Obesity is a recognized chronic disease, posing a major healthcare challenge. Weight loss can be achieved through lifestyle changes, medication, and surgery, but maintaining weight loss is a lifelong challenge. Primary care providers (PCPs) play a vital role in managing obesity. This article examines long-term clinical trial outcomes to identify effective weight maintenance strategies for PCPs.
The Growing Concern of Obesity
Obesity is now widely recognized as a disease, and its increasing prevalence makes it a major global health challenge. In 2008, over 200 million men and nearly 300 million women were estimated to be obese, representing more than 10% of the world's adult population. An additional 1.4 billion adults are overweight, and both overweight and obesity are increasing in children.
Obesity is associated with high morbidity and mortality, including cancer, cardiovascular disease, depression, dyslipidaemia, hypertension, obstructive sleep apnoea, osteoarthritis, and type 2 diabetes. The World Health Organization estimates that overweight and obesity are the fifth leading cause of death globally. Public health campaigns aimed at preventing obesity must be complemented by strategies to manage the disease in individuals who are already obese.
Treatment Options and the Importance of Lifestyle Intervention
Patients with overweight or obesity can be treated with lifestyle interventions alone, or with such interventions in combination with weight-loss medications or with bariatric surgery. However, even when therapy involves medications or surgery, lifestyle intervention continues to be critically important for achieving treatment goals. Following weight loss, weight maintenance is a challenge, regardless of the initial modality used for weight loss.
The Role of Primary Care Providers
Primary care providers (PCPs) play a critical role in supporting individuals attempting to lose weight and in maintaining their weight loss for long‐term. This important role is acknowledged in the American Heart Association (AHA)/American College of Cardiology (ACC)/The Obesity Society (TOS) obesity guidelines, which are aimed at PCPs and designed to aid treatment decisions to support weight loss and maintenance. Patients often seek and trust the advice of PCPs on weight management.
Read also: From "Morbidly Obese" to Healthy
PCPs have the opportunity and credibility to educate their patients on the negative health outcomes associated with obesity, the treatment options available to them, the challenges of weight maintenance, and the various approaches to successful weight‐loss maintenance. As with other chronic diseases, such as diabetes and hypertension, it is important that PCPs discuss obesity with their patients and how this disease can negatively impact health. However, it must also be acknowledged that it is challenging for PCPs to balance time constraints and competing demands in order to treat obesity effectively. Questions still remain on the effectiveness of obesity treatment in primary care and the optimal role of PCPs in the maintenance of weight loss.
Several effective and well‐tolerated pharmacotherapies are now available that complement both the weight‐loss and weight‐maintenance efforts of an individual, and other pharmacotherapies are under development.
Research Methodology
A PubMed search was conducted for articles related to the review topic and published in the English language prior to 28 February 2015. The search method employed was a structured rather than a systematic approach; this strategy was judged to be more appropriate because of the broad nature of the review topic. The search terms included ‘(weight) AND (loss OR reduc* OR decreas) AND (maintenance OR maintain OR sustain* OR control) AND (manag OR treat* OR therap) AND (obesity) AND (benefit)’. This search provided 825 articles. The search was further refined by adding more specific search terms to the string. Additional terms included: ‘metabol’, ‘disease’, ‘cardiovasc’, ‘diabet’, ‘risk’, ‘chronic’, ‘vascul’, ‘complications’, ‘primary care provider/specialist/multidisciplin’, ‘educat’, ‘pharmacother’, ‘lifestyle’, ‘diet’, ‘exercise/physical activity’, ‘behavio’, ‘gene/genetics’, ‘mechanism’, ‘regain’, ‘guideline’ and ‘surg’. Articles were scanned for relevance to the review topic and included if they were considered to be related to weight‐loss maintenance. Selected articles included peer‐reviewed reviews and original research articles, guidelines and articles published by regulatory bodies. The bibliographies of selected articles were also searched for any additional relevant literature. Article selection was based upon the author's own judgement, clinical experience and knowledge of the literature.
Defining Effective Weight-Loss Maintenance
The initial weight‐loss goal is 5-10% - a reduction that is sufficient to improve health and prevent or ameliorate many weight‐related complications. Currently, there is no consensus on a definition of ‘effective’ or ‘sufficient’ weight‐loss maintenance. Although such a definition should be based upon the degree of sustained weight loss needed to optimize health outcomes, there is a lack of evidence on the minimum weight loss needed to achieve these outcomes over the long term.
Benefits of Weight Loss and Maintenance
The evidence base for the benefits of weight loss and maintenance is substantial. Such benefits include improvements in cardiometabolic disease (cardiovascular disease risk, diabetes, dyslipidaemia, hypertension, metabolic syndrome, non‐alcoholic fatty liver disease and prediabetes), depression, gastroesophageal reflux disease, osteoarthritis, polycystic ovary syndrome, sleep apnoea, urinary incontinence and others.
Read also: Weight Loss Journey
Sustained weight loss (3 kg lost over 2-3 years) leads to reductions in blood pressure. Long‐term weight loss is also associated with a reduced risk of developing type 2 diabetes and improved glucose control in patients with type 2 diabetes. In men with obesity with a waist circumference >100 cm, weight maintenance (-4.8 kg after 23 months) is associated with decreased glucose and insulin concentrations. Some studies have suggested that intentional long‐term (>2 years) weight loss may reduce the risk of all‐cause mortality for women and people with diabetes. In a retrospective cohort study, 2,500 patients (74% men) undergoing bariatric surgery had significantly lower mortality than matched controls after 1-5 years (hazard ratio [HR]: 0.45; 95% confidence interval [CI]: 0.36-0.56) and after 5-14 years (HR: 0.47; 95% CI: 0.39-0.58).
The Challenge of Weight Regain
Many people with obesity, however, struggle to maintain their weight, following weight loss. A variety of effects following weight regain have been reported. There is evidence that some benefits are sustained following transient weight loss, despite weight regain. For example, if patients with diabetes, hypertension or sleep apnoea are able to sustain lower glycosylated haemoglobin A1c (HbA1c), lower blood pressure, and alleviate apnoea over the period of weight loss, this can lower the health risks these diseases exert on patients over their lifetime. With better glycaemic control, fewer microvascular complications, and reduced cardiovascular disease have been observed. In the Diabetes Prevention Program (DPP), subjects randomized to intensive lifestyle therapy experienced a 4-7% weight loss over the 4 years of the study, but continued to exhibit decreased rates of progression to type 2 diabetes after 10 years, despite regaining weight to a level equal to that in the control (placebo) group.
However, evidence also indicates that some benefits may be lost. Minimal weight regain (i.e. 2-6%) has been reported to cause metabolic risk factors (e.g. plasma lipids, blood pressure, fasting glucose and insulin concentrations) to revert to baseline levels. For postmenopausal women, partial weight regain following intentional weight loss is associated with an increased cardiometabolic risk. Serum triglycerides and low‐density lipoprotein‐cholesterol levels typically decrease with weight loss, but return to former levels after weight regain.
Lifestyle Modification for Weight Loss Maintenance
Lifestyle modification is effective in achieving weight loss. Landmark studies on the maintenance of weight loss with lifestyle modification are reviewed in this section. When reviewing these data, it is important to consider factors such as duration and intensity of treatment, as these can influence outcome. The National Weight Control Registry (NWCR), a US database founded in 1993, has provided evidence in relation to specific strategies for achieving and maintaining weight loss. This registry has identified the lifestyle modifications practiced by those individuals who were able to successfully maintain weight loss. It is important that PCPs are aware of this information so that they can better educate and support their patients in their weight maintenance journey.
For inclusion of patients in this database as weight maintainers, their weight loss had to be ≥13.6 kg and their new weight sustained for ≥1 year. A 10‐year observational study of 2,886 participants found that mean weight loss was 23.1 ± 0.4 kg at 10 years and that ≥87% of participants maintained a weight loss of ≥10%. A decrease in leisure‐time physical activity, dietary restraint and frequency of self‐weighing and an increase in the proportion of energy intake derived from fat were associated with a greater weight regain. Participants with ≥2 years of weight loss maintenance at enrolment continued to maintain larger weight losses at 5 and 10 years. Longer duration of weight maintenance was associated with better long‐term weight loss outcomes. The study concluded that most weight loss can be maintained over 10 years, but that it requires a sustained behaviour change.
Read also: Fame and Addiction: Josh Peck's Story
The Look AHEAD Study
The Look AHEAD (Action for Health in Diabetes) study assessed the effects of intensive lifestyle intervention (ILI) on clinically important health outcomes in people with overweight or obesity with type 2 diabetes. Participants were randomly assigned to one‐on‐one ILI or conventional diabetes support and education (DSE). ILI included diet modification and physical activity to induce and maintain ≥7% weight loss at 1 year and beyond.
At 1 year, the ILI group, compared with the DSE group, had lost a greater percentage of their initial weight (−8.6% vs. −0.7%); had improved fitness (assessed by treadmill test); had improvements in HbA1c, systolic and diastolic blood pressure, triglyceride, high‐density lipoprotein (HDL)‐cholesterol and urine albumin/creatinine; and had a reduced need for type 2 diabetes, hypertension and lipid‐lowering medications. Although the greatest benefits were often seen at 1 year, the ILI group still had greater improvements than the DSE group in terms of weight reduction (−6.15% vs. −0.88%), fitness, HbA1c levels, systolic blood pressure and HDL‐cholesterol levels at 4 years. Factors indicative of the long‐term success of ILI included use of meal replacements, high levels of exercise, self‐monitoring and individualized diets using ‘healthy meal plans’ that worked with personal and cultural food preferences.
The Diabetes Prevention Program (DPP)
The DPP evaluated if modest weight loss through dietary changes and increased physical activity or treatment with metformin could prevent or delay the onset of type 2 diabetes. Participants were randomized into three groups as follows: (i) the lifestyle intervention group received intensive training in diet, physical activity and behaviour modification (24‐week curriculum), with the aim of losing ≥7% of their body weight and maintaining that weight loss; (ii) a second group received 850 mg of metformin twice daily, and (iii) a third group received placebo. The metformin and placebo groups both received information on diet and exercise but received no intensive or individualized counselling.
Half of the lifestyle intervention group achieved the 7% weight reduction goal after 24 weeks. After 2.8 years, participants assigned to the lifestyle intervention group had shown a greater increase in physical activity and greater weight loss (−5.6 kg) than those on metformin (−2.1 kg) or placebo (−0.1 kg) (P < 0.001 for both). Compared with placebo, lifestyle intervention and treatment with metformin had reduced the incidence of type 2 diabetes by, respectively, 58% and 31%, and had reduced the incidence of metabolic syndrome by 41% and 17%. These findings demonstrate that intense lifestyle intervention can be effective in long‐term weight loss, weight maintenance and in risk associated with comorbidities. In the 10‐year follow‐up, the lifestyle group had lost, on average, 7 kg by year 1 and then had partly regained weight (although still 2 kg less than at randomization), while the metformin group had maintained a modest weight loss of 2.5 kg. An additional analysis of the lifestyle intervention arm found that the overall 2‐year weight loss (from baseline) was the strongest predictor of a reduced incidence of type 2 diabetes and improved cardiometabolic risk. These subjects reported that they had planned meals in advance and selected lower calorie foods, and had self‐monitored their food intake, calories and weight.
Weight-Loss Maintenance Trial
In the weight‐loss maintenance trial, adults with overweight or obesity (body mass index [BMI] 25-45 kg m−2) who lost ≥4 kg in a 6‐month behaviour weight‐loss intervention (phase I) were randomized to one of three 30‐month maintenance interventions (phase II). In phase II, participants received behaviour intervention via interactive internet‐based technology (IT), monthly personal counselling (PC) or no further intervention (self‐directed control, SD). Mean weight changed range from −2.3% (African-American women) to −4.5% (Caucasian men) after 36 months. Although participants regained some weight during phase II, mean weight at the end of the study was significantly different from baseline in all three groups.
Ian Peck's Transformation
The actor Ian Peck, known for his role as Curly in Peaky Blinders, has garnered attention due to his dramatic weight loss. Fans were surprised by his transformation, sparking curiosity about the reasons behind it.
Who is Ian Peck?
Ian George Peck, born on October 18, 1957, is a British actor known for his roles in various films and TV shows, including Harry Potter, Robin Hood, and Wolfman. He gained significant recognition for his portrayal of Curly in Peaky Blinders.
The Weight Loss Transformation
Peaky Blinders fans were shocked to see the dramatic weight loss of actor Ian Peck, who plays Curly in the show. The actor had lost a significant amount of weight, leaving viewers wondering if he had been replaced. The show’s credits confirmed that Ian Peck was still playing the role of Curly, but his drastic transformation left many fans open-mouthed. On social media, viewers expressed their surprise at the change and speculated about what could have caused it.
It is likely that Ian Peck has been following a strict diet and exercise regime in order to achieve his new look. He may also have adopted healthier lifestyle habits such as cutting out processed foods and drinking more water. Whatever the cause, it is clear that he has put in a lot of hard work to get into shape for the show. The transformation has certainly paid off, with viewers praising him for his dedication and commitment to getting into shape for Peaky Blinders. It is also likely that this will inspire other people to make positive changes in their own lives and strive for better health and fitness. Overall, Ian Peck’s dramatic weight loss has been an inspiration to many Peaky Blinders fans who are now motivated to make positive changes in their own lives. His dedication and commitment have certainly paid off, with viewers praising him for his transformation.
Reasons Behind the Weight Loss
Ian Peck's decision to lose weight may have been influenced by industry standards and a focus on health and body image. While his acting talent was never in question, the pressure to meet societal expectations regarding weight and appearance may have motivated him to embark on a weight loss journey.
Ian Peck's Diet and Workout Plan
While Ian Peck has not publicly disclosed specific details about his diet and workout plan, it is believed that he follows a healthy lifestyle that includes a balanced diet consisting of fruits, vegetables, and nutritious foods. His workout routine likely incorporates aerobic exercise and regular visits to the gym. Despite being 65 years old, Ian Peck remains committed to maintaining his fitness and overall well-being.
Curly's Disability in Peaky Blinders
The character of Curly in Peaky Blinders has been a subject of speculation regarding potential learning disabilities. Curly is portrayed as someone with developmental delay or autism, often assigned physical jobs rather than intellectual ones. Ian Peck, the actor who plays Curly, does not appear to be autistic or disabled in real life but supports mental illness awareness.
Ian Peck's Filmography
Ian Peck has had a prolific career, appearing in numerous films and TV shows, including:
- Robin Hood (2008)
- Criminal Justice (2009)
- Wolfman (2010)
- Harry Potter (2011)
- Peaky Blinders (2013-2022)
- His Dark Materials (2019-2022)
- Coronation Street (2024)
Addressing Common Questions
- What happened to the actor who plays Curly in Peaky Blinders? Ian Peck, the actor who plays Curly, underwent a significant weight loss transformation, leading to speculation about a possible replacement. However, it was confirmed that Ian Peck continued to portray the character.
- Is Ian Peck autistic in real life? Ian Peck is not autistic but supports mental illness awareness.
- Is Ian Peck dead or still alive? Ian Peck is still alive and enjoying a healthy life.
- What is Ian Peck's net worth? Ian Peck’s Net Worth is $150 million.