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Intensive lifestyle weight-loss program reduces physical disability later in life
Adults with type 2 diabetes and overweight or obesity assigned to an intensive lifestyle intervention for weight loss were less likely to experience long-term moderate to severe disability than those assigned to diabetes support and education, according to an analysis of data from the Look AHEAD trial.
Edward W. Gregg, PhD, chief of the epidemiology and statistics branch in the division of diabetes translation at the CDC, and colleagues evaluated data on 5,137 adults with type 2 diabetes and overweight or obesity (aged 45-76 years; mean age, 59 years; mean BMI, 36 kg/m2; mean diabetes duration, 7 years; 63% white) randomly assigned to a 10-year intensive lifestyle intervention (n = 2,567) or diabetes support and education (n = 2,570) to determine the effect of the intervention on years spent with and without physical disability.
The intensive lifestyle intervention was used to increase physical activity and to reduce caloric and total fat consumption. Participants attended weekly group and individual sessions for 6 months followed by two group and one individual session for another 6 months. During years 2 to 4, participants received twice-monthly contact and then monthly contact for the remaining 5 years. Participants assigned to diabetes support and education were offered three group sessions per year focused on diet, physical activity and social support.
During follow-up, the lifestyle group had a lower incidence of moderate to severe physical disability compared with the diabetes education group (6% per year vs. 6.8% per year; P < .01). Relative reductions in disability incidence were observed among women in the lifestyle group compared with the diabetes education group (6.7% per year vs. 8.2% per year; P < .01) and among those without prior cardiovascular disease (7.1% vs. 8.2% per year; P < .01); no significant associations were observed for men or those with prior CVD. The incidence of severe disability was less common among the lifestyle group, but it did not significantly differ from that of the diabetes education groups; however, the incidence was lower among lifestyle women compared with diabetes education women (P = .04) and those without CVD compared with those with CVD (P = .02).
In men at age 60 and 75 years, incidence of moderate to severe disability per year was lower in the lifestyle group compared with the diabetes education group (5.1% vs. 5.8% at age 60 years; 7.8% vs. 8.8% at age 75 years). In men at age 60 and 75 years, incidence of remission was higher in the lifestyle group compared with the diabetes education group (25.7% vs. 23.1% at age 60 years; 15% vs. 13.4% at age 75 years). In women at age 60 and 75 years, incidence of moderate to severe disability per year was lower in the lifestyle group compared with the diabetes education group (7.6% vs. 8.7% at age 60 years; 11.5% vs. 13% at age 75 years). Further, in women at age 60 and 75 years, incidence of remission was higher in the lifestyle group compared with the diabetes education group (23.1% vs. 22.1% at age 60 years; 13.4% vs. 12.7% at age 75 years).
Although researchers observed no between-group differences for total years of life, the lifestyle group delayed its age of onset of moderate to severe physical disability and increased its number of nondisabled years of life by 0.8 to 0.9 years compared with the diabetes education group. Researchers also observed that the effect of the intervention on number of active years of life was statistically significant from age 50 to 60 years, but not after age 70 years. The number of nondisabled years in women and in those without CVD was associated with the lifestyle intervention, but no association was observed for men or those with CVD. Women and participants with CVD experienced onset of disability at a younger age compared with men and participants without CVD.
“These findings indicate that an [intensive lifestyle intervention] that focuses on caloric restriction and increased physical activity can reduce long-term physical disability and has an impact on disability-free life expectancy despite not affecting total life expectancy,” the researchers wrote. “Given the continued high prevalence of diabetes in the U.S. and the increasing life spans of adults with diabetes, these findings have important implications for the compression of morbidity and improvement of quality of life among overweight and obese adults with type 2 diabetes.” – by Amber Cox
Disclosures: Gregg reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.