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Title: One-year weight losses in the Look AHEAD study: Factors associated with success

item WADDEN, THOMAS - University Of Pennsylvania
item WEST, DELIA - University Of Arkansas
item NEIBERG, REBECCA - Wake Forest University
item WING, RENA - Brown University
item RYAN, DONNA - Pennington Biomedical Research Center
item JOHNSON, KAREN - University Of Tennessee
item FOREYT, JOHN - Baylor College Of Medicine
item HILL, JAMES - University Of Colorado
item TRENCE, DACE - University Of Washington
item VITOLINS, MARA - Wake Forest University

Submitted to: Obesity
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/12/2008
Publication Date: 4/1/2009
Citation: Wadden, T.A., West, D.S., Neiberg, R.H., Wing, R.R., Ryan, D.H., Johnson, K.C., Foreyt, J.P., Hill, J.O., Trence, D.L., Vitolins, M.Z. 2009. One-year weight losses in the Look AHEAD study: factors associated with success. Obesity. 17(4):713-722.

Interpretive Summary: This study examined the factors associated with successful one-year outcomes of a trial conducted to determine the long-term effects of an intensive lifestyle intervention (ILI) on weight loss in individuals with type 2 diabetes. Participants assigned to the ILI, that involved diet, physical activity, and behavior modification, lost 8.6% of their initial body weight. Greater self-reported physical activity was the strongest predictor of weight loss. Also, the more sessions participants attended, the greater their weight reductions. Consuming a greater number of meal replacements also had a significant effect on outcomes. The use of orlistat, a weight management drug, increased weight loss only marginally. The results of this study provide critical information for establishing recommendations with regard to inducing weight loss in individuals with type 2 diabetes.

Technical Abstract: This report provides a further analysis of the first year weight losses in the Look AHEAD (Action for Health in Diabetes) study and identifies factors associated with success. Participants were a total of 5,145 men and women with type 2 diabetes who were recruited at 16 sites and randomly assigned to an intensive lifestyle intervention (ILI) or a control condition, Diabetes Support and Education (DSE). During year 1, participants in ILI received comprehensive diet and physical activity counseling in a total of 42 group and individual sessions, compared with three educational sessions for DSE participants. As reported previously, at the end of the year, ILI participants lost 8.6% of initial weight, compared to 0.7% for DSE (P < 0.001). Within the ILI group, all racial/ethnic groups achieved clinically significant weight losses (>5.5%), although there were significant differences among groups. For the year, ILI participants attended an average of 35.4 treatment sessions and reported exercising a mean of 136.6 min/week and consuming a total of 360.9 meal replacement products. Greater self-reported physical activity was the strongest correlate of weight loss, followed by treatment attendance and consumption of meal replacements. The use of orlistat, during the second half of the year, increased weight loss only marginally in those ILI participants who had lost <5% of initial weight during the first 6 months and chose to take the medication thereafter as a toolbox option. The lifestyle intervention was clinically effective in all subsets of an ethnically and demographically diverse population.