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Is setting a criterion for ‘clinically significant weight loss’ necessary?

The prevention and treatment of obesity remain major public health challenges. Obesity management guidelines worldwide have identified weight loss as the primary target to determine treatment success as weight loss is associated with benefit across a wide range of health outcomes (1). How much weight loss is required for health benefit, however, continues to be the source of uncertainly and debate. In recent years, it has been suggested that “clinically significant weight loss” should be set at a threshold of 5% (2). Although it is true that for most health outcomes a 5% weight loss is associated with benefit, it is also true that for adults who adopt and sustain physical activity combined with a healthful diet, significant health benefits are achieved in association with very modest (less than 3%) or even no weight loss (3). Strong evidence in support of this notion comes from the Diabetes Prevention Study wherein participants who increased physical activity for about 150 min per week but did not achieve “clinically significant weight loss,” reduced diabetes incidence by 44% (4), observations consistent with the findings of the Diabetes Prevention Program (5). The findings from these and numerous randomized controlled trials (3) consistently report that physical activity is associated with benefit for many health outcomes with or without weight loss.