Three percent weight reduction is the minimum requirement to improve health hazards in obese and overweight people in Japan

doi:10.1016/j.orcp.2013.10.003

Obesity Research & Clinical Practice

Volume 8, Issue 5, September–October 2014, Pages e466-e475

https://doi.org/10.1016/j.orcp.2013.10.003 Get rights and content

Summary

Objective

Adequate goal-setting is important in health counselling and treatment for obesity and overweight. We tried to determine the minimum weight reduction required for improvement of obesity-related risk factors and conditions in obese and overweight Japanese people, using a nationwide intervention programme database.

Methods

Japanese men and women (n = 3480; mean age ± standard deviation [SD], 48.3 ± 5.9 years; mean body mass index ± SD, 27.7 ± 2.5 kg m⁻²) with “Obesity Disease” or “Metabolic Syndrome” participated in a 6-month lifestyle modification programme (specific health guidance) and underwent follow-up for 6 months thereafter. The relationship between percent weight reduction and changes in 11 parameters of obesity-related diseases were examined.

Results

Significant weight reduction was observed 6 months after the beginning of the programme, and it was maintained for 1 year. Concomitant improvements in parameters for obesity-related diseases were also observed. One-third of the subjects reduced their body weight by ≥3%. In the group exhibiting 1% to <3% weight reduction, plasma triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), haemoglobin A1c (HbA1c), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and γ-glutamyl transpeptidase (γ-GTP) decreased significantly, and high-density lipoprotein cholesterol (HDL-C) increased significantly compared to the control group (±1% weight change group). In addition to the improvements of these 7 parameters (out of 11), significant reductions in systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting plasma glucose (FPG) and uric acid (UA) (total 11 of 11 parameters) were observed in the group with 3% to <5% weight reduction. In the group with ≥5% weight reduction, the same 11 parameters also improved as those in the group with 3% to <5% weight reduction.

Conclusion

The 6-month lifestyle modification programme induced significant weight reduction and significant improvement of parameters of obesity-related diseases. All the measured obesity-related parameters were significantly improved in groups with 3% to <5% and ≥5% weight reduction. Based on these findings, the minimum weight reduction required for improvement of obesity-related risk factors or conditions is 3% in obese and overweight (by WHO classification) Japanese people.

Introduction

Obesity, as defined by excessive fat accumulation in the body, is often associated with lifestyle-related diseases such as hypertension, dyslipidemia, type 2 diabetes and atherosclerotic cardiovascular disease (CVD) [1], [2]. Recently, Metabolic Syndrome, a clustering of high plasma glucose, dyslipidemia and high blood pressure in the presence of abdominal fat accumulation, has emerged as a high-risk syndrome for CVD and diabetes [3], [4], [5]. In Japan, as in other developed and developing countries, obesity is a medical and social problem. Prevention of weight gain is therefore crucial for decreasing risks and manifestations of these life-threatening diseases.

In 1997, the International Association for the Study of Obesity (IASO) and World Health Organization (WHO) jointly proposed criteria for obesity and overweight, i.e., body mass index (BMI) ≥30 kg m⁻² and 25 to <30 kg m⁻², respectively [6]. In Japan in 2000, the Japan Society for the Study of Obesity (JASSO) defined obesity as BMI ≥ 25.0 kg m⁻² because in Japan this value has been established as the cut-off for increased risk for obesity-related complications, such as hypertension, dyslipidemia and hyperglycemia [7].

In 2000, JASSO also defined criteria for “Obesity Disease,” i.e., obesity associated with life-threatening diseases, as one or more lifestyle-related diseases in the presence of BMI ≥ 25 kg m⁻² [7], and in 2005, criteria for “Metabolic Syndrome” were also established [8]. In 2008, the Japanese government (Ministry of Health, Labor and Welfare) implemented a new system of health check-ups followed by specific counselling to screen for people with these risk factors [9]. Within this system, based on the results of their annual health check-up, people with “Obesity Disease” or “Metabolic Syndrome” were assigned to participate in lifestyle modification programmes.

In previously reported large-scale lifestyle intervention studies, such as the Diabetes Prevention Programme (DPP) [10] and the Finnish Diabetes Prevention Study [11], 5–7% weight reduction resulted in improvements in blood pressure (BP), lipids and glucose profile. It has been shown that ≥5% or ≥10% body weight reduction is required to improve obesity-related health hazards in Caucasian populations [12], [13]. There is a scarcity of information, however, on the minimum weight reduction required for obtaining these effects in Asian populations. We hypothesised that ≥3% weight reduction is enough to prevent or eliminate obesity-related health hazards in Asian populations.

The aim of the present study was to investigate the relationship between the degree of weight reduction and the improvement of obesity-related metabolic parameters, and to determine the minimum weight reduction required for improvement of obesity-related risk factors or conditions in Japanese who have “Obesity Disease.” Another research question was whether the recommended proposal by JASSO that a 3 kg reduction in body weight or 3 cm reduction in abdominal circumference is effective for the prevention or improvement of “Metabolic Syndrome”.

Section snippets

Subjects

We studied 3480 Japanese (3251 men and 229 women; mean age ± standard deviation [SD], 48.3 ± 5.9 years) who underwent annual check-ups for 2 consecutive years and were diagnosed with “Obesity Disease” or “Metabolic Syndrome” as defined by JASSO [7], [8] at the first check-up. “Obesity Disease” was defined as the association of BMI ≥ 25 kg m⁻² with one or more lifestyle-related diseases as mentioned below [7].

The baseline BMI ± SD was 27.7 ± 2.5 kg m⁻² and none of the study participants were taking medication

Changes in anthropometric and biochemical parameters

The weight of the subjects 1 year after the beginning of the lifestyle modification programme was significantly decreased compared to baseline values (reduced by 1.5 ± 3.6 kg, p < 0.001). In addition, BMI, abdominal circumference, SBP, DBP, TG, LDL-C, FPG, HbA1c, AST, ALT, γ-GTP and UA levels were significantly reduced and HDL-C was significantly increased (Table 1).

Weight reduction rates and changes in laboratory parameters

One year after beginning the programme, 53.7% of subjects reduced their weight by ≥1%, 33.3% reduced by ≥3% and 19.6% reduced by ≥5%

Discussion

Although substantial weight reduction is associated with significant health benefits, it is often difficult for obese or overweight individuals to attain optimal body weight. In previously reported intervention studies, such as the Diabetes Prevention Programme (DPP) [10], the Finnish Diabetes Prevention Study [11] and the Malmö feasibility study [15], the interventions were conducted by case managers on a one-to-one basis, which was very costly.

Foster et al. stress that it is important to

Conflict of interest

The authors declare no conflict of interest.

Acknowledgement

The study was supported by a Health Labor Sciences Research Grant.

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Original ArticleThree percent weight reduction is the minimum requirement to improve health hazards in obese and overweight people in Japan

Summary

Objective

Methods

Results

Conclusion

Introduction

Section snippets

Subjects

Changes in anthropometric and biochemical parameters

Weight reduction rates and changes in laboratory parameters

Discussion

Conflict of interest

Acknowledgement

The effect of age on the association between body-mass index and mortality

N Engl J Med

Prevalence of obesity, diabetes, and obesity-related health risk factors

JAMA

The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men

JAMA

Cardiovascular morbidity and mortality associated with the metabolic syndrome

Diabetes Care

Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults

Circulation

Obesity. preventing and managing the global epidemic

Japan Society for the Study of Obesity: New criteria for ‘obesity disease’ in Japan

Circ J

Metabolic syndrome-definition and diagnostic criteria in Japan

J Jpn Soc Int Med

New strategy on prevention and control of noncommunicable lifestyle-related diseases focusing on metabolic syndrome in Japan

Asian Perspectives and Evidence on Health Promotion and Education

Original Article
Three percent weight reduction is the minimum requirement to improve health hazards in obese and overweight people in Japan