Changes in body composition over 8 years in a randomized trial of a lifestyle intervention: The look AHEAD study
Open accessAbstract
Objective: To determine the effects of an intensive lifestyle intervention versus a comparison group on body composition in obese or overweight persons with type 2 diabetes at baseline and at 1, 4, and 8 years. Methods: Body composition was measured by dual‐energy X‐ray absorptiometry in a subset of 1019 Look AHEAD study volunteers randomized to intervention or comparison groups. The intervention was designed to achieve and maintain ≥7% weight loss through increased physical activity and reduced caloric intake. The comparison group received social support and diabetes education. Results: At 1 year, the intervention group lost fat (5.6 ± 0.2 kg) and lean mass (2.3 ± 0.1 kg) but regained fat (∼100%) and lost lean mass between years 1 and 8. Between baseline and year 8, weight loss was greater in intervention versus comparison groups (4.0 ± 0.4 vs. 2.3 ± 0.4 kg); comparison group weight loss was mostly lean mass (2.1 ± 0.17 kg). Fat mass in the intervention group was lower than that of the comparison group at all post‐baseline time points. Conclusions: Reduced fat mass may place the intervention group at a lower risk of obesity‐linked sequelae, a hypothesis that can be tested by future studies of this cohort.
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Treatment discontinuation typically results in rapid weight regain, with the majority of this gain attributed to increases in fat mass.
“treatment discontinuation typically results in rapid weight regain4,9,10, with the majority of this gain attributed to increases in fat mass11–13”
From GDF8 and activin A blockade protects against GLP-1–induced muscle loss while enhancing fat loss in obese male mice and non-human primates (2025) · cites this paper as [11]
The Results (page unavailable) report that weight regained by the intervention group between years 1 and 8 was approximately 100% fat mass, supporting the fat-mass portion of the claim. But the Methods > Interventions section says the intervention continued through years 2–8; this study does not establish rapid regain after treatment discontinuation. (LLM, conf=0.88)
Experimental — accuracy not yet measuredBody weight regained after stopping treatment is likely disproportionately composed of adipose tissue, with little regain of lean mass and little increase in energy expenditure.
“Furthermore, it is likely the body weight regained after stopping treatment is disproportionately composed of adipose tissue, with little regain of lean mass and little increase in energy expenditure.”
From Strategies for minimizing muscle loss during use of incretin‐mimetic drugs for treatment of obesity (2025) · cites this paper as [14]
The Results (page unavailable) report that weight regained from years 1 to 8 in the intervention group was approximately 100% fat mass, with little change in lean mass. But the Methods say the intervention continued during years 2–8, so these findings are not about regain after stopping treatment. The paper does not report an increase in energy expenditure during regain. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThe initial loss of lean mass in the Look AHEAD ILI condition is of concern because weight regain brought no increase in lean mass.
“The initial loss of lean mass in the ILI condition is of concern because the weight regain in that group brought no increase in lean mass [31].”
From New drugs for the treatment of obesity: do we need approaches to preserve muscle mass? (2025) · cites this paper as [31]
In Look AHEAD, the ILI group lost fat and lean mass in the first year, but regained fat and lost lean mass between years 1 and 8.
“The ILI group lost fat (− 5.6 ± 0.2 kg) and lean mass (− 2.3 ± 0.1 kg) in the first year, but regained fat (∼100%) and lost lean mass between years 1 and 8.”
From New drugs for the treatment of obesity: do we need approaches to preserve muscle mass? (2025) · cites this paper as [31]
Long-term follow-up studies of RCTs that resulted in weight loss show that weight regain following significant intentional weight loss is comprised predominantly of fat mass.
“This finding is echoed in the few long-term follow-up studies of RCTs that resulted in weight loss, where weight regain following significant intentional weight loss is shown to be comprised predominantly of fat mass.13, 24, 25”
From Legacy effects of short-term intentional weight loss on total body and thigh composition in overweight and obese older adults (2016) · cites this paper as [25]
In the Look AHEAD trial, although a lifestyle-based caloric restriction and exercise program produced significant fat and lean mass loss during the first year of intervention, 7 years later, 100% of fat mass was regained, whereas participants continued to lose lean mass.
“Last, recent long-term data from the Look AHEAD trial examining changes in body composition over an 8-year follow-up period demonstrate that although a lifestyle-based caloric restriction and exercise program produced significant fat and lean mass loss during the first year of intervention, 7 years later, 100% of fat mass was regained, whereas participants continued to lose lean mass.25”
From Legacy effects of short-term intentional weight loss on total body and thigh composition in overweight and obese older adults (2016) · cites this paper as [25]
The efficacy of lifestyle interventions to reduce body weight depends on age, sex, ethnicity, and body weight upon inclusion.
“Lifestyle interventions to reduce body weight predominantly include exercise training and controlled reduced caloric intake, but their efficacy depends on age, sex, ethnicity, and body weight upon inclusion (219).”
From Metabolic Flexibility as an Adaptation to Energy Resources and Requirements in Health and Disease (2018) · cites this paper as [219]
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- Authors
- Pownall, H. J., Bray, G. A., Wagenknecht, L. E., Walkup, M. P., Heshka, S., Hubbard, V. S., Hill, J., Kahn, S. E., Nathan, D. M., Schwartz, A. V., Johnson, K. C., & the Look AHEAD Research Group
- Affiliations
- Baylor College of Medicine (US)
- Pennington Biomedical Research Center (US)
- Wake Forest University Health Sciences (US)
- St. Luke's-Roosevelt Hospital Center (US)
- National Institutes of Health (US)
- University of Colorado Denver (US)
- University of Washington (US)
- Harvard University (US)
- Department of Epidemiology and Biostatistics University of California San Francisco California USA
- University of Tennessee Health Science Center (US)
- Corresponding author
- Wagenknecht, Lynne E.
- Venue
- Obesity
- Publisher
- Wiley
- Published
- 2015-02-24
- Volume
- 23
- Issue
- 3
- Pages
- 565-572
- ISSN
- 1930-7381 (ISSN-L)
- 1930-739X
- PMC
- PMC4707962
- OpenAlex
- W1506839237
- Semantic Scholar
- ecd02e068192ab11fef4d795fc52e31e73c89de4
- Cited by
- 94
- References
- 40
- Citations by year
- 2026: 11 · 2025: 14 · 2024: 13 · 2023: 2 · 2022: 4 · 2021: 8 · 2020: 5 · 2019: 10 · 2018: 6 · 2017: 10 · 2016: 8 · 2015: 3
- FWCI
- 7.82
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Obesity (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion)
- Spiral (Imperial College London) (submittedVersion)
- Funders
- National Institutes of Health (U01-DK-57136)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Keywords
- body composition, type 2 diabetes, lifestyle intervention, weight loss, fat mass, lean body mass, weight regain, physical activity, caloric restriction, social support, diabetes education
- MeSH terms
- Aged, Behavior Therapy, Body Composition, Diabetes Mellitus, Type 2, Exercise Therapy, Female, Follow-Up Studies, Humans, Life Style, Male, Middle Aged, Obesity, Patient Education as Topic, Weight Loss, Absorptiometry, Photon, Caloric Restriction, Overweight, Weight Reduction Programs
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