A new study analyzing data on more than 20,000 U.S. adults links a healthier diet and greater levels of physical activity to weight loss that reduces heart disease risk. No big surprise, right? Perhaps more significantly, especially for those who keep searching for that elusive magic bullet, is what they found was linked to minimal weight loss, weight maintenance or weight gain: skipping meals and taking prescription diet pills.

The study, published recently in the Journal of the American Heart Association, is the first to compare weight-loss strategies and results in the context of the American Heart Association’s “Life’s Essential 8,” a checklist promoting heart disease risk reduction through the pursuit of recommended metrics for body weight, blood pressure, cholesterol, blood sugar, nicotine use, physical activity, diet and sleep. The AHA first defined a construct of cardiovascular health with “Life’s Simple 7” metrics in 2010, and updated the recommendations to the “Life’s Essential 8” to include sleep in June 2022.

Room for Improvement

The Ohio State University researchers found that overall, U.S. adults had an average score of 60 out of 100 on the eight measures, which suggests there is plenty of room for improvement, even among those whose diet and physical-activity behaviors helped move the needle on some metrics.

“The Life’s Essential 8 is a valuable tool that provides the core components for cardiovascular health, many of which are modifiable through behavior change,” explains senior study author Colleen Spees, PhD, MEd, RDN, associate professor of medical dietetics in the School of Health and Rehabilitation Sciences at Ohio State. 

“Based on the findings in this study, we have a lot of work to do as a country,” says Dr. Spees. “Even though there were significant differences on several parameters between the groups, the fact remains that, as a whole, adults in this country are not adopting the Life’s Essential 8 behaviors that are directly correlated with heart health.”

Data for the analysis came from 20,305 U.S. adults aged 19 or older (average age of 47) who participated in the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2016. Participants reported their smoking status, physical activity, average hours of sleep per night, weight history and weight-loss strategy, and what they had eaten in the previous 24 hours. Health exams and lab tests measured their body mass index (BMI), blood pressure, non-high-density lipoprotein cholesterol level and blood glucose.

The Ohio State researchers used the data to determine individuals’ values for Life’s Essential 8 metrics and assessed their diet quality according to the Healthy Eating Index, which gauges adherence to U.S. Dietary Guidelines for Americans.

What the Research Means to Health and Exercise Professionals

Within the sample, 17,465 individuals had lost less than 5% of their body weight, maintained their weight or gained weight in the past year. The other 2,840 reported intentional loss of at least 5% of their body weight in the same timeframe.

“Clinically significant weight loss results in improvements in some health indices,” Spees explains. “People should feel hopeful in knowing that losing just 5% of their body weight is meaningful in terms of clinical improvements. This is not a huge weight loss. It’s achievable for most, and I would hope that incentivizes people instead of being paralyzed with a fear of failure.”

In this study, adults with clinically significant weight loss reported higher diet quality, particularly with better scores on intakes of protein, refined grains and added sugar, as well as more moderate and vigorous physical activity and lower non-high-density lipoprotein cholesterol than the group without clinically significant weight loss. On the other hand, the weight-loss group also had a higher average BMI and HbA1c blood sugar measure and fewer hours of sleep—all metrics that would bring down their composite Life’s Essential 8 score.

A greater proportion of people who did not lose at least 5% of their weight reported skipping meals or using prescription diet pills as weight-loss strategies. Additional strategies reported by this group included low-carb and liquid diets, taking laxatives or vomiting, and smoking.

“We saw that people are still gravitating to non-evidence-based approaches for weight loss, which are not sustainable. What is sustainable is changing behaviors and eating patterns,” Spees says.

As a health and exercise professional, you are a source of guidance and education for your clients, not only for physical activity, but also for making healthy lifestyle choices. This is particularly true when it comes to weight loss, which, as the study reveals, often leads people to take drastic measures that cause more harm than good. If your clients ask you about extreme or unhealthy weight-loss measures, this research provides solid evidence that sticking to the basics of regular physical activity, a high-quality diet and sufficient sleep is much more effective.

It’s Time to Focus on Prevention

With federal data estimating that more than 85% of the adult U.S. population will have overweight or obesity by 2030 (compared to the current prevalence of 73%), Spees believes that a paradigm shift toward prevention is necessary to fend off related increases in heart disease and other health problems.

“We absolutely need to be moving toward prevention of disease versus waiting until people are diagnosed with a disease. This becomes quite overwhelming, and individuals may feel it’s too late at that point,” she says. “We have fantastic research, we have incredible educators. What we don’t have is policy that promotes optimal health across the lifespan.”


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