• Am. J. Med. · Mar 2013

    Randomized Controlled Trial Multicenter Study

    The long-term effectiveness of a lifestyle intervention in severely obese individuals.

    • Jessica L Unick, Daniel Beavers, Dale S Bond, Jeanne M Clark, John M Jakicic, Abbas E Kitabchi, William C Knowler, Thomas A Wadden, Lynne E Wagenknecht, Rena R Wing, and Look AHEAD Research Group.
    • Weight Control and Diabetes Research Center, The Miriam Hospital and Warren Alpert Medical School at Brown University, Providence, RI 02903, USA. junick@lifespan.org
    • Am. J. Med. 2013 Mar 1; 126 (3): 236242.e2422236-42, 242.e1-2.

    ObjectiveSevere obesity (body mass index [BMI] ≥40 kg/m(2)) 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.MethodsThere were 5145 individuals with type 2 diabetes (45-76 years, BMI ≥25 kg/m(2)) 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.ResultsAcross 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).ConclusionLifestyle interventions can result in important long-term weight losses and improvements in cardiovascular disease risk factors among a significant proportion of severely obese individuals.Copyright © 2013 Elsevier Inc. All rights reserved.

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