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Klein, H.* ; Pachter, D.* ; Goldberg Toren, D.T.* ; Kamer, O.* ; Alufer, L.* ; Ebstein Karamani, N.* ; Chassidim, Y.* ; Shelef, I.* ; Rudich, A.* ; Yoel, U.* ; Ben-Arie, G.* ; Zelicha, H.* ; Yaskolka Meir, A.* ; Tsaban, G.* ; Bartal, C.* ; Blüher, M. ; Stumvoll, M.* ; Ceglarek, U.* ; Isermann, B.* ; Qi, L.* ; Stampfer, M.J.* ; Hu, F.B.* ; Shai, I.*

How effective is rejoining a long-term weight loss program? The 5- and 10-year MRI-assessed Follow Interventions Trial (FIT) project.

BMC Med. 24:121 (2026)
Verlagsversion Forschungsdaten DOI PMC
Open Access Gold
Creative Commons Lizenzvertrag
BACKGROUND: It remains unclear whether reengaging in lifestyle weight loss interventions is effective for the long-term. METHODS: We conducted the CENTRAL (trial 1, T1) lifestyle weight-loss trial in 2012-2014, and the DIRECT-PLUS (trial 2, T2) weight-loss trial in 2017-2018. All participants were invited for follow-up in 2022-2024 to assess weight, metabolic biomarkers, and fat depots via magnetic-resonance-imaging (MRI) five years after the second trial. RESULTS: The analysis included 572 trial observations contributed by 480 participants; of these, 388 participated in one of the two trials and 92 participated in both (T1 + T2 rejoiners). At follow-up, 384/480 (80%) were re-evaluated, including 76/92 (83%) rejoiners. In T1, participants who participated once and those who later rejoined T2 exhibited similar responses to their first intervention, including comparable weight-loss (-3.3% vs. -3.4%; FDR = 0.93). However, T1 + T2 rejoiners began their second intervention with a similar baseline BMI to their first (31.8 kg/m2 vs. 31.3 kg/m2; FDR = 0.12). Nevertheless, they presented a more favourable abdominal fat and metabolic profiles at T2 baseline than at their initial T1 baseline (visceral adipose tissue (VAT): 135.5 cm2 vs. 160.0 cm2; homeostatic model assessment of insulin resistance (HOMA-IR): 3.8 vs. 4.5; high density lipoprotein cholesterol (HDL-C)/Triglycerides: 3.6 vs. 4.2; all FDR < 0.05). In response to T2, rejoiners exhibited attenuated improvements compared to those achieved during their previous T1 intervention (weight: -1.5% vs. -3.5%; VAT: -7.2% vs. -33.3%; deep subcutaneous adipose tissue (SAT): -4.0% vs. -31.9%; superficial SAT: -3.3% vs. -25.4%; all FDR < 0.05), and compared to first-time T2 participants (weight: -3.5%; FDR < 0.05, VAT: -11.6%; FDR = 0.20, deep SAT: -9.9%; FDR < 0.05, superficial SAT: -9.3%; FDR = 0.05). Yet, 5 years after completing T2, T1 + T2 rejoiners exhibited significantly less weight regain compared with first-time T2 participants (+ 0.2% vs. + 2.9%; FDR < 0.05), deep-SAT regain (+ 2.4% vs. + 13.3%; FDR < 0.05), and superficial-SAT regain (+ 12.8% vs. + 24.3%; FDR < 0.05), though similar VAT regain. Overall, although T1 + T2 rejoiners had higher baseline obesity parameters than first-time participants, they presented comparable values by the 5- and 10-year follow-up. CONCLUSIONS: Despite an attenuated weight-loss response, repeated engagement in a structured lifestyle intervention yields meaningful long-term impacts with sustainable metabolic benefits. TRIAL REGISTRATION: CENTRAL (Clinical-trials-identifier:NCT01530724); DIRECT-PLUS (Clinical-trials-identifier:NCT03020186).
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Publikationstyp Artikel: Journalartikel
Dokumenttyp Wissenschaftlicher Artikel
Schlagwörter Lifestyle ; Mri ; Randomized Clinical Trial ; Visceral Adipose Tissue ; Weight Cycling ; Weight-loss; Insulin-resistance; Adipose-tissue; Obesity; Risk; Fat; Glucose; Impact; Food
ISSN (print) / ISBN 1741-7015
e-ISSN 1741-7015
Zeitschrift BMC Medicine
Quellenangaben Band: 24, Heft: 1, Seiten: , Artikelnummer: 121 Supplement: ,
Verlag Springer
Verlagsort Campus, 4 Crinan St, London N1 9xw, England
Begutachtungsstatus Peer reviewed
Institut(e) Helmholtz Institute for Metabolism, Obesity and Vascular Research (HI-MAG)
Förderungen Deutsche Forschungsgemeinschaft