Weight loss of as little as 5% to 10% produces meaning- ful improvements in vascular risk factors.279 Only 1 trial has tested the effect of an intensive lifestyle interven- tion for weight loss on the prevention of vascular disease, and it was stopped early for futility.292 Inadequate aver- age weight loss in the active treatment group and statin therapy in the control group might explain the negative findings. Observational research provides some evidence that weight loss after bariatric surgery may reduce risk Approximately 24% to 30% of patients with acute ischemic stroke are obese.295 Paradoxically, they have a reduced risk for stroke recurrence,296,297 but this is likely attributable to selection bias.298 Weight loss after stroke is expected to improve stroke risk factors, but the effect on future brain health has not yet been directly examined. Recommendation-Specific Supportive Text 1. Our recommendation for weight loss in patients with overweight or obesity after stroke is consis- tent with the 2013 AHA guideline on obesity,27 the 2014 AHA guideline on primary prevention,18 and other professional guidelines on management Even a modest weight loss of 5% to 10% is associated with important improvements in conventional cardiovascular risk factors.279 In particular, weight loss can improve glucose con- trol in patients with diabetes.277 The DiRECT trial (Diabetes Remission Clinical Trial) compared food substitution followed by stepped food reintroduc- tion and structured support with best practice by guideline among patients with diabetes and BMI . After 12 months, 24% of par- ticipants in the intervention group lost 15 kg compared with none in the control group. Diabetes remission was achieved in 46% of patients in the intervention group and 4% in the control group. Studies of metabolic surgery confirm that weight loss is associated with improvements in glucose control, BP, indicators of inflammation, and lipid 2. 