Limited Long-Term Efficacy of Lifestyle-Mediated Weight Loss on Blood Pressure Control and the Biology of Weight Regain

fell 23.9%. Mean blood pressure (BP) the declined ~11.8/4.3 mmHg from 94.7/64.5 Abstract Hypocaloric weight reduction, with or without increased physical activity, lowers blood pressure (BP). Heart rate, sympathetic nervous system, and renin-angiotensin-aldosterone system activity also decline. However, with time, substantial weight is typically regained in most individuals who lose weight, and the beneficial effects of weight loss on BP decline or are reversed. The initial decline in BP with weight loss is likely enhanced by negative caloric balance. Thus, even with isocaloric weight loss maintenance, the magnitude of the initial BP reduction appears to decline with time. Of further concern, the complex physiological (counterregulatory) adaptations to weight loss foster weight regain as more calories are desired than required and energy expenditure falls. Sustained weight loss generally requires a substantial long-term time commitment to physical activity and a high level of vigilance. High protein, low glycemic, high fiber, and reduced energy density diets may also be beneficial in reducing hunger and increasing satiety. Individuals who are counseled to lose weight should be aware of the challenges in maintaining weight loss, receive education on the lifestyle changes required to sustain weight loss, and commit to an evidence-based plan designed to foster long-term success. Future research directed at blocking or ameliorating the disproportionately large reductions of anorexigenic hormones and decreases in energy expenditure that accompany weight loss would help sustain the beneficial effects of weight loss on BP.