How did some of the men and women in the Look AHEAD (Action for Health in Diabetes) trial defy the odds by managing to stay the course and keep weight off? Although this study ended prematurely in 2012 because intensive weight loss was not shown to reduce the risk of heart attacks, strokes and other cardiovascular problems in people with diabetes, the researchers have been able to glean important insights regarding weight loss.

For example, according to a 2011 Look AHEAD study in the journal Obesity, people who sustained a 10 percent or greater reduction for four years (dubbed "super weight maintainers") attended significantly more treatment sessions with counselors than people who lost less weight. This finding strongly suggests that regularly working with a counselor, who can provide psychological support and assist with setting goals and other healthful behaviors, is an important key to helping you keep lost pounds from returning.

Look AHEAD researchers have also noted that the super weight maintainers in their study have a number of qualities in common with members of the National Weight Control Registry (NWCR). The NWCR was created as a way to learn more about the habits and behaviors of successful dieters.

The registry currently includes more than 10,000 people who lost at least 30 pounds and kept the weight off for at least one year. Interviews with registry members reveal a number of practices the majority of them follow, including:

  • Counting calories
  • Consuming a low fat diet
  • Eating breakfast almost every day
  • Weighing themselves at least once a week
  • Keeping track of what they eat and their physical activity
  • Exercising at least once a week
  • Watching less than 1 hour of TV daily

There is a perception, supported by some research, that weight loss may be more challenging for people with type 2 diabetes. That makes the success of the weight maintainers in Look AHEAD even more impressive.

The benefits of "only" 5 percent

A 5 percent drop in weight may not seem like it could make much difference in overall health; for a person who weighs 200 pounds that would mean maintaining a weight loss of 10 pounds. But data from the Look AHEAD trial suggest that maintaining a weight loss of 5 percent or more leads to changes that have the potential to help you keep your blood glucose, blood pressure and cholesterol levels under control.

The researchers found that people who sustained weight loss after four years:

  • Were significantly more fit than their counterparts, as measured by walking tests on treadmills.
  • Experienced a 0.36 percent reduction in their HbA1c levels compared with minimal reduction for those following the usual advice.
  • Enjoyed a greater drop in blood pressure and blood levels of fats called triglycerides, while their healthful HDL ("good") cholesterol rose.

The bottom line

The take-home message is clear: Regular adherence to dietary and exercise recommendations in conjunction with sustained weight loss and ongoing support is key. Medicare and many private insurers provide at least a few nutritional counseling sessions with a referral from your doctor. If you can't continue to meet one-on-one with a counselor on a regular basis, consider joining a diabetes support group at your local hospital.

Another option is to consider a weight loss program, such as Weight Watchers or TOPS (Take Off Pounds Sensibly) that embraces many of the practices of the weight loss maintainers. If you decide on such a program to help you lose weight, it's a smart idea to share the materials with your doctor or nutritionist. That way, she or he can help you adapt the program to your personal needs.

And be sure to see your doctor regularly. The positive feedback you receive in terms of glucose control, lowered blood pressure and an improved cholesterol profile can help motivate you to stick with the lifestyle changes you've made.

Publication Review By: Rita Rastogi Kalyani, M.D., and Simeon Margolis, M.D., Ph.D.

Published: 24 Jul 2013

Last Modified: 11 Sep 2015