Meaningful, Long-term Weight Loss Is Possible: Look AHEAD

Marlene Busko

January 02, 2014

The 8-year weight-loss results from the Look AHEAD: Action for Health in Diabetes study of overweight or obese patients with type 2 diabetes suggest it is possible to lose and keep weight off with a program of intensive lifestyle counseling, researchers report in an article published online January 2 in Obesity.

"The primary finding is that overweight participants with type 2 diabetes could lose weight and were very successful in keeping their weight off at 8 years," lead author Thomas Wadden, PhD, from the University of Pennsylvania, Philadelphia, told Medscape Medical News. This is very different from most previous studies, which report that by 3 to 5 years, most people have regained any lost weight, he added.

In Look AHEAD, at 1 year, 68.0% of participants who received intensive lifestyle counseling vs 13.3% of participants who received usual care lost at least 5% of their initial body weight. At 8 years, these percentages were 50.3% vs 35.7%, respectively. A 5% weight loss can result in significant improvements in type 2 diabetes, sleep apnea, depression, and physical functioning, Dr. Wadden noted. It remains to be determined why participants in the usual-care arm continued to lose more weight as time went by, he added.

"This is the largest and longest controlled evaluation of a behavioral weight-loss program to date," Dr. Wadden said. "I think the study does provide new hope for dieters and practitioners that long-term weight loss is possible with a long-term commitment to meet with a lifestyle counselor."

Intensive Lifestyle Intervention vs Usual Care

The Look AHEAD researchers enrolled 5145 ethnically diverse overweight or obese adults aged 45 to 76 years who had type 2 diabetes and randomly assigned them to either an intensive behavioral intervention or usual care.

The intervention, adapted from the Diabetes Prevention Program, consisted of frequent group and individual counseling sessions given by a dietician, psychologist, or exercise specialist in the first year, followed by monthly individual counseling in years 2 to 8. Usual care consisted of a limited number of group sessions that provided diabetes support and education.

The trial was stopped in September 2012 after a mean follow-up of 9.6 years, when researchers failed to show that the intervention would reduce the risk for cardiovascular morbidity and mortality, the trial's primary outcome.

On average, participants in the intervention group lost 8.5% of their initial weight at 1 year and 4.7% of their initial weight at 8 years. Participants in the usual-care group lost 0.6% of their initial weight at 1 year and 2.1% of their initial weight at 8 years.

In the intervention arm, about a third of participants (37.7%) lost at least 10% of their initial weight at 1 year, and about 40% of these individuals maintained this weight loss at 8 years.

Some of the weight loss in the trial participants may be a normal part of aging, as the participants were about age 58 years at the start of the trial, the researchers suggest.

Importantly, the trial showed that the individuals who lost the most weight (10% or more) were also more likely to engage in good health practices: to walk most days; eat a lower-calorie, lower-fat diet; and weigh themselves at least weekly.

"This sets a new bar in terms of thinking that you can lose weight, and if you continue to receive some monthly ongoing support, you've really got a good shot at keeping the weight off," Dr. Wadden summarized.

Encouraging, but Will It Work in the "Real World"?

"The lessons learned from Look AHEAD are for the most part quite encouraging," Michael G. Perri, PhD, from the College of Public Health and Health Professions, University of Florida, Gainesville, writes in an accompanying editorial.

Men and women from diverse ethnic and racial backgrounds were able to achieve a meaningful weight loss that was accompanied by improvements in several disease conditions, he notes. This weight-loss success was likely a result of the intensive, comprehensive nature of the lifestyle intervention.

"These positive findings are tempered by the finding that lifestyle participants experienced a regaining of weight despite ongoing care, and a vital question that remains to be addressed is whether the intensive lifestyle intervention delivered in the resource-rich environment of Look AHEAD can be adapted to produce comparable benefits in real-world clinical and community settings," Dr. Perri observes.

"The intervention potentially could be translated to be a reasonable cost, in much the same way that the Diabetes Prevention Program — the 'mother' of Look AHEAD — is being provided in YMCAs," Dr. Wadden suggested.

Obesity. Published online January 2, 2014. Available at http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1930-739X.

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