Weight regain following successful lifestyle interventions is common, raising questions about whether metabolic benefits achieved during weight loss can be maintained over time. Long-term follow-up data from two randomized controlled trials suggest that changes in body fat distribution, particularly reductions in visceral adipose tissue, may have lasting implications for cardiometabolic health beyond changes in body weight alone. The analysis was published in the Circulation.

Investigators conducted a follow-up study of participants from the CENTRAL and DIRECT-PLUS randomized controlled trials, which evaluated dietary interventions combined with structured physical activity. 

Among 381 eligible participants, 366 (96%) were successfully contacted and evaluated 5 and 10 years after completion of the 18-month interventions. Follow-up assessments included magnetic resonance imaging measurements of visceral adipose tissue, superficial and deep subcutaneous adipose tissue, intrahepatic fat, and intrapancreatic fat, along with clinical and metabolic evaluations.

Findings

• Despite complete weight regain during follow-up, reductions in waist circumference and abdominal fat depots remained partially preserved (false discovery rate ≤0.01 for all).
• In contrast, reductions in intrahepatic fat were fully regained, while intrapancreatic fat exceeded baseline levels during follow-up (false discovery rate ≤0.01 for both).
• Each 10% reduction in visceral adipose tissue achieved during the intervention was associated with long-term improvements in the Metabolic Score for Insulin Resistance, composite cardiometabolic risk score, and Metabolic Syndrome Severity Score (all P<0.05).
• Similar associations with favorable long-term metabolic outcomes were observed for intervention-induced reductions in superficial subcutaneous adipose tissue and intrapancreatic fat (all P<0.05).
• Only visceral adipose tissue reduction remained independently associated with a lower risk of incident type 2 diabetes, with each 10% loss linked to a 28% lower risk during follow-up (HR, 0.72; 95% CI, 0.54–0.94).

The findings suggest that lifestyle interventions may produce durable cardiometabolic benefits even when body weight is eventually regained. Although the observational nature of the long-term follow-up limits causal interpretation, the results indicate that reductions in visceral adipose tissue may be a particularly important determinant of long-term metabolic health and future diabetes risk.