In type 2 diabetes, sustained weight loss with an intensive lifestyle intervention.

The Look AHEAD (Action for Health in Diabetes) study is an ongoing randomised trial examining the consequences of weight loss in overweight and obese people with type 2 diabetes.  This publication reports on factors influencing sustained weight loss after four years of an intensive lifestyle intervention focusing on diet and exercise.

Clinical question:

In overweight or obese people with type 2 diabetes receiving an intensive lifestyle intervention, what factors predict successful weight loss?

The evidence:

Participants were randomly assigned to receive an Intensive Lifestyle Intervention (ILI) or usual care (Diabetes Support and Education, or DSE).  All participants received an initial session of diabetes education with recommendations for healthy eating and activity and addressed safety issues related to hypoglycemia and foot care.

The ILI comprised an intensive programme of group workshops by experienced lifestyle counselors, supplemented by regular individual sessions.  Interventions were delivered by a range of professionals, including dietitians, psychologists, and exercise specialists.  Participants were helped to implement detailed meal and exercise plans.  Each intervention plan was tailored to individual needs according to strict protocols.

Previous reports had shown that participants in the Intensive Lifestyle Intervention achieved a 4.7% average reduction in initial weight at year 4 compared with usual care.  This report shows that these losses were maintained over a longer period.

Of the 887 participants who achieved a reduction of 10% or more in their body weight at year 1, 42% maintained it to year 4, and 70.5% maintained a loss of ≥ 5% or more compared with their starting weight.

Of the 729 who lost less than 5% of their body weight in year 1, only 7% went on to achieve ≥ 10% at year 4, and 14.7% achieved ≥ 5%.

Losing a large amount of weight in the first year was by far the strongest determinant of achieving a large loss at year 4.

Older participants were also more likely to lose weight than younger ones, probably because they attended more sessions and were more compliant with the intervention.  There were no differences between men and women, and between ethnic groups, at four year follow-up.

With long-term participant support, weight loss achieved with a behavioral intervention is not invariably followed by a return to baseline weight…

Appraisal hints:

Users of this research should consider:

  • Was there adequate allocation concealment at the start of the trial?
  • Could other co-interventions may have brought about the changes (e.g. medication)?
  • Could this intervention be delivered in your setting?
  • Was the comparison intervention equivalent to usual practice in your setting?
  • The clinical benefits of weight loss are not addressed in this paper.


Wadden TA, Neiberg RH et al. Four-year weight losses in the Look AHEAD study: factors associated with long-term success. Obesity (Silver Spring). 2011 Oct;19(10):1987-98. doi: 10.1038/oby.2011.230.

Get the protocol for the original trial.

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I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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