Advertisement
Research Commentary| Volume 114, ISSUE 4, P537-542, April 2014

The Look AHEAD Study: Implications for Clinical Practice Go Beyond the Headlines

Published:March 18, 2014DOI:https://doi.org/10.1016/j.jand.2014.01.008
      On Friday, October 19, 2012, the National Institutes of Health (NIH) announced that the lifestyle “intervention was stopped early in NIH-funded study of weight loss in overweight and obese adults with type 2 diabetes after finding no harm, but no cardiovascular benefits.” The primary study question of the long-term Look AHEAD (Action for Health in Diabetes) Study had been answered. An intensive lifestyle intervention program aimed at a 10% weight loss and 175 minutes of physical activity per week did not reduce cardiovascular events (defined as heart attack, stroke, hospitalization for angina, or death) in people with type 2 diabetes compared with a program of diabetes support and education.

      National Institutes of Health. Weight loss does not lower heart diseases risk from type 2 diabetes (press release). October 19, 2012. http://www.gov/news/health/oct2012/niddk-19.htm Accessed December 28, 2012.

      A review of the primary study results, along with careful consideration of the previously published data, can put the study's results in perspective and go beyond the headlines.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. National Institutes of Health. Weight loss does not lower heart diseases risk from type 2 diabetes (press release). October 19, 2012. http://www.gov/news/health/oct2012/niddk-19.htm Accessed December 28, 2012.

        • The Look AHEAD Research Group
        Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes.
        N Engl J Med. 2013; 369: 145-154
        • Brancati F.
        • Evans M.
        • Furberg C.
        • et al.
        Midcourse correction to a clinical trial when the event rate is underestimated: The Look AHEAD (Action for Health in Diabetes) Study.
        Clin Trials. 2012; 9: 113-124
        • Gregg E.
        • Chen H.
        • Wagenknecht L.
        • et al.
        Impact of intensive lifestyle intervention on the remission of type 2 diabetes: The Look AHEAD Study.
        JAMA. 2012; 308: 2489-2496
        • The Look AHEAD Research Group
        Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: One-year results of the Look AHEAD trial.
        Diabetes Care. 2007; 30: 1374-1383
        • The Look AHEAD Research Group
        Long term effects of lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes: Four year results of the Look AHEAD trial.
        Arch Intern Med. 2010; 170: 1566-1575
        • Ribisl P.
        • Gaussoin S.
        • Lang W.
        • et al.
        Lifestyle intervention improves heart rate recovery from exercise in adults with type 2 diabetes: Results from the Look AHEAD Study.
        J Obes. 2012; 2012 ([published online ahead of print November 22, 2012]): 309196
        • Neiberg R.
        • Wing R.
        • Bray G.
        • et al.
        Patterns of weight change associated with long-term weight change and cardiovascular disease risk factors in the Look AHEAD study.
        Obesity (Silver Spring). 2012; 20: 2048-2056
        • Redmon B.
        • Bertoni A.
        • Connelly S.
        • et al.
        Effect of the Look AHEAD Study intervention on medication use and related cost to treat cardiovascular disease risk factors in individuals with type 2 diabetes.
        Diabetes Care. 2010; 33: 1153-1158
        • Foy C.
        • Lewis B.
        • Hairston K.
        • et al.
        Intensive lifestyle intervention improves physical function among obese adults with knee pain: Findings from the Look AHEAD Trial.
        Obesity (Silver Spring). 2011; 19: 83-93
        • Rejeski J.
        • Ip E.
        • Bertoni A.
        • et al.
        Lifestyle change and mobility in obese adults with type 2 diabetes.
        N Engl J Med. 2012;29; 366: 1209-1217
        • Williamson D.
        • Rejeski J.
        • Lang W.
        • et al.
        Impact of a weight management program on health-related quality of life in overweight adults with type 2 diabetes.
        Arch Intern Med. 2009; 169: 163-171
      2. The Look AHEAD Research Group. Impact of intensive lifestyle intervention on depression and health-related quality of life in type 2 diabetes: The Look AHEAD trial. Diabetes Care. 2014. In press.

        • Stewart T.
        • Bachand A.
        • Ryan D.
        • Bray G.
        • Williamson D.
        Look Ahead Body Image Research Group. Body image changes associated with participation in an intensive lifestyle weight loss intervention.
        Obesity (Silver Spring). 2011; 19: 1290-1295
        • Faulconbridge L.
        • Wadden T.
        • Rubin R.
        • et al.
        One-year changes in symptoms of depression and weight in overweight/obese individuals with type 2 diabetes in the Look AHEAD study.
        Obesity (Silver Spring). 2012; 20: 783-793
      3. Official Peer-Reviewed Highlights from the American Diabetes Association 73rd Scientific Sessions 2013. www.professional.diabetes.org/SS2013report. Accessed December 27, 2013.

        • Belalcazar M.
        • Haffner S.
        • Lang W.
        • et al.
        Lifestyle intervention and/or statins for the reduction of C-reactive protein in diabetes: From the Look AHEAD Study.
        Obesity (Silver Spring). 2013; : 944-950
        • Lazo M.
        • Solga S.
        • Horska A.
        • et al.
        Effect of a 12-month intensive lifestyle intervention on hepatic steatosis in adults with type 2 diabetes.
        Diabetes Care. 2010; 33: 2156-2163
        • Phelan S.
        • Kanaya A.
        • Subak L.
        • et al.
        Weight loss prevents urinary incontinence in women with type 2 diabetes: Results from the Look AHEAD Trial.
        J Urol. 2012; 187: 939-944
        • Foster G.
        • Borradaile K.
        • Sanders M.
        • et al.
        A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: The Sleep AHEAD Study.
        Arch Intern Med. 2009; 169: 1619-1626
        • Kuna S.
        • Reboussin D.
        • Borradaile K.
        • et al.
        Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes.
        Sleep. 2013; 36: 641A-649A
        • Wing R.R.
        • Bond D.S.
        • Gendrano 3rd, I.N.
        • et al.
        Effect of intensive lifestyle intervention on sexual dysfunction in women with type 2 diabetes: Results from an ancillary Look AHEAD Study.
        Diabetes Care. 2013; 36 ([published online ahead of print June 11, 2013]): 2937-2944
        • The Diabetes Prevention Program Research Group
        Role of insulin secretion and sensitivity in the evolution of type 2 diabetes in the Diabetes Prevention Program: Effects of lifestyle intervention and metformin.
        Diabetes. 2005; 54: 2404-2414
        • Albu J.
        • Heilbronn L.
        • Kelley D.
        • et al.
        Metabolic changes following a 1-year diet and exercise intervention in patients with type 2 diabetes.
        Diabetes. 2010; 59: 627-633
        • Wadden T.
        • West D.
        • Neiberg R.
        • et al.
        One-year weight losses in the Look AHEAD study: Factors associated with success.
        Obesity. 2009; 17: 713-722
        • Unick J.
        • Beavers D.
        • Jakicic J.
        • et al.
        The effectiveness of lifestyle interventions for individuals with severe obesity and type 2 diabetes: Results from the Look AHEAD Trial.
        Diabetes Care. 2011; 34: 2152-2157
        • Delahanty L.M.
        An expanded role for dietitians in maximizing retention in clinical trials: Implications for clinical practice.
        J Hum Nutr Diet. 2010; 23: 336-343
        • Delahanty L.M.
        • Nathan D.M.
        Implications of the Diabetes Prevention Program and Look AHEAD clinical trials for lifestyle interventions.
        J Am Diet Assoc. 2008; 108: S66-S72
      4. Anderson A, Fabricatore A, Foreyt J, et al. Readiness redefined: A behavioral task during screening predicted 1-year weight loss in the Look AHEAD Study [published online ahead of print October 22, 2013]. Obesity (Silver Spring). http://dx.doi.org/10.1002/oby.20648.

      Biography

      L. M. Delahanty is chief dietitian and director of nutrition and behavioral research, Massachusetts General Hospital Diabetes Center, Boston, MA; and instructor, Department of Medicine, Harvard Medical School, Boston, MA.