Maintaining Weight Loss in Patients With Obesity and NAFLD Often Challenging

Researchers in a real-world clinical practice study assessed the incidence of weight loss and weight regain in patients with NAFLD and overweight or obesity.

A real-world clinical practice study found that approximately one-third of patients with nonalcoholic fatty liver disease (NAFLD) who were initially overweight or obese achieved at least a 5% weight loss, which is associated with reductions in steatosis, but only one-quarter of these patients were found to maintain this weight loss over time. The findings from this study were published in Clinical Gastroenterology and Hepatology.

The TARGET-NASH study included 2019 patients (median age, 57 years) with NAFLD who were overweight or obese and who were receiving care in usual clinical practice. Researchers collected medical record data up to 3 years before enrollment and prospectively for up to 5 years. The purpose of the study was to assess the incidence of weight loss, which was defined as at least a 5% reduction in baseline weight, as well as weight regain, which was defined as a return to baseline or greater weight.

Approximately one-third of patients were classified as obese at baseline, and 38.6% of patients had type 2 diabetes. The researchers found documentation of lifestyle or diet modifications for half of the cohort.

Changes in weight over a median follow-up period of 39.3 months ranged from -58.3 kg to +45.1 kg, with 32.3% of patients having a weight reduction of at least 5% and 33.3% having a weight reduction of at least 10%. The median time to initial weight loss was shorter for patients in obesity class 2/3.

Of patients who achieved initial weight loss, 21.2% regained back to their baseline weight during a median follow-up period of 32.3 months; 59% of patients regained their weight within the first year of the initial weight loss. Patients with a longer follow-up duration after the initial weight loss were more likely to regain weight over time.

Factors associated with increased odds of achieving at least a 5% weight loss included obesity category (obesity class 2/3 vs overweight: odds ratio [OR] 1.57; 95% CI, 1.21-2.04), insurance type (Medicaid vs private: OR 1.41; 95% CI, 1.05-1.9; Medicare vs private: OR 1.13; 95% CI, 0.85-1.5), and frequency of provider encounters (OR 1.16; 95% CI, 1.1-1.23).

Limitations of this study included the relatively short follow-up duration as well as the lack of standardized intervals between weight measurements.

The investigators noted that “more frequent encounters with providers may provide increased opportunities for counseling, early interventions for changes in medical condition, and possibly stronger commitment to engagement in care.”


Malespin MH, Barritt AS 4th, Watkins SE, et al. Weight loss and weight regain in usual clinical practice: results from the TARGET-NASH observational cohort. Clin Gastroenterol Hepatol. Published online January 21, 2021. doi:10.1016/j.cgh.2021.01.023