Randomized Controlled Trial

. 2020 Sep;28(9):1678-1686.

doi: 10.1002/oby.22936.

Intensive Weight Loss Intervention and Cancer Risk in Adults with Type 2 Diabetes: Analysis of the Look AHEAD Randomized Clinical Trial

Look AHEAD Research Group; Hsin-Chieh Yeh¹, John P Bantle², Maria Cassidy-Begay³, George Blackburn⁴, George A Bray⁵, Tim Byers⁶, Jeanne M Clark⁷, Mace Coday⁸, Caitlin Egan⁹, Mark A Espeland¹⁰, John P Foreyt¹¹, Katelyn Garcia¹⁰, Valerie Goldman¹², Edward W Gregg¹³, Helen P Hazuda¹⁴, Louise Hesson¹⁵, James O Hill¹⁶, Edward S Horton¹⁷, John M Jakicic¹⁸, Robert W Jeffery¹⁹, Karen C Johnson⁸, Steven E Kahn²⁰, William C Knowler³, Mary Korytkowski²¹, Anne Kure²⁰, Cora E Lewis²², Christos Mantzoros⁴, Maria Meacham³, Maria G Montez¹⁴, David M Nathan¹², Nicholas Pajewski¹⁰, Jennifer Patricio²³, Anne Peters²⁴, F Xavier Pi-Sunyer²³, Henry Pownall²⁵, Donna H Ryan⁵, Monika Safford²⁶, Rebecca L Sedjo²⁷, Helmut Steinburg²⁸, Mara Vitolins²⁹, Thomas A Wadden¹⁵, Lynne E Wagenknecht³⁰, Rena R Wing⁹, Antonio C Wolff³¹, Holly Wyatt³², Susan Z Yanovski³³

Affiliations

¹ Departments of Medicine, Epidemiology, and Oncology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA.
² Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
³ National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix Epidemiology and Clinical Research Branch, Phoenix, Arizona, USA.
⁴ Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
⁵ Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA.
⁶ Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁷ Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
⁸ Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁹ Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
¹⁰ Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
¹¹ Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
¹² Diabetes Clinical Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
¹³ Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
¹⁴ Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
¹⁵ Center for Weight and Eating Disorders, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
¹⁶ Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹⁷ Department of Medicine, Joslin Diabetes Center, Boston, Massachusetts, USA.
¹⁸ Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁹ Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
²⁰ Department of Medicine, VA Puget Sound Health Care System / University of Washington, Seattle, Washington, USA.
²¹ Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
²² Division of Preventive Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
²³ Columbia University Medical Center, New York, New York, USA.
²⁴ Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
²⁵ Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA.
²⁶ Department of Medicine, Weill Cornell Medical College of Cornell University, New York, New York, USA.
²⁷ Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
²⁸ Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
²⁹ Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
³⁰ Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
³¹ Department of Oncology, The Johns Hopkins Sydney Kimmel Cancer Center, Baltimore, Maryland, USA.
³² Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
³³ National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.

PMID: 32841523
PMCID: PMC8855671
DOI: 10.1002/oby.22936

Randomized Controlled Trial

Intensive Weight Loss Intervention and Cancer Risk in Adults with Type 2 Diabetes: Analysis of the Look AHEAD Randomized Clinical Trial

Look AHEAD Research Group et al. Obesity (Silver Spring). 2020 Sep.

. 2020 Sep;28(9):1678-1686.

doi: 10.1002/oby.22936.

Authors

Affiliations

¹ Departments of Medicine, Epidemiology, and Oncology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA.
² Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
³ National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix Epidemiology and Clinical Research Branch, Phoenix, Arizona, USA.
⁴ Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
⁵ Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA.
⁶ Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁷ Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
⁸ Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
⁹ Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
¹⁰ Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
¹¹ Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
¹² Diabetes Clinical Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
¹³ Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
¹⁴ Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
¹⁵ Center for Weight and Eating Disorders, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
¹⁶ Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹⁷ Department of Medicine, Joslin Diabetes Center, Boston, Massachusetts, USA.
¹⁸ Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁹ Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
²⁰ Department of Medicine, VA Puget Sound Health Care System / University of Washington, Seattle, Washington, USA.
²¹ Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
²² Division of Preventive Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA.
²³ Columbia University Medical Center, New York, New York, USA.
²⁴ Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
²⁵ Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA.
²⁶ Department of Medicine, Weill Cornell Medical College of Cornell University, New York, New York, USA.
²⁷ Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
²⁸ Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
²⁹ Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
³⁰ Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
³¹ Department of Oncology, The Johns Hopkins Sydney Kimmel Cancer Center, Baltimore, Maryland, USA.
³² Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
³³ National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA.

PMID: 32841523
PMCID: PMC8855671
DOI: 10.1002/oby.22936

Abstract

Objective: This study was designed to determine whether intensive lifestyle intervention (ILI) aimed at weight loss lowers cancer incidence and mortality.

Methods: Data from the Look AHEAD trial were examined to investigate whether participants randomized to ILI designed for weight loss would have reduced overall cancer incidence, obesity-related cancer incidence, and cancer mortality, as compared with the diabetes support and education (DSE) comparison group. This analysis included 4,859 participants without a cancer diagnosis at baseline except for nonmelanoma skin cancer.

Results: After a median follow-up of 11 years, 684 participants (332 in ILI and 352 in DSE) were diagnosed with cancer. The incidence rates of obesity-related cancers were 6.1 and 7.3 per 1,000 person-years in ILI and DSE, respectively, with a hazard ratio (HR) of 0.84 (95% CI: 0.68-1.04). There was no significant difference between the two groups in total cancer incidence (HR, 0.93; 95% CI: 0.80-1.08), incidence of nonobesity-related cancers (HR, 1.02; 95% CI: 0.83-1.27), or total cancer mortality (HR, 0.92; 95% CI: 0.68-1.25).

Conclusions: An ILI aimed at weight loss lowered incidence of obesity-related cancers by 16% in adults with overweight or obesity and type 2 diabetes. The study sample size likely lacked power to determine effect sizes of this magnitude and smaller.

Trial registration: ClinicalTrials.gov NCT00017953.

PubMed Disclaimer

Conflict of interest statement

Disclosure: Dr. Jakicic reports personal fees from WW (formerly Weight Watchers International, Inc.), outside the submitted work. No other conflicts of interest to declare.

Figures

**Figure 1:**
Flowchart for screening, randomization, and cancer analysis

**Figure 2a:**
Cumulative incidence of all cancers

**Figure 2b:**
Cumulative incidence of obesity-related cancers

**Figure 2c:**
Cumulative probability of cancer mortality

**Figure 3:**
Hazard ratios (95% CI) of obesity related cancer for randomization arm in subgroups

See this image and copyright information in PMC

Comment in

Obesity and Cancer: It's Causal and…Reversible?
Brown JC, McTiernan A. Brown JC, et al. Obesity (Silver Spring). 2020 Sep;28(9):1575. doi: 10.1002/oby.22962. Obesity (Silver Spring). 2020. PMID: 32841526 Free PMC article. No abstract available.

References

1. Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K, et al. Body Fatness and Cancer--Viewpoint of the IARC Working Group. The New England journal of medicine. 2016. Aug 25;375(8):794–8. - PMC - PubMed
1. Renehan AG, Tyson M, Egger M, Heller RF, Zwahlen M. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet. 2008. Feb 16;371(9612):569–78. doi: 10.1016/S0140-6736(08)60269-X. - DOI - PubMed
1. Ma Y, Yang Y, Wang F, Zhang P, Shi C, Zou Y, Qin H. Obesity and risk of colorectal cancer: a systematic review of prospective studies. PLoS One. 2013;8(1):e53916. doi: 10.1371/journal.pone.0053916. - DOI - PMC - PubMed
1. Chen Y, Liu L, Wang X, Wang J, Yan Z, Cheng J, Gong G, Li G. Body mass index and risk of gastric cancer: a meta-analysis of a population with more than ten million from 24 prospective studies. Cancer Epidemiol Biomarkers Prev. 2013. Aug;22(8):1395–408. doi: 10.1158/1055-9965.EPI-13-0042. - DOI - PubMed
1. Chen Y, Wang X, Wang J, Yan Z, Luo J. Excess body weight and the risk of primary liver cancer: an updated meta-analysis of prospective studies. Eur J Cancer. 2012. Sep;48(14):2137–45. doi: 10.1016/j.ejca.2012.02.063. - DOI - PubMed

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Intensive Weight Loss Intervention and Cancer Risk in Adults with Type 2 Diabetes: Analysis of the Look AHEAD Randomized Clinical Trial

Affiliations

Intensive Weight Loss Intervention and Cancer Risk in Adults with Type 2 Diabetes: Analysis of the Look AHEAD Randomized Clinical Trial

Authors

Affiliations

Abstract

Conflict of interest statement

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Comment in

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