- Today we're diving into two fascinating studies that challenge our understanding of weight loss and longevity. First, we'll explore groundbreaking men analysis that reveals surprising insights about lifestyle interventions and their impact on weight loss. Then we'll examine an eye-opening study about the American Heart Association's Life Essential H score and its relationship with mortality in people with obesity. Stay tuned as we break down what these findings mean for being a lifelong athlete. Let's get started. Welcome back team to the Building Life Long Out These Podcast. I'm your host Jordan Renicki. Thanks so much for stopping by. We haven't met yet. Once again, my name is Jordan. I'm a dual board certified physician in family and sports medicine. And the goal of this podcast help keep you active and healthy for life through actual evidence informed education. And as I mentioned before, we're talking about two cool studies. So let's dive in right away. So this study we're gonna talk about right here. This is talking about lifestyle interventions for weight loss. And overall global obesity and overweight rates are increasing with an estimated one third of the world's population fitting into that either obese or overweight category. Current guidelines recommend lifestyle modifications for managing overweight and obesity based on observational studies, which link obesity to various health risks, including metabolic syndrome, diabetes, arthritis, heart disease, cancer, and the list goes on and on. However, lots of questions remain regarding the effectiveness of lifestyle interventions in achieving sustained weight loss and the required intensity, the duration, and the actual impact on mortality. And so this meta analysis aims to examine the relationship between the dose of lifestyle interventions, long-term weight reduction and mortality. So let's start with the methods here. So overall, this was a meta analysis and the study followed a PRISMA guidelines, which PRISMA are kind of the standardized way of preparing a meta analysis. The researchers conducted a comprehensive search around multiple databases, including Medline, Google, Science Wreck, all the fun stuff for randomized controlled trials. We're only looking at randomized controlled trials here. And the inclusion criteria were these. These were studies comparing lifestyle interventions to control interventions for weight loss. There had to be a minimum of 100 participants. They had a report, weight change and mortality data for at least one year. And intervention arm had to be focused on weight loss through a hypocaloric diet for at least one face-to-face intervention. And then the control groups in this were receiving standard care without specific weight loss guidance. And they had to lose less than 5% of the participants to follow up. And overall, the primary outcome was weight loss at one year. And so what were the results? Well, overall, this analysis included 31 randomized controlled trials with over 20,000 participants. And 70% of these people had cardiometabolic risk factors in some way, shape or form. And although there were no studies that explicitly focused on those with established cardiovascular disease, there was one study here called the LICK-A-HEAD trial, which was a big component of this entire study. 14% of those participants did have established cardiovascular disease. So that's just something to mention. And lifestyle interventions resulted in moderate weight reduction. So an average weight loss of about 3.63 kilograms at one year compared to the control group. And this difference actually decreased over time with an average weight loss of about 2.45 kilograms at three years. So at one year, we lost about 3.36 kilograms and then it kind of narrowed down only 2.45 compared to control at two years. But there was a dose response relationship and that was observed between the number of lifestyle interventions and how the weight loss was attained. So weight loss interventions is kind of vague here, but they pretty much talk about anytime there was an interaction with the health system, whether that's a doctor's appointment, talking with a therapist, talking with a nutritionist, dietician, or actually having group fitness stuff. So like any like interaction was counted as some sort of intervention. And the studies found that if you had more than 28 interventions per year, it resolved greater weight loss, right around 4.5 kilograms compared to studies with 28 or fewer, which is only about 2.38 kilograms. And so that's kind of where they saw that. And they did a regression model estimated about a 0.6 kilogram weight loss difference for every 10 additional interventions. So what are they saying? They're saying that those who interacted more with the health system, be it the fitness industry or medical professionals, they had higher amount of weight loss and compared to those who had lower than 28. So that's just what they saw specifically. And they're saying that for every 10 additional interventions, increased weight loss of about 0.6 kilograms. And overall, they did look at mortality. A total of 593 deaths occurred all across different studies. The weighted average follow-up was about 9.2 years. So they'd look at it, but on average, the average mortality was about 0.3% per year. And although it was not statistically significant, mortality was lower in the intervention group compared to the control group. And once again, it was not statistically significant, but it was trending in that direction that there was less people dying in the group that had more interventions than not. And the number of interventions and weight loss in the first year were not significantly associated with mortality. That's the takeaway from that. And once again, that look ahead trial that was embedded inside this look ahead trial, which was the largest and longest study did influence the results. It included 25% of the total participants and accounted for 63% of the deaths. And so this is where we got a lot of the data from. And this trial focused on overweight or obese patients with type 2 diabetes. As I mentioned before, 14% also had established cardiovascular disease. And the intervention involved frequent face-to-face meetings leading to about a 5% to 10% weight loss, which was great. And the hazard ratio there for all cause mortality was 0.85%. So that's actually great. So the intervention led to a 15% reduction in essentially all cause mortality. And the estimated effects on mortality and body weight in the look ahead trial were similar to those observed in all their studies combined, but it was a huge percentage. So I just wanna mention that we had a big, big study that looked at this and it kind of skewed a little bit of the results. So what we see here will really affect what we ultimately see 'cause it was such a big component of it. But for the discussion on this, you know, the four key conclusions really emerged from this analysis. You know, the majority of the studies focused on middle-aged individuals around 50 to 60 years old with cardiometabolic risk factors. So it kind of limits generalizability to other populations, right? So people who are a little younger can't really extrapolate to that. Lifestyle interventions led to modest but sustained weight loss averaging, once again, 3.63 at one year with two thirds of that maintained after years two to three. And there was a dose response relationship with more frequent intervention resulting in greater weight loss, which was great. So the more interactions you had, the more weight loss specifically. And lifestyle interventions were associated with a potential but not statistically significant reduction in all cause mortality, like we mentioned before, trending there but not statistically significant. And overall, despite the large sample size and follow-up duration, the low mortality rate across studies made it difficult to definitively determine, you know, what the impact was on mortality. That's really what it was. And Look Ahead trial, as I mentioned before, provided valuable insights into the long-term benefits of sustained weight loss. And it did demonstrate similar mortality reduction in other studies specifically. And these findings really highlight the need for, you know, a comprehensive and sustained interventions to achieve clinically significant weight loss. So that's a big thing. 20 interventions, that's a lot of interventions. 20 interventions is a lot of interventions. And it's really challenging. So what we're seeing is the more touches, the better results. And this kind of challenges the notion that like, hey, simple lifestyle changes can lead to success. And I'm not here to poo-poo that and say like, oh, you can't do it. 'Cause obviously you can, you know, you don't have to have that. But it just shows that the more you have accountability, it seems to be a little bit better. And so it does remain unclear whether weight loss is maintained after the cessation of these. So they'd got three years. They don't know if it kept going. Most studies didn't report post-gen-rencheon outcomes. And so, but it seemed like a lot of touches was better. And the effectiveness of lifestyle program in the real world may differ significantly from these highly motivated participants and these ones in clinical trials, right? Who had, you know, they were holding their hands, essentially saying, hey, like, we're gonna follow up with you and do that. So how do we extrapolate that into the real world? I mean, I don't know, other than accountability is good. I think that's the big takeaway I take from this is that the more people you have, the more touch points you have, the better odds you have of sustaining your weight loss, having more weight loss and sustaining that weight loss. And so that's some kind of a take home point for me. But there were definitely limitations to the study. You know, the lack of individual participant data limited the analysis a little bit. They couldn't evaluate weight loss variability between individuals. The benefit of weight loss in subgroups with the greatest weight loss couldn't be assessed either 'cause we didn't have individual data as well. But, you know, also because we didn't have individual data, right, we couldn't necessarily see if factors influencing weight loss, like BMI, gender, age, ethnicity, if they were really playing a factor as well. And, but yeah, overall, those are kind of the big things. On the top of that, a lot of times, details on the food intake, exercise patterns, a lot of this was self-reported, we're not necessarily sure, kind of changed from one to one. So that is kind of the big limitations there. But overall, I think this is a cool meta-analysis and because this meta-analysis emphasizes that it's important to have frequent and sustained lifestyle interventions for achieving clinically significant weight loss, which, you know, could then potentially contribute to reduce mortality long-term. Maybe the data doesn't necessarily show that, but it's pretty intuitive that if we lose weight, we're probably gonna have better outcomes. That's kind of what it is. But the big take home point is that, you know, get those frequent and sustained lifestyle interventions. And in this study, yeah, a lot of times it was falling off someone face to face. But I think what it's really showing, if you look at this, is, hey, if you make this change and you stick with it, then you're gonna have much better results, which is like the least shocking thing in the world. Like, hey, like, so you're telling me if I stick to my diet and exercise plan, things will go better? Like, yeah, least shocking thing in the world. But what I'm saying is that's not new news, but what this is is that, hey, maybe it takes a little bit more check-in to do that. You know, 'cause everyone knows if you stay on something and do it long-term, you'll have success. But it's usually we start for a little bit and then we kind of fall off. But what if we had, you know, an accountability group or you're seeing a clinician or something like that, kind of check in, keep you on track. I think that's really where the benefit from this study shows that like, hey, it can sometimes take an army or, you know, it takes a village to raise an army. And so, yeah, that's kind of what it is. But overall, I really enjoyed this. You know, there was definitely some areas of improvement, but I think it was kind of, yeah, I think it was kind of helpful in general to kind of see this trend that, you know, when you're trying to lose weight, it's okay. You don't have to necessarily do it alone. And it can be helpful to get, to reach out and get help on that. And that's kind of the takeaway from this met analysis. All right, next, moving on, we're gonna talk about an article that looked at the essential eight in those with obesity. And the essential eight, as we'll talk about here in a second is the AHA's recommendations of the eight things you need to do to be healthy. And this article looked at those with obesity and how the essential eight kind of affected health outcomes. So let's get started. Obesity is a major global public health concern linked to chronic diseases and premature death. And it's defined by the WHO as having a BMI of greater than 30. So 30 is kind of that cutoff. And obesity increases the risk of cardiovascular disease, diabetes, certain cancers, and higher all-cause mortality. And assessing and evaluating the health status of those who have obesity is crucial to figure out how we develop effective interventions, right? So a lot of times, you know, we sometimes will definitely have a negative bias towards patients who have obesity saying, oh, like, you know, that's the number one thing we have to take care of. What this study is looking at is, hey, in those who have obesity, if we adjust other things like these lifestyle factors, what does that do to health outcomes? So that's what we're specifically looking at here. And one quick second, I wanna take a step back. We wanna look at Life's Simple Seven versus Life's Essential Eight. So the American Heart Association developed Life's Simple Seven many years back to kind of assess overall cardiovascular health. The Simple Seven includes seven key health metrics and behaviors, including smoking, body weight, physical activity, diet, blood pressure, blood sugar, and cholesterol levels. And that should sound familiar if we talk about that all the time, those things. But then the AHA then updated the, you know, the seven to Life's Essential Eight, which incorporated sleep for a more comprehensive assessment. So once again, LE8 has pretty much the same thing as LS7, but main thing, once again, the eight things now are gonna be smoking, body composition, physical activity, diet, blood pressure, blood sugar, cholesterol, and sleep. Those are the big things we're looking at there. And they've used this for many years now. And the LE8, or, you know, we're gonna refer to that as their Life's Essential Eight LE8, shows potential in predicting cardiovascular events and all cause mortality. So that's kind of been the history there. And the focus of this study, they did this because there's limited research on the LE8, you know, that application for this in obese population, the patients with obesity. In this study, they use the NHANES data to evaluate the relationship between LE8 scores and the mortality in obese individuals. And the hypothesis is that a higher LE8 score, they're associated with lower all cause and cause specific mortality rates. So the better your score was, the less mortality you would have is essentially the goal. So what did this study population look like? Well, specifically data from 9,143 obese participants, once again, with a BMI over 30. This was in the NHANES study, and this looked at date ranges between 2005, 2018. So it looked at about 9,000 people from that date range that are analyzed. And participants who had either missing data or lost a follow-up were excluded. And the definition of the LE8 was kind of interesting. I dove into this a little more. It includes four health behaviors. So specifically diet, right? Physical activity, nicotine exposure, and sleep. Those are like the quote-unquote health behaviors. And diets, specifically, they're looking at consumption of things like veggies, fruit, red meat, whole grains, beans, processed foods, et cetera. That's a big thing. Physical activity is kind of self-reported how much you're doing. Nicotine exposure, essentially, is talking about smoking, but it also does have other nicotine products as well. And then sleep is a big thing. And then there are four health factors, which they looked at were BMI, cholesterol levels, specifically non-HDL, blood glucose, and blood pressure. And so those eight things were all looked at. Each component was then measured at baseline according to LE8 standards. And then this score, this LE8 total score, that was all combined and kind of added up. So what they did though, they had an unweighted score. So unweighted average of all the components, and they added up and categorized them into low, moderate, and high cardiovascular health. Where the low was zero to 49 score, moderate 50 to 79, high 80 to 100. And you can actually calculate this yourself. I was kind of figuring out, they didn't have it in the actual paper, so I had to do a little digging, but you can actually go on the heart.org, and there's a link in the show notes. You can kind of calculate your own health score. Which is kind of fun to do. So that's kind of, you can follow along, you can kind of see where you're doing and where you fit in there. But yeah, that's a side note there, but link in the description as well. And what did they find? Well, overall, and they looked at mortality outcomes. That's big thing, right? They were looking at survival status. They linked the NHANES with this mortality database, looked at what's going on with overall death, whether it was cause specific, did it come from cardiovascular disease, non-cardiovascular disease, all those things. And then they also collected data on different demographics, socioeconomic factors, health statics, all those fun things. And so what did they find? Well, overall, these about 9,000 participants were divided into three groups based on their scores. So the average age was around 50. Overall, we had about 2,200 participants in the low cardiovascular health group, 6,500 in the moderate, and then only 338 in the high cardiovascular health group. And in that group, the higher CVH group, they were younger typically, had a lower proportion of males, they drank less, and had fewer cardiovascular diseases and depression. That's kind of what they found from baseline characteristics. And follow-up data-wise, the median follow-up, so average follow-up is about 7.3 years. So that's pretty good. There were 867 all-cause deaths, about 9.5% of participants, 246 cardiovascular deaths, and 621 non-cardiovascular-related deaths. And mortality rates varied across the CVH groups, meaning the cardiovascular health groups, there definitely was a difference between who had mortality in that group or whatnot specifically. What they did find is that all-cause mortality, there was about 16.8% in the low group, 7.4 in the moderate, and only 1.5 of the deaths happened in the high group, so the vast majority happening low, not surprising there. Specifically cardiovascular mortality, only 5% in the low, 2% moderate, 0.3% high. And then once again, non-cardiovascular-related, 11.7 low, 5.4 moderate, 1.2 high. Not necessarily, it doesn't matter what those numbers really show, but all they show is that as you increase cardiovascular fitness, that you had a lower chance of dying is what it came down to. And they also ran that statistical analysis, the Kaplan-Meier curves, this analysis showed significant differences in all-cause cardiovascular and non-cardiovascular mortality across those CVH groups specifically. And right here, you can kind of see just a sample. There's multiple of these in the data, but if you kind of look at here, the red line is gonna be the high group, so the red is the highest fitness, and you can see on the Y axis is survival probability, so how likely you are to survive over in the X axis is time. So over time, how likely to survive. Early on, very, very likely, and then it starts to go a little bit longer, but it stays pretty darn high. That's pretty close to 100, and that's our highest group. And then, whereas let's just take low, for example. Low, you can see right away, we start to see this big difference. And by the time we get out to the 175 months, we are seeing a significant difference between the high and low groups in terms of mortality, and that's what we're looking at here in that, that's how a Kaplan-Meier curve looks like. It's kind of looking at the difference between them. So I thought it was kind of interesting and at least worth seeing. And from the other data analysis, all-cause mortality compared to the lowest group, so talk about hazard ratio. So if you use low as kind of the baseline, the hazard ratios for moderate was 0.63 versus 0.25 and high. And that's a big thing specifically. What they're saying there is that for high, 0.25 hazard ratio means like you're 75% less likely to have all-cause mortality if you have high cardiovascular fitness in this group. That's what it's pretty much saying there. You know, you had a reduction of 75% is what it came down to. For cardiovascular disease mortality compared to the low one skin, hazard ratio is 0.61 for moderate, 0.19 for high. So almost a little over 80% better, which is awesome. And then non-cardiovascular disease mortality, same thing showed once again, 0.64 for moderate, 0.27 for high. So being fit is good for you, who would have thought? But they also did some more calculations found that each 10-point increase in these scores was associated with a 20% reduction in all-cause mortality, 21% reduction in cardiovascular mortality, and 20% reduction in non-cardiovascular disease-related mortality. That's kind of a big thing. And then they also ran this kind of stratified analysis and showed a kind of, to see if there were other clues from demographics that can kind of lean into it. And what they found was that it showed a dose response relationship between the LE8 scores and decreased mortality risks. Once again, that's kind of the big thing there. There's looking at it again from a different angle and found that pretty much the same results. And so what were the key findings in this? Well, the key findings were that a higher LE8 scores, they're significantly associated with lower all-cause mortality, lower cardiovascular disease mortality, and lower non-cardiovascular disease mortality in obese individuals. And I think the LE8 is a kind of a valuable tool for assessing the health status and mortality of patients who have obesity. I think it's gonna be a cool tool to kind of say, hey, let's go from there and look at it. And the reason this was cool was 'cause there was limited research on the LE8, on its necessary mortality, and specifically in patients with obesity. And so this study kind of provides further evidence supporting the LE8's role in predicting health outcomes in obese individuals. And I think this is really awesome because ultimately this gives us something to focus on other than just talking about someone's weight. I think this can be a stigma in healthcare system where you come in and the first thing you think about is, okay, we gotta lose weight, gotta lose weight. I think ultimately you can't be afraid to talk about that 'cause it's very important. Very clearly, this is not saying obesity is not a risk factor, that's not saying that at all. That is a very well-established risk factor for many things. So I'm not saying that. But if you just focus on that, then we're missing a lot of improvements that we could have. This could impact a lot of health behaviors and health outcomes. And specifically, if we're focusing on healthy diet, physical activity, sleep, all those things have a huge impact on the health of patients who have obesity. And so this, for me, this is what this is reiterating is that, hey, while we're working on weight, weight doesn't happen overnight, right? That is not happening specifically. Can it happen quickly if you're on medications or do something? Yeah, potentially. But let's say, hey, we're just doing this and we're getting slow and steady progress, that's great. But we're gonna say like, okay, let's not work on the other things until we get there. No, we're gonna work on everything together. So if we're still struggling with weight, we can still do these other things and have a big improvement. And so once again, there's kind of that concept of, you hit your personal quote unquote fat threshold where you're not really having health outcomes until you hit a certain amount. Here, it's like, hey, we can kind of stay that off, potentially, we can improve lots of outcomes, specifically mortality, not diets early, if we do the other things, if our diet is improving, if we're having good sleep and we're exercising and we're controlling our cholesterol and blood pressure and glucose and not smoking and doing all those things, like all the things I talk about all the time, these are big rock things. And so it's just an important thing that yes, BMI and weight is one of the big rocks, I will say that, but there are seven or eight other big rocks as well that we need to focus on. And so as a healthcare provider, don't just focus on one big rock, focus on all the big rocks and sometimes if you're moving other big rocks, that helps the other rock move as well. And so that's something I have to think about. So overall, this was cool. There were some strength limitations I wanna talk about. Strength, this was a large sample size. This had national representation as well. They use some great statistical analysis, kind of look at it. So I thought a cool study. Limitations wise though, there was a lack of followup exams, potential for self-reporting bias 'cause a lot of this is self-reported and just anytime you have this big of an observational study it's kinda hard to know. But in conclusion, a higher LEH scores, they're significantly associated with lower all-cause mortality in general and lower cardiovascular and non-cardiovascular disease mortality in obese individuals. And I think it's ignored. Once again, as I mentioned, the takeaways is that we focus only on obesity quite often and obesity is one risk factor out of many, but not the only one. So we need to counsel patients on more than just weight loss as so many other factors have a really big impact on health and mortality. And the LEH can serve as an effective predictor of health status and mortality risk. And so we can use this to kind of help guide us as well. And hopefully we get some future studies kind of carving this and figuring out how to use this more, but overall thought this is a really, really cool study. And that's gonna be it for today. Thanks so much for stopping by. If you found this information helpful, please take a moment to leave a five star review in your favorite podcast platform of choice. It really helps get this content out to other people. And to stay up to date with the latest health news, please sign up for the newsletter so you don't miss any content. But that's it for today. Now get out your phone and get outside and we'll see you next time. Disclaimer, this podcast is for entertainment, education and informational purposes only. The topics discussed should not solely be used to diagnose, treat or prevent any condition. The information presented here was created with an evidence-based approach, but please keep in mind that science is always changing and at the time of listing this, there may be some new data that makes this information incomplete or inaccurate. Always seek the advice of your personal physician or qualified healthcare provider for questions regarding any medical condition.
