Weight Change During the Postintervention Follow-up of Look AHEAD

Abstract

Objective. Patients with type 2 diabetes are encouraged to lose weight, but excessive weight loss in older adults may be a marker of poor health and subsequent mortality. We examined weight changes during the post-intervention period of Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) and diabetes support and education (DSE; control) in individuals with overweight/obesity and type 2 diabetes and sought to identify predictors of excessive post-intervention weight loss and its association with mortality. <p>Research Design and Methods. These secondary analyses compared post-intervention weight change (year-8 to final visit [median 16 years]) in ILI and DSE in 3999 Look AHEAD participants. Using empirically derived trajectory categories, we compared four subgroups: Weight Gainers (N= 307), Weight Stable (N=1561), Steady Losers (N=1731) and Steep Losers (N=380) on post-intervention mortality, demographic variables and health status at randomization and year-8.</p> <p>Results. Post-intervention weight change averaged -3.7 ±9.5%, with greater weight loss in DSE than ILI. The steep weight loss trajectory subgroup lost on average 17.7 + 6.6%.; 30% of Steep Losers died during post-intervention follow-up vs 10-18% in other trajectories (p<. 0001). The following variables distinguished Steep Losers from Weight Stable: <i>Baseline </i>- older; longer diabetes duration; higher BMI; greater multimorbidity; <i>Intervention </i>– randomization to control group; less weight loss in years 1-8; <i>Year 8 </i>- higher prevalence of frailty, multimorbidity and depressive symptoms; lower use of weight control strategies. </p> <p>Conclusion. Steep weight losses post-intervention were associated with increased risk of mortality. Older individuals with longer duration diabetes and multi-morbidity should be monitored for excessive, unintentional weight loss. </p>

Dietary adaptation for weight loss maintenance at Yale (DAWLY): Protocol and predictions for a randomized controlled trial

“…Current treatments for obesity (2) can produce short-term weight loss and associated health benefits (6) but weightregain frequently follows and is associated with return of associated morbidity (7). The high rates of recidivism that characterize this complex chronic medical problem highlight the pressing need for identifying strategies to improve weight loss maintenance (2)(3)(4)(5)74).…”

“…Current pharmacological treatments and lifestyle behavioral weight loss interventions for obesity focusing on reducing energy intake and increasing physical activity are effective at producing short-term weight loss (2), but weight loss maintenance remains a significant challenge (2)(3)(4)(5). Weight loss reduces morbidity (6) while regain following obesity treatment is associated with increased medical problems (7).…”

A closer look at weight loss interventions in primary care: A systematic review and meta-analysis

“…Weight nadir in clinical trials is consistently achieved between 6-12 months with weight regain following, despite ongoing intensive lifestyle modification (34,35) or pharmacotherapy. (36,37) Results from the current analysis are highly aligned with those previously reported.…”

Weight changes during the COVID‐19 shutdown in older individuals with type 2 diabetes: the Look AHEAD Study

“…We hypothesized that, in this population, weight loss during the COVID-19 shutdown would be more common than weight gains. This hypothesis was based on our prior data showing that, in general, the participants in Look AHEAD have been experiencing weight loss over the past 10 years [12] and on epidemiological studies showing that older adults experience weight loss over time [13]. We also compared those Look AHEAD participants who, during the shutdown, had large weight losses (>5%) or small weight losses (2%-5%), remained weight stable (±2%), or gained weight (>2%) on self-reported reasons for their weight changes, weight-related behaviors, psychosocial measures, and their self-report of both negative and positive impacts of the shutdown on their life experiences.…”