. Results: No differences in 18-month changes in body weight or body composition were found between individuals with metabolically healthy vs unhealthy overweight or obesity or between individuals with normal weight with and without risk factors for metabolic syndrome. Conclusions: Baseline metabolic health did not predict long-term weight loss maintenance. All individuals should have access to the highest quality weight loss maintenance support possible to ensure equitable and effective health outcomes.