Cardiometabolic Gains Unrelated to Weight Loss–Adjusted Body Fat or Distribution Changes in Adults With and Without Diabetes

Objective This study assessed whether changes in body composition or fat distribution after weight loss are associated with cardiometabolic improvements, independent of weight loss magnitude. Methods We analyzed data from a 1‐year lifestyle intervention in adults with obesity and type 2 diabetes (Study I) and a 12‐week hypocaloric diet intervention in adults with overweight/obesity without diabetes (Study II). Body composition was assessed by DXA and fat distribution by either abdominal computed tomography (Study I) or DXA‐derived trunk to total fat ratio (Study II). Insulin sensitivity was assessed by glucose clamp (Study I) and HOMA‐IR (both studies). Additional markers included glucose, lipids, and blood pressure. Changes in body composition and fat distribution were adjusted for baseline values and weight loss using regression analysis. Results Body weight decreased by 9.8% in Study I and 5.3% in Study II, with fat mass accounting for 64% (95% CI: 0.51%–0.77%) and 77% (95% CI: 0.68%–0.86%) of weight lost, respectively. Clamp‐derived insulin sensitivity increased by 50% (Study I), and HOMA‐IR decreased by 26% in both studies. No cardiometabolic changes were associated with weight loss–adjusted changes in body fat percentage or fat distribution. Conclusions Cardiometabolic improvements from weight loss appear independent of changes in body fat percentage or fat distribution.