- •Intensive lifestyle interventions can result in significant long-term reductions in body weight among a considerable proportion of severely obese individuals with type 2 diabetes.
- •Modest reductions in body weight, even despite persistent severe obesity, can significantly improve cardiovascular disease risk factors in this population.
- •Behavioral weight loss programs should not be ignored as a potential treatment strategy for individuals with a body mass index ≥40 kg/m2.
|Overweight (n=395)||Class I (n=892)||Class II (n=654)||Severe (n=562)||P Value for Group Mean Differences|
|Body weight (kg)|
|Δ (4 year – BL)||−2.8±0.4a||−4.4±0.3b||−4.6±0.3b||−6.1±0.4c||<.001|
|Δ (4 year – BL)||−0.8±0.2a||−1.4±0.1b||−1.5±0.1b||−2.0±0.1c||<.001|
|LDL cholesterol (mg/dL)|
|Δ (4 year – BL)||−16.6±1.5a||−17.6±1.0a||−17.7±1.2a||−15.3±1.3a||.461|
|HDL cholesterol (mg/dL)|
|Δ (4 year – BL)||4.8±0.4a||4.0±0.3a,b||3.9±0.3a,b||3.1±0.4b||.023|
|Δ (4 year – BL)||−24.0±5.5a||−21.6±3.6a||−25.6±4.3a||−22.4±4.7a||.909|
|Systolic blood pressure (mm Hg)|
|Δ (4 year – BL)||−4.8±0.9a||−5.5±0.6a||−4.6±0.7a||−1.4±0.7b||<.001|
|Diastolic blood pressure (mm Hg)|
|Δ (4 year – BL)||−2.9±0.4a||−3.6±0.3a||−3.3±0.3a||−2.5±0.4a||.145|
|Δ (4 year – BL)||−0.21±0.06a||−0.24±0.04a||−0.15±0.05a||−0.13±0.05a||.338|
|Serum glucose (mg/dL)|
|Δ (4 year – BL)||−12.7±2.4a||−10.2±1.6a||−8.6±1.9a||−6.1±2.1a||.183|
Weight Change at Year 4
Changes in Weight from Year 1 to 4
Cardiovascular Disease Risk Factors
Central Resources Centers
- Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010.JAMA. 2012; 307: 491-497
- Obesity and severe obesity forecasts through 2030.Am J Prev Med. 2012; 42: 563-570
- Mortality and cardiac and vascular outcomes in extremely obese women.JAMA. 2006; 296: 79-86
- The disease burden associated with overweight and obesity.JAMA. 1999; 282: 1523-1529
- Increases in morbid obesity in the USA: 2000-2005.Public Health. 2007; 121: 492-496
- Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis.Am J Med. 2009; 122: 248-256.e5
- Effects of bariatric surgery on mortality in Swedish obese subjects.N Engl J Med. 2007; 357: 741-752
- Metabolic/bariatric surgery Worldwide 2008.Obes Surg. 2009; 19: 1605-1611
- Lifestyle interventions for the treatment of class III obesity: a primary target for nutrition medicine in the obesity epidemic.Am J Clin Nutr. 2010; 91: 289S-292S
- Effects of diet and physical activity interventions on weight loss and cardiometabolic risk factors in severely obese adults: a randomized trial.JAMA. 2010; 304: 1795-1802
- Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes.Control Clin Trials. 2003; 24: 610-628
- Effectiveness of lifestyle interventions for individuals with severe obesity and type 2 diabetes: results from the Look AHEAD trial.Diabetes Care. 2011; 34: 2152-2157
- Long-term maintenance of weight loss: current status.Health Psychol. 2000; 19: 5-16
- Randomized clinical trials of weight loss maintenance: a review.J Cardiovasc Nurs. 2009; 24: 58-80
- Long-term weight loss maintenance.Am J Clin Nutr. 2005; 82: 222S-225S
- Nonsurgical weight loss for extreme obesity in primary care settings: results of the Louisiana Obese Subjects Study.Arch Intern Med. 2010; 170: 146-154
- Reduced access to care resulting from centers of excellence initiatives in bariatric surgery.Arch Surg. 2010; 145: 993-997
- Bariatric surgery or lifestyle intervention?.Obes Res Clin Pract. 2009; 3: 193-201
- Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial.Diabetes Care. 2007; 30: 1374-1383
- The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it.Obesity (Silver Spring). 2006; 14: 737-752
- The development and description of the comparison group in the Look AHEAD trial.Clin Trials. 2011; 8: 320-329
- Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial.Arch Intern Med. 2010; 170: 1566-1575
- Weight loss maintenance in severely obese adults after an intensive lifestyle intervention: 2- to 4-year follow-up.Obesity (Silver Spring). 2007; 15: 413-420
- Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report.Obes Res. 1998; 6: 51S-210S
- Handbook of Obesity Treatment.The Guilford Press, New York2002
Funding: This study is supported by the Department of Health and Human Services through the following cooperative agreements from the National Institutes of Health: DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135, and DK56992. The following federal agencies have contributed support: National Institute of Diabetes and Digestive and Kidney Diseases; National Heart, Lung, and Blood Institute; National Institute of Nursing Research; National Center on Minority Health and Health Disparities; National Institutes of Health (NIH) Office of Research on Women's Health; and the Centers for Disease Control and Prevention. This research was supported in part by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases. The Indian Health Service (IHS) provided personnel, medical oversight, and use of facilities. The opinions expressed in this article are those of the authors and do not necessarily reflect the views of the IHS or other funding sources. Additional support was received from The Johns Hopkins Medical Institutions Bayview General Clinical Research Center (M01RR02719); the Massachusetts General Hospital Mallinckrodt General Clinical Research Center and the Massachusetts Institute of Technology General Clinical Research Center (M01RR01066); the University of Colorado Health Sciences Center General Clinical Research Center (M01RR00051) and Clinical Nutrition Research Unit (P30 DK48520); the University of Tennessee at Memphis General Clinical Research Center (M01RR0021140); the University of Pittsburgh General Clinical Research Center (GCRC) (M01RR000056), the Clinical Translational Research Center (CTRC) funded by the Clinical & Translational Science Award (UL1 RR 024153) and NIH grant (DK 046204); the VA Puget Sound Health Care System Medical Research Service, Department of Veterans Affairs; and the Frederic C. Bartter General Clinical Research Center (M01RR01346). The following organizations have committed to make major contributions to Look AHEAD: FedEx Corporation; Health Management Resources; LifeScan, Inc., a Johnson & Johnson Company; OPTIFAST of Nestle HealthCare Nutrition, Inc.; Hoffmann-La Roche Inc.; Abbott Nutrition; and Slim-Fast Brand of Unilever North America.
Conflict of Interest: Dr Jakicic reported serving on the scientific advisory board for Alere Wellbeing; he was the principal investigator on a research grant awarded to the University of Pittsburgh from BodyMedia, Inc., and he received an honorarium for a scientific presentation from Jenny Craig and Nestle Nutrition Institute. No other authors reported any other conflicts of interest or financial disclosures.
Authorship: All authors significantly participated in the preparation of this manuscript.
Trial Registration: clinicaltrials.gov Identifier: NCT00017953.