Intensive weight loss intervention and cancer risk in adults with type 2 diabetes: Analysis of the look ahead randomized clinical trial
Open accessAbstract
Objective: This study was designed to determine whether intensive lifestyle intervention (ILI) aimed at weight loss lowers cancer incidence and mortality. Methods: Data from the Look AHEAD trial were examined to investigate whether participants randomized to ILI designed for weight loss would have reduced overall cancer incidence, obesity‐related cancer incidence, and cancer mortality, as compared with the diabetes support and education (DSE) comparison group. This analysis included 4,859 participants without a cancer diagnosis at baseline except for nonmelanoma skin cancer. Results: After a median follow‐up of 11 years, 684 participants (332 in ILI and 352 in DSE) were diagnosed with cancer. The incidence rates of obesity‐related cancers were 6.1 and 7.3 per 1,000 person‐years in ILI and DSE, respectively, with a hazard ratio (HR) of 0.84 (95% CI: 0.68‐1.04). There was no significant difference between the two groups in total cancer incidence (HR, 0.93; 95% CI: 0.80‐1.08), incidence of nonobesity‐related cancers (HR, 1.02; 95% CI: 0.83‐1.27), or total cancer mortality (HR, 0.92; 95% CI: 0.68‐1.25). Conclusions: An ILI aimed at weight loss lowered incidence of obesity‐related cancers by 16% in adults with overweight or obesity and type 2 diabetes. The study sample size likely lacked power to determine effect sizes of this magnitude and smaller.
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Most available evidence on diabetes and cancer comes from type 2 diabetes cohorts, possibly because type 2 diabetes is most prevalent, although increased risk of certain cancers has also been reported for type 1 diabetes.
“Most of the available evidence is generated from T2D cohorts, possibly because it is the most prevalent DM, although increased risk of certain cancers also has been reported for persons with T1D.1763”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1763]
The Methods describe a trial in adults with type 2 diabetes, but do not assess whether most diabetes–cancer evidence comes from type 2 diabetes cohorts. Searches for type 1 diabetes and the proposed prevalence explanation found no passages addressing either point; the References list alone does not establish them. No page numbers are available in our copy. (LLM, conf=0.72)
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GLP‐1 Receptor Agonists and Cancer Risk in Obesity Treatment
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- Authors
- Look AHEAD Research Group, Yeh, H., Bantle, J. P., Cassidy‐Begay, M., Blackburn, G., Bray, G. A., Byers, T., Clark, J. M., Coday, M., Egan, C., Espeland, M. A., Foreyt, J. P., Garcia, K., Goldman, V., Gregg, E. W., Hazuda, H. P., Hesson, L., Hill, J. O., Horton, E. S., Jakicic, J. M., Jeffery, R. W., Johnson, K. C., Kahn, S. E., Knowler, W. C., Korytkowski, M., Kure, A., Lewis, C. E., Mantzoros, C., Meacham, M., Montez, M. G., Nathan, D. M., Pajewski, N., Patricio, J., Peters, A., Xavier Pi‐Sunyer, F., Pownall, H., Ryan, D. H., Safford, M., Sedjo, R. L., Steinburg, H., Vitolins, M., Wadden, T. A., Wagenknecht, L. E., Wing, R. R., Wolff, A. C., Wyatt, H., & Yanovski, S. Z.
- Affiliations
- Johns Hopkins University (US)
- University of Minnesota (US)
- National Institute of Diabetes and Digestive and Kidney Diseases (US)
- Beth Israel Deaconess Medical Center (US)
- Pennington Biomedical Research Center (US)
- Colorado School of Public Health (US)
- University of Tennessee Health Science Center (US)
- Brown University (US)
- Wake Forest University Health Sciences (US)
- Baylor College of Medicine (US)
- Massachusetts General Hospital (US)
- Imperial College London (GB)
- The University of Texas at San Antonio Health Science Center (US)
- University of Pennsylvania (US)
- University of Alabama at Birmingham (US)
- Joslin Diabetes Center (US)
- University of Pittsburgh (US)
- University of Washington (US)
- Columbia University Irving Medical Center (US)
- University of Southern California (US)
- Columbia University Medical Center New York New York USA
- Cornell University (US)
- University of Colorado Anschutz (US)
- National Institutes of Health (US)
- Corresponding author
- Yeh, Hsin‐Chieh
- ORCID
- Yeh, Hsin‐Chieh
- Clark, Jeanne M.
- Coday, Mace
- Espeland, Mark A.
- Gregg, Edward W.
- Hazuda, Helen P.
- Hill, James O.
- Horton, Edward S.
- Jakicic, John M.
- Johnson, Karen C.
- Kahn, Steven E.
- Knowler, William C.
- Lewis, Cora E.
- Mantzoros, Christos
- Pajewski, Nicholas
- Peters, Anne
- Pownall, Henry
- Ryan, Donna H.
- Safford, Monika
- Vitolins, Mara
- Wadden, Thomas A.
- Wagenknecht, Lynne E.
- Wing, Rena R.
- Wolff, Antonio C.
- Wyatt, Holly
- Yanovski, Susan Z.
- Venue
- Obesity
- Publisher
- Wiley
- Published
- 2020-08-25
- Volume
- 28
- Issue
- 9
- Pages
- 1678-1686
- ISSN
- 1930-7381 (ISSN-L)
- 1930-739X
- PMC
- PMC8855671
- OpenAlex
- W3080103554
- Cited by
- 82
- References
- 40
- Citations by year
- 2026: 12 · 2025: 15 · 2024: 11 · 2023: 14 · 2022: 17 · 2021: 11 · 2020: 2
- FWCI
- 3.97
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Obesity (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (DK57136, DK57149, DK56990, DK57177, DK57171, DK571)
- Topics
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- intensive lifestyle intervention, weight loss, type 2 diabetes, cancer incidence, cancer mortality, obesity-related cancer, Look AHEAD trial, diabetes support and education, overweight and obesity
- MeSH terms
- Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Neoplasms, Obesity, Weight Loss
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