Four-year weight losses in the Look AHEAD study: factors associated with long-term success

Wadden TA, Neiberg RH, Wing RR, et al; for the Look AHEAD Research Group. Four-year weight losses in the Look AHEAD study: factors associated with long-term success. Obesity. 2011;19(10):1987-1998. 

Alert: October 20, 2012: Look AHEAD has been halted due to futility. Click here for exclusive commentary from Look AHEAD study investigator Anne Peters, MD, on the lack of benefit conferred by lifestyle modifications on CV events. 

This analysis of 4-year data from the Look AHEAD (Action for Health in Diabetes) trial examined the effect of lifestyle on weight loss and identified demographic characteristics and lifestyle behaviors associated with sustained weight loss in the intensive lifestyle intervention treatment group.  

Look AHEAD trial profile1  

  • Assessed long-term effects (up to 11.5 years) of intensive lifestyle intervention over 4 years on CV morbidity and mortality  
  • Overweight, obese individuals with type 2 diabetes (N=5,145) randomized to
    • Intensive lifestyle intervention (ILI): goal to achieve and maintain weight loss ≥7% of initial body weight (n=2,570)*  
    • Diabetes support and education (DSE): control group (n=2,575) 
     
  • Primary outcome: time to incidence of major cardiovascular disease (CVD) event  

Results at 4 Years 

The percent reduction from initial weight was -4.7% in the ILI group and -1.1% in the DSE group (P<0.001).2 Subjects in the ILI group had greater weight loss than those in the DSE group at all annual assessments at years 1-4.  

The percent of subjects achieving study weight loss goals was as follows in the ILI and DSE groups, respectively:  

  • ≥7% loss of body weight (study-wide weight loss goal): 35% vs 18%; P<0.0001  
  • ≥10% loss of body weight: 23% vs 10%; P<0.0001 

In addition, more subjects in the DSE group gained weight from baseline to Year 4 (45% in the DSE group vs 26% in the ILI group; P<0.001).Weight loss at Year 1 was strongly related to meeting weight loss goals at Year 4.  

Weight reduction by subgroup in the ILI group was as follows:  

  • Men lost more weight in first 3 years vs females; differences not statistically significant at 4 years  
  • No significant differences seen for ethnicities; greatest differences seen at Year 1, substantial decline by Year 3  
  • Oldest patients (aged 65-75 years at baseline) lost more weight at all 4 years  

Significant variation in weight loss was seen with insulin use at baseline and Year 4 for both groups.  

  • Insulin nonusers at baseline or Year 4 in ILI group had significantly greater weight loss  
  • Insulin nonusers at baseline who took insulin at Year 4 lost significantly more weight vs those who took insulin at baseline but not at Year 4  
  • A similar pattern was seen among those in control group  

Among 887 ILI group participants who lost ≥10% of initial body weight during Year 1:  

  • 42% (n=374) achieved loss of this size at Year 4  
  • 28% (n=251) maintained loss of 5.0-9.9%  
  • 20% (n=174) maintained loss of 0% to 4.9%  
  • 10% (n=88) gained weight from baseline 

Those who maintained 10% weight loss had more treatment contacts over Years 2-4 and reported engaging in more physical activity and lower calorie intake at Year 4 vs those who did not maintain weight loss or who gained weight.  

*Individual participants were given a goal of ≥10% weight loss to increase the likelihood that they would meet the ≥7% study-wide goal.  

1. Ryan DH, Espeland MA, Foster GD, et al; for the Look AHEAD Research Group. 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(5):610-628.  

2. The Look AHEAD Research Group. 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(17):1566-1575.  

 

October 2012  

This overview was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a promotional/commercial interest.  

Related content  

Slide: Look AHEAD: 4-Year Data Analysis  

Slide: Look AHEAD at 4 Years: Weight Reduction  

Slide: Look AHEAD at 4 Years: Percent Weight Reduction and Gain  

Slide: Look AHEAD at 4 Years: Weight Reduction By Subgroup, Insulin Use  

Slide: Look AHEAD at 4 Years: Weight Maintenance  

Slide: Look AHEAD: Design  

Slide: Look AHEAD: Lifestyle Interventions  

Slide: Look AHEAD: 1-Year Interim Results  

Slide: Look AHEAD at 1 Year: Interventions  

Slide: Look AHEAD at 1 Year: Change in Body Weight  

Slide: Look AHEAD at 1 Year: Change in Fitness Levels  

Slide: Look AHEAD at 1 Year: Additional Results  

Overview: Effectiveness of lifestyle interventions for individuals with severe obesity and type 2 diabetes: results from the Look AHEAD trial 

Last Modified: 11/15/2013