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Weight management and cardiometabolic health

Diagnostic insights to navigate weight management for better health

Obesity is epidemic, and associated cardiometabolic risk factors are on the rise. Excess weight contributes to related conditions like cardiovascular disease, poor glycemic control, chronic kidney disease, fatty liver disease, and many common endocrine disorders. Lifestyle changes and new weight loss drugs are beginning to show potential in reversing these trends.

Therapies such as glucagon-like peptide-1 (GLP-1) receptor agonist medications can lead to significant weight loss. But without lifestyle changes, including exercise to maintain muscle mass, the long-term benefit on cardiometabolic health is not sustained.1,2 There is also evidence of weight regain and resumption of cardiometabolic risk when medications are no longer used.1

Quest Diagnostics can help providers assess and monitor the effects of weight management, define patients’ personalized cardiometabolic risk using diagnostic laboratory insights, and help achieve the goal of healthy living.

Assess the effects of weight management on cardiometabolic risk

By integrating routine monitoring with laboratory testing, providers can determine whether patients focused on weight loss and lifestyle changes are on track to achieve sustainable, improved cardiometabolic health.

Individuals suitable for testing

  • Individuals with cardiometabolic conditions or risk factors, such as being overweight/obese, or having prediabetes, or type 2 diabetes
  • Individuals being considered for, currently taking, or who have previously taken prescription weight loss medication
  • Individuals who want to quantify the benefits of weight loss from prescription weight loss medications and lifestyle changes
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Comprehensive insights along the patient’s weight management journey

Laboratory testing can help inform whether cardiometabolic health has improved with weight loss and if treatment modifications are necessarya

Changes in weight may impact insulin, blood glucose, and insulin resistance.3
Tests to consider:

b Metabolic Risk Panel (39447): the following components may be ordered together: HbA1c, Insulin Resistance Panel with Score, Lipid Panel, and ApoB.

c Insulin Resistance Panel with Score: Insulin, Intact, LC/MS-MS (93103); C-Peptide (372).

Changes in weight may impact lipids and vascular inflammation.4 Lipid-modifying therapies may require adjustment as weight changes are sustained.5
Tests to consider:

b Metabolic Risk Panel (39447): the following components may be ordered together: HbA1c, Insulin Resistance Panel with Score, Lipid Panel, and ApoB.

d Lipid Panel: Cholesterol Total (91717); Triglycerides (91718); HDL Cholesterol (91719)

Hormones, such as thyroid stimulating hormone and testosterone, are associated with weight changes and exercise capacity.6,7
Tests to consider:

Note: side effects of different prescription weight loss medications impact thyroid health and may be considered for monitoring with laboratory testing.

e Testosterone, Free (Dialysis) and Total (MS): Testosterone, Total, MS (15983).

Chronic kidney disease and nonalcoholic fatty liver disease risk are impacted by sustained changes in weight.8,9
Tests to consider:

f Comprehensive Metabolic Panel with FIB-4 Index, Reflex to ELF: Liver Fibrosis, Fibrosis-4 (FIB-4) Index Panel (30555); Enhanced Liver Fibrosis (ELF) Score (10350); Comprehensive Metabolic Panel (10231); Glucose (483); Calcium (303); Sodium (836); Potassium (733); Carbon Dioxide (CO2) (310); Blood Urea Nitrogen (BUN) (294); Creatinine with eGFR (375); BUN/Creatinine Ratio (296); Protein, Total (754); Albumin (223); Globulin; Albumin/Globulin Ratio; Alkaline Phosphatase (ALP) (234); Aspartate Aminotransferase (AST) (822); Alanine Aminotransferase (ALT) (823); Bilirubin, Total (287); Platelet Count (723).

g Liver Fibrosis, Fibrosis-4 (FIB-4) Index Panel (30555): Aspartate Aminotransferase (AST) (822); Alanine Aminotransferase (ALT) (823);
Platelet Count (723); FIB-4 Index.

h Reflex testing may be performed at an additional charge, if indicated by the initial test result.

i Kidney Profile: Albumin, Random Urine with Creatinine (6517); Creatinine with eGFR (375).

Essential vitamin and mineral levels may be affected by diet, exercise, and weight changes.10 Assessment is important to help maintain muscle mass.
Tests to consider:

j Iron, TIBC, and Ferritin Panel: Iron, Total and Total Iron Binding Capacity (7573); Ferritin (457).
a Panel and profile components may be ordered together or separately. Details for testing are provided in the cardiometabolic sections above.

References

  1. Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553-1564. doi:10.1111/dom.14725
  2. Jensen SBK, Blond MB, Sandsdal RM, et al. Healthy weight loss maintenance with exercise, GLP-1 receptor agonist, or both combined followed by one year without treatment: a post-treatment analysis of a randomised placebo-controlled trial. eClinicalMedicine. 2024;69:102475. doi:10.1016/j.eclinm.2024.102475
  3. Perreault L, Davies M, Frias JP, et al. Changes in glucose metabolism and glycemic status with once-weekly subcutaneous semaglutide 2.4 mg among participants with prediabetes in the step program. Diabetes Care. 2022;45(10):2396-2405. doi:10.2337/dc21-1785
  4. Hatoum IJ, Nelson JJ, Cook NR, et al. Dietary, lifestyle, and clinical predictors of lipoprotein-associated phospholipase A2 activity in individuals without coronary artery disease. Am J Clin Nutr. 2010;91(3):786-793. doi:10.3945/ajcn.2009.2887 0
  5. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111-188. doi:10.1093/eurheartj/ehz455
  6. Svare A, Nilsen TIL, Bjøro T, et al. Serum TSH related to measures of body mass: longitudinal data from the HUNT Study, Norway: Serum TSH and body mass. Clin Endocrinol. (Oxf). 2011;74(6):769-775. doi:10.1111/j.1365-2265.2011.04009.x
  7. Brand JS, van der Tweel I, Grobbee DE, et al. Testosterone, sex hormone-binding globulin and the metabolic syndrome: a systematic review and metaanalysis of observational studies. Int J Epidemiol. 2011;40(1):189-207. doi: 10.1093/ije/dyq15 8
  8. Yun HR, Kim H, Park JT, et al. Obesity, metabolic abnormality, and progression of CKD. Am J Kidney Dis. 2018;72(3):400-410. doi:10.1053/j.ajkd.2018.02.36 2
  9. Cusi K, Isaacs S, Barb D, et al. American Association of Clinical Endocrinology Clinical Practice Guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings: co-sponsored by the American Association for the Study of Liver Diseases (AASLD). Endocr Pract. 2022;28(5):528-562. doi:10.1016/j.eprac.2022.03.01 0
  10. Fadanelli Schoenardie Poli V, Sanches RB, dos Santos Moraes A, et al. The excessive caloric intake and micronutrient deficiencies related to obesity after a long-term interdisciplinary therapy. Nutrition. 2017;38:113-119. doi:10.1016/j.nut.2017.01.012

Assess the effects of weight management on cardiometabolic risk

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