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

Author
item UNICK, JESSICA - Brown University School Of Medicine
item BEAVERS, DANIEL - Wake Forest School Of Medicine
item BOND, DALE - Brown University School Of Medicine
item CLARK, JEANNE - Johns Hopkins University
item JAKICIC, JOHN - University Of Pittsburgh
item KITABCHI, ABBAS - University Of Tennessee
item KNOWLER, WILLIAM - National Institute Of Diabetes And Digestive And Kidney Diseases
item WADDEN, THOMAS - University Of Pennsylvania
item WAGENKNECHT, LYNNE - Wake Forest School Of Medicine
item WING, RENA - Brown University School Of Medicine
item FOREYT, JOHN - Children'S Nutrition Research Center (CNRC)

Submitted to: American Journal of Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/1/2012
Publication Date: 3/1/2013
Citation: Unick, J.L., Beavers, D., Bond, D.S., Clark, J.M., Jakicic, J.M., Kitabchi, A.E., Knowler, W.C., Wadden, T.A., Wagenknecht, L.E., Wing, R.R., Foreyt, J.P., The Look Ahead Research Group. 2013. The long-term effectiveness of a lifestyle intervention in severely obese individuals. American Journal of Medicine. 126(3):236-242.

Interpretive Summary: In 2009-2010, it was estimated that 6.3% of the United States adult population was severely obese. It is also expected that the prevalence of severe obesity will nearly double over the next two decades. While bariatric surgery is highly effective, it currently treats 1% of the eligible population; therefore, more reasonable treatments are needed. Intensive lifestyle interventions can result in significant long-term reductions in body weight among a considerable proportion of severely obese individuals with type 2 diabetes. At all BMI levels, participants achieved significantly larger weight losses compared with diabetes support and education participants. Modest reductions in body weight, even despite persistent severe obesity, can significantly improve cardiovascular disease risk factors in this population. Behavioral weight loss programs should not be ignored as a potential treatment strategy for individuals that are severly obese.

Technical Abstract: Severe obesity (body mass index [BMI] greater than or equal to 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, class I, and class II obese participants. There were 5145 individuals with type 2 diabetes (45-76 years, BMI 25 kg/m**2) randomized to an intensive lifestyle intervention (ILI)or diabetes support and education (DSE). The ILI intervention group received a behavioral weight loss program that included group and individual meetings, a greater than or equal to 10% weight loss goal, calorie restriction, and increased physical activity. DSE received a less intense educational intervention. Four-year changes in body weight and cardiovascular disease risk factors were assessed. Across BMI categories, 4-year changes in body weight were significantly greater in ILI participants compared with DSE (Ps<.05). At year 4, severely obese ILI 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, HbA1c, and blood glucose were similar across BMI categories in ILI 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). 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.