title: Incremental weight loss improves cardiometabolic risk in extremely obese adults.
abstract: OBJECTIVE
  Excessively obese adults often acquire many metabolic disorders that put them at high risk for developing type 2 diabetes mellitus and cardiovascular disease. We investigated the hypothesis that cardiometabolic risk in a primary care cohort of 208 excessively obese adults (body mass index 40-60 kg/m(2), 48 with type 2 diabetes mellitus) would deteriorate with additional weight gain and improve incrementally beginning with 5% weight reduction.
  
  
  METHODS
  Further analysis of the Louisiana Obese Subjects Study of excessively obese patients enrolled and followed during 2005-2008 is reported.
  
  
  RESULTS
  Weight loss correlated significantly with improvements in fasting plasma glucose, triglycerides, high- and low-density lipoprotein cholesterol, uric acid, alanine aminotransferase, lactate dehydrogenase, and high-sensitivity C-reactive protein. Most parameters deteriorated with weight gain and progressively improved with 5% or more weight loss. Except for low-density lipoprotein cholesterol, all risk factors significantly improved with ≥ 20% loss of body weight. Among patients who had not been diagnosed with type 2 diabetes mellitus and had normoglycemia at baseline, median fasting plasma glucose increased significantly (13%) with stable or gained weight at 1 year, but did not change significantly with reduced weight. Although glucose levels did not change significantly in patients with type 2 diabetes mellitus who gained weight, a decline beginning after 5% weight reduction culminated in 25% glucose reduction with ≥ 20% weight loss. Resting blood pressure declined independently of weight change.
  
  
  CONCLUSIONS
  Very obese adults can improve their cardiometabolic risk under primary care weight management. Incremental success may help motivate further therapeutic weight reduction.
authors.affiliation: Pennington Biomedical Research Center, Baton Rouge, LA 70808-4124, USA. William.Johnson@pbrc.edu
authors.forename: William D
authors.initials: WD
authors.lastname: Johnson
authors.forename: Meghan M
authors.initials: MM
authors.lastname: Brashear
authors.forename: Alok K
authors.initials: AK
authors.lastname: Gupta
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Rood
authors.forename: Donna H
authors.initials: DH
authors.lastname: Ryan
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000378:metabolism; D009767:Obesity, Morbid / Q000150:complications / Q000378:metabolism; D015431:Weight Loss / Q000502:physiology*
chemical_list: D001786:Blood Glucose