Personalized Weight-Loss Targets for Metabolic Syndrome Reversal: A BMI-Normalization Achievement Rate-Based Cohort Study.

Abstract

This study aimed to explore personalized weight-loss targets for metabolic syndrome (MetS) reversal by introducing the BMI-normalization achievement rate (BMI-NAR), a novel baseline-BMI-scaled metric. In a longitudinal cohort of 7340 adults with overweight/obesity and MetS from the ChinaHEART project, BMI-NAR was defined as the percentage of progress toward a normal BMI (< 24 kg/m²). Logistic regression and restricted cubic splines assessed the dose-response relationship between BMI-NAR and MetS reversal. Each 50% increase in BMI-NAR was significantly associated with MetS reversal (overall: OR = 1.10, 95% CI: 1.07-1.12; overweight: OR = 1.08, 95% CI: 1.06-1.11; obesity: OR = 2.36, 95% CI: 2.00-2.80). The probability of reversal increased steeply beyond exploratory minimum effective thresholds (37% BMI-NAR for overall; 53% for overweight; 22% for obesity), with benefits observed up to ~165% in the total population, beyond which data were sparse. No clear upper plateau was identified in populations with overweight and obesity. These exploratory thresholds translate into personalized weight-loss targets: a minimum reduction of 2%-8% for typical overweight (baseline BMI 25-27.99 kg/m²) and 3%-9% for obesity. MetS reversal does not require full BMI normalization. BMI-NAR provides a hypothesis-generating, quantifiable framework for exploring personalized minimum effective weight-loss goals in this high-risk population. However, external validation is required before clinical application.