Eight‐year weight losses with an intensive lifestyle intervention: The look AHEAD study

Abstract

Objective To evaluate 8-year weight losses achieved with intensive lifestyle intervention (ILI) in the Look AHEAD (Action for Health in Diabetes) study. Design and Methods Look AHEAD assessed the effects of intentional weight loss on cardiovascular morbidity and mortality in 5,145 overweight/obese adults with type 2 diabetes, randomly assigned to ILI or usual care (i.e., diabetes support and education [DSE]). The ILI provided comprehensive behavioral weight loss counseling over 8 years; DSE participants received periodic group education only. Results All participants had the opportunity to complete 8 years of intervention before Look AHEAD was halted in September 2012; ≥88% of both groups completed the 8-year outcomes assessment. ILI and DSE participants lost (mean±SE) 4.7±0.2% and 2.1±0.2% of initial weight, respectively (p<0.001) at year 8; 50.3% and 35.7%, respectively, lost ≥5% (p<0.001), and 26.9% and 17.2%, respectively, lost ≥10% (p<0.001). Across the 8 years ILI participants, compared with DSE, reported greater practice of several key weight-control behaviors. These behaviors also distinguished ILI participants who lost ≥10% and kept it off from those who lost but regained. Conclusions Look AHEAD’s ILI produced clinically meaningful weight loss (≥5%) at year 8 in 50% of patients with type 2 diabetes and can be used to manage other obesity-related co-morbid conditions. Trial Registration clinicaltrials.gov Identifier: NCT00017953

Weight maintenance: challenges, tools and strategies for primary care physicians

“…Although the greatest benefits were often seen at 1 year, the ILI group still had greater improvements than the DSE group in terms of weight reduction (−6.15% vs. −0.88%), fitness, HbA 1c levels, systolic blood pressure and HDL‐cholesterol levels at 4 years 61. Factors indicative of the long‐term success of ILI included use of meal replacements, high levels of exercise, self‐monitoring and individualized diets using ‘healthy meal plans’ that worked with personal and cultural food preferences 61. The study also found that participants who maintained their weight loss after 4 years reported more favourable physical activity and food intake, and attended more treatment sessions than those who had not maintained their weight loss – indicating the importance of a sustained lifestyle change in successful weight‐loss maintainers 62.…”

“…The Look AHEAD (Action for Health in Diabetes) study assessed the effects of intensive lifestyle intervention (ILI) on clinically important health outcomes in people with overweight or obesity with type 2 diabetes 59, 60, 61. Participants were randomly assigned to one‐on‐one ILI or conventional diabetes support and education (DSE) 59.…”

“…At 1 year, the ILI group, compared with the DSE group, had lost a greater percentage of their initial weight (−8.6% vs. −0.7%); had improved fitness (assessed by treadmill test); had improvements in HbA 1c , systolic and diastolic blood pressure, triglyceride, high‐density lipoprotein (HDL)‐cholesterol and urine albumin/creatinine; and had a reduced need for type 2 diabetes, hypertension and lipid‐lowering medications 59. Although the greatest benefits were often seen at 1 year, the ILI group still had greater improvements than the DSE group in terms of weight reduction (−6.15% vs. −0.88%), fitness, HbA 1c levels, systolic blood pressure and HDL‐cholesterol levels at 4 years 61. Factors indicative of the long‐term success of ILI included use of meal replacements, high levels of exercise, self‐monitoring and individualized diets using ‘healthy meal plans’ that worked with personal and cultural food preferences 61.…”

“…Individualized calorie goals, based upon an individual's desire to maintain or lose more weight 61, 62 Use of meal replacements for one or more meals or snacks per day 61 Planning meals in advance 66 Individualized healthy meal plans that accommodate personal and cultural food preferences 61, 62 Self‐monitoring of food intake and calories 66 …”

“…Individualized calorie goals, based upon an individual's desire to maintain or lose more weight 61, 62 …”