The Long-term Effectiveness of a Lifestyle Intervention in Severely Obese Individuals

doi:10.1016/j.amjmed.2012.10.010

The American Journal of Medicine

Volume 126, Issue 3, March 2013, Pages 236-242.e2

https://doi.org/10.1016/j.amjmed.2012.10.010 Get rights and content

Abstract

Objective

Severe obesity (body mass index [BMI] ≥40 kg/m²) is a serious public health concern. Although bariatric surgery is an efficacious treatment approach, it is limited in reach; thus, nonsurgical treatment alternatives are needed. We examined the 4-year effects of an intensive lifestyle intervention on body weight and cardiovascular disease risk factors among severely obese, compared with overweight (25 ≤BMI <30), class I (30 ≤BMI <35), and class II obese (35 ≤BMI <40) participants.

Methods

There were 5145 individuals with type 2 diabetes (45-76 years, BMI ≥25 kg/m²) randomized to an intensive lifestyle intervention or diabetes support and education. The lifestyle intervention group received a behavioral weight loss program that included group and individual meetings, a ≥10% weight loss goal, calorie restriction, and increased physical activity. Diabetes support and education received a less intense educational intervention. Four-year changes in body weight and cardiovascular disease risk factors were assessed.

Results

Across BMI categories, 4-year changes in body weight were significantly greater in lifestyle participants compared with diabetes support and education (Ps <.05). At year 4, severely obese lifestyle participants lost 4.9% ± 8.5%, which was similar to class I (4.8% ± 7.2%) and class II obese participants (4.4% ± 7.6%), and significantly greater than overweight participants (3.4% ± 7.0%; P <.05). Four-year changes in low-density-lipoprotein cholesterol, triglycerides, diastolic blood pressure, HbA_1c, and blood glucose were similar across BMI categories in lifestyle participants; however, the severely obese had less favorable improvements in high-density-lipoprotein cholesterol (3.1 ± 0.4 mg/dL) and systolic blood pressure (−1.4 ± 0.7 mm Hg) compared with the less obese (Ps <.05).

Conclusion

Lifestyle interventions can result in important long-term weight losses and improvements in cardiovascular disease risk factors among a significant proportion of severely obese individuals.

Section snippets

Participants

As previously reported, 5145 individuals from 16 centers were enrolled in the Look AHEAD trial.¹⁹ Participants had type 2 diabetes, were 45-76 years of age, and had a BMI ≥25 kg/m² (or ≥27 kg/m² if taking insulin). Individuals passed a maximal exercise test at baseline and completed 2 weeks of self-monitoring to demonstrate behavioral adherence. Further inclusion criteria were HbA_1c ≤11%, triglycerides <600 mg/dL, and systolic and diastolic blood pressure ≤160 and ≤100 mm Hg, respectively.

Results

The baseline characteristics of study participants stratified by BMI category have previously been reported,¹² and selected ones are shown in the Table. In short, severely obese participants were younger, had lower physical activity and fitness, a larger proportion were female, and a similar percentage were classified as being non-Hispanic white (64.1%), compared with those with a BMI <40. Outcome assessments were completed in ≥95% of participants in each BMI category at Year 4 (see primary

Discussion

This study demonstrates that severely obese individuals with type 2 diabetes can be treated effectively using an intensive lifestyle intervention, with a significant proportion of individuals meeting weight loss and cardiovascular disease risk factor goals at 4 years. The mean 4.9% weight loss achieved by severely obese lifestyle participants at Year 4 was similar, if not better, than their lighter counterparts. Furthermore, 26% of severely obese lifestyle participants achieved a ≥10% weight

Acknowledgements

Some of the information contained herein was derived from data provided by the Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene.

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: 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.

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Clinical research studyThe Long-term Effectiveness of a Lifestyle Intervention in Severely Obese Individuals

Abstract

Objective

Methods

Results

Conclusion

Section snippets

Participants

Results

Discussion

Acknowledgements

Am J Prev Med

Public Health

Am J Med

Am J Clin Nutr

Am J Clin Nutr

Obes Res Clin Pract

Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010

JAMA

Mortality and cardiac and vascular outcomes in extremely obese women

JAMA

The disease burden associated with overweight and obesity

JAMA

Effects of bariatric surgery on mortality in Swedish obese subjects

N Engl J Med

Metabolic/bariatric surgery Worldwide 2008

Obes Surg

Effects of diet and physical activity interventions on weight loss and cardiometabolic risk factors in severely obese adults: a randomized trial

JAMA

Clinical research study
The Long-term Effectiveness of a Lifestyle Intervention in Severely Obese Individuals