Dietary Patterns During Weight Loss Maintenance vs. Weight Regain: A Secondary Analysis of the Look AHEAD Trial

TL;DR

This study compares dietary patterns in people who regain weight versus those who maintain weight loss after a diabetes intervention.

Contribution

The study identifies specific dietary pattern changes linked to weight regain versus maintenance after initial weight loss.

Findings

Weight regain was associated with greater decreases in DASH diet scores and Pattern 1 (vegetable, fruit, and fish) from Year 1 to Year 4.

Weight regain was also linked to increases in Pattern 2 (low-fiber grains and high-fat animal proteins) over time.

Sex differences showed that only WLR women and WLM men increased sweets consumption from Year 1 to Year 4.

Abstract

Background/Objectives: Limited information exists on how dietary patterns change in adults who experience weight regain vs. those who maintain weight loss after lifestyle interventions. Methods: Five hundred fifty-two adults (60 ± 1.0 years, 33.8 ± 0.4 kg/m2) with type 2 diabetes mellitus from the Look AHEAD Trial achieved ≥ 7% weight loss after Year 1, completed follow-up visits through Year 4, and provided three 134-item food frequency questionnaires. Weight “regain” (WLR) was defined as regaining ≥ 50% of the initial weight lost. Dietary patterns were determined using established DASH diet scores (scale: 0–9) and principal component analysis (PCA; higher scores = more adherent). Repeated measures linear mixed models assessed group and sex differences in dietary patterns. Results: Dietary patterns were similar between groups during weight loss (baseline to Year 1). WLR DASH scores decreased more from Year 1 to Year 4 compared to “maintain” (WLM) (WLR: Y1: 5.66 ± 0.14, Y4: 4.60 ± 0.14; WLM: Y1: 5.49 ± 0.13, Y4: 4.92 ± 0.13; difference-p < 0.01). Of the two PCA-derived dietary patterns, Pattern 1 (vegetable, fruit, and fish) decreased more in WLR (WLR: Y1: 0.12 ± 0.16, Y4: −0.14 ± 0.16, WLM: Y1: 0.06 ± 0.14, Y4: 0.25 ± 0.15; difference-p < 0.01), while Pattern 2 (low-fiber grains and high-fat animal proteins) increased in WLR (WLR: Y1: 0.40 ± 0.11, Y4: 0.61 ± 0.11, WLM: Y1: 0.34 ± 0.10, Y4: 0.21 ± 0.10, difference-p < 0.01). Sex differences showed that only WLR women and WLM men increased sweets from Y1 to Y4 (WLR women Y1: 0.26 ± 0.04, Y4: 0.41 ± 0.04; p < 0.01; WLM men: Y1: 0.23 ± 0.04, Y4: 0.38 ± 0.04; p < 0.01). Conclusions: These data demonstrate that differences in dietary patterns between WLR and WLM emerge after the initial weight loss intervention with some sex differences. This suggests that longer-term shifts in dietary patterns after lifestyle interventions may influence weight loss maintenance.

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