Look AHEAD: Intensive lifestyle intervention aided weight-loss management

The Look AHEAD trial, the largest weight-loss study in the United States, reported maintenance of weight loss via intensive lifestyle intervention, with nearly 40% of participants losing more than 10% of their initial weight and maintaining that loss through 8 years.

“This study shows intensive lifestyle programs that involve frequent treatment visits in the first year, and weight-loss maintenance programs in years 2 to 8, can help keep the weight off over the long term and reduce comorbid conditions,” Thomas Wadden, PhD, director of the Center for Weight and Eating Disorders at the Perelman School of Medicine, University of Pennsylvania, said in a press release.

The Look AHEAD study analyzed the effects of weight loss on cardiovascular morbidity and mortality in 5,145 overweight or obese participants with type 2 diabetes by randomly assigning them to the standard of care (diabetes support and education) or intensive lifestyle intervention (ILI), including comprehensive behavioral weight-loss counseling.

At year 8, the ILI group lost a mean of 4.7 ± 0.2% of their baseline weight while the standard of care group lost 2.1 ± 0.2% (P<.001). Of those groups, 50.3% of the ILI group and 35.7% of the standard of care group lost at least 5% of their total weight, and 26.9% of the ILI group and 17.2% of the standard of care group lost at least 10% (P<.001).

Researchers reported that participants in the ILI group achieved significantly greater increases in their moderate-intensity physical activity at each assessment vs. their standard of care peers. Additionally, participants in the ILI group measured their weekly body weight more often and increased the number of weeks in which they reported exercising, reducing calorie and fat intake and using meal replacements vs. the standard of care group.

“The success in keeping off the weight is as good or better than achieved in any other long-term study of diet and exercise for weight loss,” Adam Tsai, MD, MSCE, assistant professor of medicine at the University of Colorado, Denver, and chair of The Obesity Society Public Affairs Committee, said in the press release. “Intensive lifestyle interventions, like Look AHEAD, can be successful for people affected by obesity and overweight across the board, regardless of racial-ethnic background, and can lead to improvements in quality of life, mood, mobility, fitness and reduced need for medication. … The next step is to replicate interventions like Look AHEAD, but at a lower cost and for more people, and to determine which individuals can benefit most.”

In an accompanying editorial, Michael G. Perri, PhD, ABPP, of the department of clinical and health psychology at the University of Florida, Gainesville, said the trial’s retention rate of more than 88% at 8 years and the behavioral management aspect of its success should be commended.

“The problem of poor maintenance of lost weight has been one of the greatest challenges associated with lifestyle interventions. The Look AHEAD findings demonstrate that a substantial degree of long-term weight loss is possible. However, the achievement of that outcome appears to require intensive, ongoing care, based on sound behavioral principles,” Perri wrote. “The lifestyle intervention in Look AHEAD included a comprehensive array of empirically supported behavioral treatment components, individually tailored through the use of problem-solving and ‘tool box’ strategies, and delivered via structured programs of ongoing group and individual contacts.”

For more information:

Look AHEAD Research Group. Obesity. 2014;doi:10.1002/oby.20662.

Perri MG. Obesity. 2014;doi:10.1002/oby.20672.

Disclosure: This study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, National Heart, Lung, and Blood Institute and the CDC. The following organizations committed to make major contributions to the study: Abbott Nutrition; FedEx Corporation; Health Management Resources; Hoffmann-La Roche; LifeScan Inc., a Johnson & Johnson Company; OPTIFAST of Nestle HealthCare Nutrition Inc.; and Slim-Fast Brand of Unilever North America.