One-year weight losses in the Look AHEAD study: factors associated with success
Open accessAbstract
This report provides a further analysis of the first year weight losses in the Look AHEAD (Action for Health in Diabetes) study and identifies factors associated with success. Participants were a total of 5,145 men and women with type 2 diabetes who were recruited at 16 sites and randomly assigned to an intensive lifestyle intervention (ILI) or a control condition, Diabetes Support and Education (DSE). During year 1, participants in ILI received comprehensive diet and physical activity counseling in a total of 42 group and individual sessions, compared with three educational sessions for DSE participants. As reported previously, at the end of the year, ILI participants lost 8.6% of initial weight, compared to 0.7% for DSE ( P < 0.001). Within the ILI group, all racial/ethnic groups achieved clinically significant weight losses (>5.5%), although there were significant differences among groups. For the year, ILI participants attended an average of 35.4 treatment sessions and reported exercising a mean of 136.6 min/week and consuming a total of 360.9 meal replacement products. Greater self‐reported physical activity was the strongest correlate of weight loss, followed by treatment attendance and consumption of meal replacements. The use of orlistat, during the second half of the year, increased weight loss only marginally in those ILI participants who had lost <5% of initial weight during the first 6 months and chose to take the medication thereafter as a toolbox option. The lifestyle intervention was clinically effective in all subsets of an ethnically and demographically diverse population.
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In people with type 2 diabetes and ABCD, improvements in A1C, blood pressure, and lipids require more than 5% weight loss and are progressive up to and exceeding 15% weight loss, whereas other common complications of ABCD, such as obstructive sleep apnea and NASH, may require more than 10% weight loss for clinical benefits.
“In persons with T2D and ABCD, improvements in A1C, BP, and lipids require >5% weight loss and are progressive up to and exceeding 15% weight loss,678,679 whereas other common complications of ABCD, such as OSA and NASH, may require >10% weight loss for clinical benefits.680–685”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [685]
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredPrior research has linked long-term weight control to several behaviors: increasing physical activity, monitoring body weight, reducing calorie and fat intake, and using meal replacements.
“All participants also reported at baseline and years 1–4, as well as at year 8, the number of weeks in the prior year that they engaged in behaviors previously determined to be associated with long-term weight control: 1) increasing physical activity;27–29 2) monitoring body weight;30,31 3) reducing calorie and fat intake;32,33 and 4) using meal replacements.33”
From Eight-year weight losses with an intensive lifestyle intervention: The look AHEAD study (2014) · cites this paper as [33]
The Results (Treatment Adherence and Weight Loss; page unavailable) link greater meal-replacement use to greater weight loss at one year. The Methods (Treatment Conditions; page unavailable) prescribe calorie and fat limits, but the paper does not establish that reducing both intakes was associated with long-term weight control. The physical-activity and weight-monitoring items have separate citations in the citing sentence. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAt year 1, more ILI than DSE participants lost at least 10% of initial weight (37.7% vs. 2.9%, p<0.001).
“As reported previously,33 more ILI than DSE participants lost ≥5% of initial weight (68.0% vs. 13.3%, p <0.001), as well as ≥10% (37.7% vs. 2.9%, p<0.001).”
From Eight-year weight losses with an intensive lifestyle intervention: The look AHEAD study (2014) · cites this paper as [33]
The Results section (“Weight Loss in ILI and DSE Groups”; page not available) reports that significantly more ILI than DSE participants lost at least 10% of initial weight at year 1 (p < 0.001). The ILI figure is 37.7%, as claimed, but the paper gives 3.3% for DSE, not 2.9%. (LLM, conf=0.92)
Experimental — accuracy not yet measuredAt year 1, more ILI than DSE participants lost at least 5% of initial weight (68.0% vs. 13.3%, p<0.001).
“As reported previously,33 more ILI than DSE participants lost ≥5% of initial weight (68.0% vs. 13.3%, p <0.001), as well as ≥10% (37.7% vs. 2.9%, p<0.001).”
From Eight-year weight losses with an intensive lifestyle intervention: The look AHEAD study (2014) · cites this paper as [33]
The Results section, “Weight Loss in ILI and DSE Groups” (page unavailable), reports significantly greater year-1 weight loss in ILI and gives comparisons at the ≥7% and ≥10% thresholds. It does not report the claimed ≥5% figures of 68.0% and 13.3%, so those specific percentages are unsupported by our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe ILI and DSE groups did not differ significantly on baseline characteristics.
“ILI and DSE participants did not differ significantly on baseline characteristics, as reported previously (see Table 1).2,33”
From Eight-year weight losses with an intensive lifestyle intervention: The look AHEAD study (2014) · cites this paper as [33]
Weight loss of 10% or more is required to remedy other common complications of ABCD, such as obstructive sleep apnea and nonalcoholic steatohepatitis.
“Weight loss of 10% or more is required to remedy other common complications of ABCD, such as OSA 680–682 and NASH.683–685”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [685]
The Discussion reports a mean 8.6% weight loss in participants with type 2 diabetes, but does not address treatment of obstructive sleep apnea or nonalcoholic steatohepatitis. Searches for OSA, NASH, and a 10% weight-loss threshold found no passage linking that threshold to remedying either condition; the paper’s mentions of 10% concern weight-loss categories and medication eligibility. (LLM, conf=0.76)
Experimental — accuracy not yet measuredIn those studies, weight-loss success was attributed to the best adherence to behavioral and dietary recommendations.
“weight loss success was attributed to the best adherence to behavior and dietary recommendations.193–195”
Traditional lifestyle modification typically induces a mean 5-10% reduction in baseline weight at 1 year, compared with 1-2% for controls.
“in contrast to 5–10% for lifestyle modification”
From The Role of Lifestyle Modification with Second-Generation Anti-obesity Medications: Comparisons, Questions, and Clinical Opportunities (2023) · cites this paper as [21]
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- Authors
- Wadden, T. A., West, D. S., Neiberg, R. H., Wing, R. R., Ryan, D. H., Johnson, K. C., Foreyt, J. P., Hill, J. O., Trence, D. L., Vitolins, M. Z., & Look AHEAD Research Group
- Affiliations
- University of Pennsylvania (US)
- University of Arkansas for Medical Sciences (US)
- Wake Forest University (US)
- Brown University (US)
- Pennington Biomedical Research Center (US)
- University of Tennessee Health Science Center (US)
- Baylor College of Medicine (US)
- University of Washington (US)
- Corresponding author
- Wadden, Thomas A.
- ORCID
- Venue
- Obesity
- Publisher
- Wiley
- Published
- 2009-04
- Volume
- 17
- Issue
- 4
- Pages
- 713-722
- ISSN
- 1930-7381 (ISSN-L)
- 1930-739X
- PMC
- PMC2690396
- OpenAlex
- W2145202496
- Cited by
- 525
- References
- 43
- Citations by year
- 2026: 11 · 2025: 21 · 2024: 18 · 2023: 23 · 2022: 27 · 2021: 18 · 2020: 33 · 2019: 26 · 2018: 29 · 2017: 43 · 2016: 38 · 2015: 34 · 2014: 41 · 2013: 48 · 2012: 36
- FWCI
- 27.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Obesity (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5p30dk046204-15)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK-57171, DK 57136, DK57149, DK 57002, DK57182, DK56990, (DK 046204, DK57008, DK57177, DK 57078, DK57219, U01DK057149, DK-57178, U01DK057151, U01DK057135, U01DK057131, U01DK056990, DK-57135, U01DK057136, DK-56992, DK57154, U01DK057178, U01DK057182, U01DK057078, U01DK057154, P30DK079637, U01DK057008, U01DK057171, DK57131, U01DK057002, U01DK057219, U01DK056992, U01DK057177, P30DK048520, DK 57151, P30-DK046204, P30-DK 48520)
- National Center for Research Resources (M01-RR-0021140, M01RR-00051, M01RR002719, M01RR000056, M01RR01346, M01RR000051, M01RR001066, M01RR001346, M0-1-RR-02719, M01-RR01066)
- 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 › Pharmacology › Pharmacology and Obesity Treatment
- Keywords
- type 2 diabetes, weight loss, intensive lifestyle intervention, Look AHEAD trial, physical activity, meal replacement products, orlistat, treatment attendance, racial and ethnic differences, diabetes support and education, nutrition counseling
- MeSH terms
- Diabetes Mellitus, Type 2, Diet, Reducing, Female, Follow-Up Studies, Humans, Life Style, Longitudinal Studies, Male, Middle Aged, Motor Activity, Patient Compliance, Patient Education as Topic, Weight Loss, Outcome Assessment, Health Care
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