A year after women lost weight, researchers saw which health gains lasted and which faded

By Dr. Priyom Bose, Ph.D.Reviewed by Lauren HardakerAug 25 2026

Researchers tracked women through weight loss and a year of partial regain to see how diet, aerobic exercise, resistance training, and continued exercise shaped their longer-term cardiometabolic risk.

Study: Weight Loss Improves Predicted 10-Year MACE and Type 2 Diabetes Risk, but Benefits Partially Rebound at 1 Year. Image Credit: shisu_ka / Shutterstock

A secondary analysis of a randomized trial published in the journal Obesity quantified changes in predicted 10-year risk of major adverse cardiovascular events (MACE) and type 2 diabetes (T2D) during and after weight loss, at 1-year follow-up, and assessed whether these risk trajectories differed by exercise modality.

Sustaining Metabolic Health After Weight Loss

Excessive weight gain in adults is associated with a cascade of metabolic changes, including reduced insulin sensitivity, elevated glucose, adverse lipid profiles, and higher blood pressure. Collectively, these factors can cluster as metabolic syndrome and significantly increase the risk of T2D and cardiovascular disease.

Intentional weight loss and structured exercise lower cardiometabolic and diabetes risks, but sustaining long-term benefits remains difficult, as weight regain can diminish early improvements. While lifestyle changes improve metabolic health, their impact lessens if weight is regained.

Exercise strengthens and extends the effects of dietary weight loss: aerobic training boosts cardiovascular health, and resistance training preserves muscle and aids glucose control. Previous studies suggest that combined aerobic and resistance training may provide broader cardiometabolic benefits, yet individual responses and changes in risk factors can vary.

Despite proven short-term efficacy, key research gaps persist. The most effective strategies for sustaining metabolic improvements after interventions end, especially when weight is regained, remain poorly understood.

The complexity of interpreting multiple shifting biomarkers complicates evaluation of long-term risk reduction. Moreover, patterns of exercise adherence post-intervention are highly variable, limiting knowledge of how to maintain cardiometabolic health over time.

Assessing the Effect of Weight Loss and Exercise on Cardiometabolic Risk

The current secondary analysis examined whether weight loss and structured exercise lower predicted 10-year risks for MACE and T2D in overweight premenopausal women. Eligible participants were African American (AA) and European American (EA) women (BMI 27-30), nonsmokers, healthy, sedentary, with regular menstrual cycles and normal glucose tolerance. Those on oral contraceptives or body composition-altering medications were excluded.

Women were randomized to Diet+Aerobic, Diet+Resistance, or Diet-only groups. All participants followed an 800 kcal/day diet to reach a BMI <25, with assessments at baseline, after weight loss, and at 1-year follow-up, standardized for menstrual phase and fasting status. Post-weight loss (PWL), participants received guidance for a balanced, low-energy-density diet.

Supervised exercise sessions lasted 50 minutes. Participants exercised three times per week during weight loss and twice weekly during follow-up. Exercise was required during weight loss but encouraged rather than mandatory during follow-up, resulting in variable adherence.

Predicted 10-year risks of MACE and T2D were calculated at each time point using established cardiometabolic disease staging (CMDS) equations. Risks were analyzed using statistical models that accounted for repeated measurements over time to estimate changes and differences between groups.

Weight Loss Lowers Predicted Cardiometabolic Risk, but Benefits Fade with Weight Regain or Less Exercise

Among 221 women (115 AA, 106 EA), 212 had sufficient baseline data to estimate predicted risk. Risk estimates were contributed by 131 women at PWL and 105 at 1 year. Baseline MACE and T2D risk scores did not predict dropout. Mean BMI dropped from 28.3 to 23.9 after weight loss, with partial regain to 25.8 at 1 year.

Time to target BMI averaged 159 days and did not differ by group. Quantitative 10-year risks are reported as percentages, and changes as percentage point (pp) differences.  

The 10-year MACE risk decreased significantly after weight loss in all groups and rebounded during weight regain, resulting in no significant net change at 1 year. The Diet-only group had a greater reduction from baseline to PWL than the Diet+Resistance group. Apart from this comparison, other between-group differences in MACE reduction, rebound, or net change were not significant, and no significant between-race differences in these changes were observed.

T2D risk declined significantly after weight loss in all groups. Only the Diet+Resistance group maintained a significant net reduction at 1 year, while the Diet-only group experienced a significant rebound. No significant differences in changes in T2D risk were found between groups. Adherence was higher during weight loss than at follow-up, and higher exercise adherence during follow-up was associated with a lower T2D risk rebound, but not with MACE risk.

Both EA and AA had significant reductions in T2D risk after weight loss. AA showed a significant rebound from PWL to 1 year, while EA maintained a significant net reduction from baseline to 1 year. No significant between-race differences were observed.

Conclusions

Diet-induced weight loss, whether achieved alone or in combination with aerobic or resistance exercise, significantly reduces the predicted 10-year risk of major adverse cardiovascular events (MACE) and type 2 diabetes (T2D) in healthy, sedentary, premenopausal women with overweight. Notably, these beneficial effects were partially attenuated with weight regain during a 1-year follow-up period.

The Diet+Resistance group was the only intervention arm to retain a statistically significant net reduction in predicted T2D risk at 1 year, although differences in T2D risk changes between intervention groups were not statistically significant.

These findings suggest that maintaining structured exercise after weight loss may help limit rebound in predicted T2D risk, while resistance exercise may offer particular benefits that warrant further investigation.

Despite these promising results, several limitations should be acknowledged. The study was restricted to healthy, sedentary premenopausal women with overweight, limiting the broader applicability of the findings to other populations such as men, older adults, or those with obesity and existing cardiometabolic conditions.

Furthermore, risk estimates were derived from predictive models rather than from direct clinical outcomes, and potential bias may have arisen because the analyses assumed that missing follow-up data were missing at random, whereas exercise adherence varied substantially during follow-up.

Differences in individual weight trajectories may also have complicated efforts to isolate weight-independent effects of the exercise interventions. 

To strengthen the evidence base, future research should include more heterogeneous populations, longer follow-up periods, sensitivity analyses for missing data, and direct measurement of clinical endpoints.