Effect of Weight Loss With Lifestyle Intervention on Risk of Diabetes

Abstract

JUDITH WYLIE-ROSETT, EDD, RD FOR THE DIABETES PREVENTION PROGRAM RESEARCH GROUPOBJECTIVE -Diabetes Prevention Program (DPP) participants randomized to the intensive lifestyle intervention (ILS) had significantly reduced risk of diabetes compared with placebo participants. We explored the contribution of changes in weight, diet, and physical activity on the risk of developing diabetes among ILS participants.RESEARCH DESIGN AND METHODS -For this study, we analyzed one arm of a randomized trial using Cox proportional hazards regression over 3.2 years of follow-up.RESULTS -A total of 1,079 participants were aged 25-84 years (mean 50.6 years, BMI 33.9 kg/m 2 ). Weight loss was the dominant predictor of reduced diabetes incidence (hazard ratio per 5-kg weight loss 0.42 [95% CI 0.35-0.51]; P Ͻ 0.0001). For every kilogram of weight loss, there was a 16% reduction in risk, adjusted for changes in diet and activity. Lower percent of calories from fat and increased physical activity predicted weight loss. Increased physical activity was important to help sustain weight loss. Among 495 participants not meeting the weight loss goal at year 1, those who achieved the physical activity goal had 44% lower diabetes incidence.CONCLUSIONS -Interventions to reduce diabetes risk should primarily target weight reduction. Diabetes Care 29:2102-2107, 2006T he Diabetes Prevention Program (DPP) reported a 58% reduction in the incidence of diabetes over almost 3 years in subjects treated with an intensive lifestyle intervention (ILS) compared with participants treated with placebo (1). The ILS involved changes in diet and physical activity aimed at producing weight loss, but the study did not randomly assign each component of the intervention. However, there was variation in the change in diet, physical activity, and weight loss among ILS participants (2). Thus, we analyzed the relative contributions of changes in diet, physical activity, or weight loss to the reduction in diabetes incidence and assessed the contribution of diet and activity changes on weight loss. This report extends the understanding of how the ILS resulted in lower diabetes incidence (1) by assessing the impact of meeting intervention goals and on the changes in risk factors among individuals randomized to the ILS.RESEARCH DESIGN AND METHODS -The design, methods, recruitment, and characteristics of the DPP participants have been reported elsewhere (3,4). In summary, participants were aged Ն25 years, had a BMI of Ն24 kg/m 2 (Ն22 kg/m 2 in Asian Americans), and had impaired glucose tolerance during an oral glucose tolerance test, based on DPP criteria (5). Participants were excluded if they had diabetes or a number of other conditions or medications. All participants gave written informed consent after approval by the appropriate institutional review board. ILSThe ILS has been described (6). Goals were to reduce weight by 7% from baseline, to achieve and/or maintain at least 150 min per week of moderate physical activity, and to reduce total dietary fat to Ͻ25% of calorie...

Effects of a Health‐Partner Intervention on Cardiovascular Risk

“…The extent to which the risk factors, when present, were modified in our cohort was comparable to the intervention groups in previously published studies. Thus, there was sustainable weight loss in those who were overweight,36, 37 lowering of blood pressure in those with high levels,38 improvement of the lipid profile and insulin resistance in those with baseline abnormalities,33, 39 and promotion of a healthy diet and exercise habits,33, 40, 41 findings similar to observations in high‐risk populations 42, 43. Importantly, no perceptible decline among those with relatively normal values was observed, indicating that health was maintained in this cohort.…”

Early Response to Preventive Strategies in the Diabetes Prevention Program

“…Another important consideration when comparing the three arms is that attainment of the physical activity and dietary goals at 12 months by participants in the lifestyle arm decreased diabetes risk over the course of the study even in the absence of attainment of the weight goal. 3 A major strength of our analysis is that the DPP was a well-conducted randomized trial with high overall followup (92.5 %) and standardized measurement of all variables reducing measurement error and enhancing internal validity. 1 The study population was diverse by race/ethnicity and age making our results generalizable to the U.S. population at risk for type 2 diabetes.…”

“…3,4 Lachin et al demonstrated that change in fasting glucose over the study duration was the strongest predictor of diabetes risk in the metformin and placebo arms, accounting for 14 % and 25 % of the decrease in risk over the course of the study in these two arms, respectively. 4 Among participants who had both impaired fasting glucose and impaired glucose tolerance at baseline, each standard deviation of mean weight loss was associated with a 34 % increased probability of regression to normal glucose regulation.…”

“…1,2 Prior research in the DPP established that weight loss (more than physical activity) mediates the beneficial effects of lifestyle change, 3 and that both weight loss and reduced glycemia mediate the beneficial effects of metformin. 4 These analyses indicate the contribution of average weight loss over a 3-year period to the success of the trial's interventions.…”

Virtual small groups for weight management: an innovative delivery mechanism for evidence-based lifestyle interventions among obese men

“…Due to the high prevalence of obesity among men and the relative lack of weight loss studies among men, it is important to focus on this understudied population. The landmark Diabetes Prevention Program (DPP) lifestyle intervention is the gold standard in diabetes prevention [20,21], finding 16 % lower diabetes risk per kilogram of weight lost [22,23]. DPP participants were nearly 70 % female Implications Policy: Given the transformation of health care and payment models from being illness-centric to prevention-centric, the future of effective obesity treatment lies in the use of technology to improve clinical care.…”