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Randomized Controlled Trial
. 2013 Mar;126(3):236-42, 242.e1-2.
doi: 10.1016/j.amjmed.2012.10.010.

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

Jessica L Unick  1 , 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; Look AHEAD Research Group
Collaborators, Affiliations
Randomized Controlled Trial

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

Jessica L Unick et al. Am J Med. 2013 Mar.

Abstract

Objective: Severe 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.

Methods: There 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.

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, 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).

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.

Trial registration: ClinicalTrials.gov NCT00017953.

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Conflict of interest statement

Potential conflicts of interest and financial disclosures: Dr. Jakicic reported serving on the scientific advisory board for Alere Wellbeing, he was the principal investigator on a research grant awarded to the University of Pittsburgh from BodyMedia, Inc., and he received honorarium for a scientific presentation from JennyCraig and Nestle Nutrition Institute. No other authors reported any other conflicts of interest or financial disclosures.

Figures

Figure 1
Figure 1
Percent change in body weight for intensive lifestyle intervention and diabetes support and education participants stratified by BMI category. Caption: Solid lines represent diabetes support and education (DSE) participants while dashed lines represent intensive lifestyle intervention (ILI) participants. BMI categories defined as follows: overweight (25≤BMI<30), class I obese (30≤BMI<35), class II obese (35≤BMI<40), severely obese (BMI≥40)
Figure 2
Figure 2
Percentage of intensive lifestyle intervention participants in each BMI category achieving a weight loss ≥ 5%, 7%, and 10% at Year 4. Caption: * indicates that severely obese are significantly different from overweight (p<0.05); + indicates that severely obese are significantly different from class I obese (p<0.05)
See this image and copyright information in PMC

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