TY - JOUR
T1 - The long-term effectiveness of a lifestyle intervention in severely obese individuals
AU - Unick, Jessica L.
AU - Beavers, Daniel
AU - Bond, Dale S.
AU - Clark, Jeanne M.
AU - Jakicic, John M.
AU - Kitabchi, Abbas E.
AU - Knowler, William C.
AU - Wadden, Thomas A.
AU - Wagenknecht, Lynne E.
AU - Wing, Rena R.
N1 - Funding Information:
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.
PY - 2013/3
Y1 - 2013/3
N2 - 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, HbA1c, 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.
AB - 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, HbA1c, 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.
KW - Cardiovascular disease risk
KW - Diabetes
KW - Lifestyle intervention
KW - Severe obesity
KW - Weight loss
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U2 - 10.1016/j.amjmed.2012.10.010
DO - 10.1016/j.amjmed.2012.10.010
M3 - Article
C2 - 23410564
AN - SCOPUS:84873663262
VL - 126
SP - 236-242.e2
JO - American Journal of Medicine
JF - American Journal of Medicine
SN - 0002-9343
IS - 3
ER -