Four-year weight losses in the Look AHEAD study: factors associated with long-term success
Open accessAbstract
This report provides a further analysis of the year 4 weight losses in the Look AHEAD (Action for Health in Diabetes) study and identifies factors associated with long‐term success. A total of 5,145 overweight/obese men and women with type 2 diabetes were randomly assigned to an intensive lifestyle intervention (ILI) or a usual care group, referred to as Diabetes Support and Education (DSE). ILI participants were provided approximately weekly group or individual treatment in year 1; continued but less frequent contact was provided in years 2–4. DSE participants received three group educational sessions in all years. As reported previously, at year 4, ILI participants lost an average of 4.7% of initial weight, compared with 1.1% for DSE (P < 0.0001). More ILI than DSE participants lost ≥5% (46% vs. 25%, P < 0.0001) and ≥10% (23% vs. 10%, P < 0.0001) of initial weight. Within the ILI, achievement of both the 5% and 10% categorical weight losses at year 4 was strongly related to meeting these goals at year 1. A total of 887 participants in ILI lost ≥10% at year 1, of whom 374 (42.2%) achieved this loss at year 4. Participants who maintained the loss, compared with those who did not, attended more treatment sessions and reported more favorable physical activity and food intake at year 4. These results provide critical evidence that a comprehensive lifestyle intervention can induce clinically significant weight loss (i.e., ≥5%) in overweight/obese participants with type 2 diabetes and maintain this loss in more than 45% of patients at 4 years.
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The data support the position that weight loss therapy is effective at all phases of type 2 diabetes, both in individuals with recent-onset disease and in people with longer durations of diabetes treated with multiple diabetes medications.
“The data also support the position that weight loss therapy is effective at all phases of type 2 diabetes, both in individuals with recent-onset disease (1,149) and in people with longer durations of diabetes treated with multiple diabetes medications (136,149).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [136]
The Abstract reports clinically significant weight loss with lifestyle intervention in overweight or obese people with type 2 diabetes, and the Results report weight loss among participants taking insulin. But the paper does not establish effectiveness at all phases of diabetes or specifically compare recent-onset disease with longer-duration disease treated with multiple diabetes medications. (LLM, conf=0.85)
Experimental — accuracy not yet measuredLifestyle intervention is the first-line treatment for people living with obesity.
“Currently, lifestyle intervention is the first-line treatment for people living with obesity.”
From A systematic review and meta-analysis of the efficacy and safety of pharmacological treatments for obesity in adults (2025) · cites this paper as [5]
The Methods (Treatment Conditions; page unavailable) describe lifestyle intervention as the initial treatment in the Look AHEAD trial, with orlistat offered to participants who did not meet weight-loss goals or regained weight. The paper does not establish that lifestyle intervention is the first-line treatment for all people living with obesity; its participants were overweight or obese adults with type 2 diabetes. (LLM, conf=0.80)
Experimental — accuracy not yet measuredThe mid-term and long-term effects and adherence data of lifestyle intervention are limited.
“However, its mid-term and long-term effects as well as adherence data are limited4,5.”
From A systematic review and meta-analysis of the efficacy and safety of pharmacological treatments for obesity in adults (2025) · cites this paper as [5]
The Discussion (page unavailable) says follow-up beyond four years was needed to determine whether the observed improvements would reduce cardiovascular morbidity and mortality, supporting a narrow limitation on long-term effects. But it reports four-year weight-loss effects, and Methods > Measures (page unavailable) describes adherence measurements across the four years. The paper does not establish the broader claim that mid-term effects or adherence data are limited. (LLM, conf=0.73)
Experimental — accuracy not yet measuredRegular physical activity and behavioral strategies are important components of lifestyle therapy for weight management.
“Regular physical activity, which can contribute to both weight loss and prevention of weight regain, and behavioral strategies are also important components of lifestyle therapy for weight management (26,74,83,135 -137).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [136]
DSMES is a fundamental component of diabetes care but does not consistently produce sufficient weight loss to achieve optimal therapeutic benefits in people with diabetes.
“while DSMES is a fundamental component of diabetes care (1), it does not consistently produce suf fi cient weight loss to achieve optimal therapeutic bene fi ts in people with diabetes (136,146,147).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [136]
Lifestyle interventions produce average weight loss of 2-9% of starting weight at one year and raise the probability of losing at least 5%.
“Lifestyle interventions lead to a mean weight loss of 2-9% of initial weight at 1y and increase the likelihood of weight loss ≥5%”
From Approach to Obesity Treatment in Primary Care: A Review (2024) · cites this paper as [32]
Intensive lifestyle intervention increases the likelihood of losing at least 5% of starting weight.
“ILI increases the likelihood of losing ≥5% of starting weight.4,32”
From Approach to Obesity Treatment in Primary Care: A Review (2024) · cites this paper as [32]
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References 56 · Cited by 465
- Authors
- Wadden, T. A., Neiberg, R. H., Wing, R. R., Clark, J. M., Delahanty, L. M., Hill, J. O., Krakoff, J., Otto, A., Ryan, D. H., Vitolins, M. Z., & ; The Look AHEAD Research Group
- Affiliations
- University of Pennsylvania (US)
- Wake Forest University (US)
- Brown University (US)
- Johns Hopkins University (US)
- Harvard University (US)
- National Institute of Diabetes and Digestive and Kidney Diseases (US)
- University of Pittsburgh (US)
- Pennington Biomedical Research Center (US)
- Corresponding author
- Wadden, Thomas A.
- ORCID
- Venue
- Obesity
- Publisher
- Wiley
- Published
- 2011-10
- Volume
- 19
- Issue
- 10
- Pages
- 1987-1998
- ISSN
- 1930-7381 (ISSN-L)
- 1930-739X
- PMC
- PMC3183129
- OpenAlex
- W2001588817
- Cited by
- 465
- References
- 56
- Citations by year
- 2026: 18 · 2025: 26 · 2024: 20 · 2023: 23 · 2022: 28 · 2021: 27 · 2020: 41 · 2019: 19 · 2018: 29 · 2017: 40 · 2016: 40 · 2015: 41 · 2014: 43 · 2013: 41 · 2012: 28
- FWCI
- 29.65
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Obesity (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Health and Human Services
- U.S. Department of Veterans Affairs (M01RR01346, M01RR01066)
- Massachusetts General Hospital (DK57151, UL1-RR024153, DK57219, DK57182, M01RR01066, DK57008, DK57178, DK57154, M01RR00051, DK57136, P30 DK48520, DK57171, DK57177, DK57149, DK57002, M01RR000056, DK56992, DK 046204, M01RR02719, M01RR01346, DK56990, DK57131, M01RR0021140, DK57078, DK57135)
- Massachusetts Institute of Technology (DK 046204, P30 DK48520, DK57182, DK57154, DK57002, DK57149, DK57178, M01RR01346, DK57135, DK57171, DK57151, DK57078, M01RR02719, UL1 RR 024153, DK57008, M01RR01066, M01RR000056, DK56990, DK57177, DK56992, M01RR0021140, DK57219, DK57136, DK57131, M01RR00051)
- University of Minnesota
- Joslin Diabetes Center
- Johns Hopkins University (M01RR02719)
- University of Pittsburgh (DK57131, DK57008, DK57154, M01RR01346, M01RR01066, DK57078, DK56990, DK57178, DK57002, DK57177, DK56992, P30 DK48520, DK 046204, M01RR02719, UL1RR024153, DK57151, M01RR0021140, DK57149, M01RR000056, M01RR00051, DK57136, DK57171, DK57219, DK57182, DK57135)
- Deutsches Krebsforschungszentrum (M01RR000056)
- National Institutes of Health (M01RR0021140, 046204, 5p30dk046204-15)
- Centers for Disease Control and Prevention (M01RR02719, M01RR000056, DK57135, DK57154, UL1RR024153, DK57131, M01RR00051, DK 046204, DK57008, M01RR01346, DK56992, M01RR0021140, DK57177, DK57151, P30 DK48520, M01RR01066, DK57182, DK57171, DK56990, DK57136, DK57149, DK57078, DK57219, DK57002, DK57178)
- Health Science Center, University of Tennessee
- National Heart, Lung, and Blood Institute (DK57219, M01RR02719, DK57131, DK57154, DK57151, DK56992, DK57078, DK57177, M01RR01346, M01RR0021140, DK 046204, DK57182, DK57002, DK57149, M01RR01066, DK57008, DK57135, P30 DK48520, DK57136, DK57178, DK56990, DK57171, M01RR00051)
- National Institute of Nursing Research (M01RR01346, DK57219, DK57008, M01RR0021140, DK57002, DK57177, M01RR01066, DK57171, DK57182, DK57135, DK57131, DK 046204, DK57151, P30 DK48520, M01RR00051, DK57136, DK56990, DK57178, DK57078, DK56992, DK57149, M01RR02719)
- National Institute of Diabetes and Digestive and Kidney Diseases (M01RR0021140, DK48520, DK-57171, DK 57136, DK57149, DK 57002, DK57182, DK56990, (DK 046204, M01RR01066, DK57008, DK57177, DK 57078, DK57219, U01DK057149, DK-57178, U01DK057151, U01DK057135, U01DK057131, U01DK056990, DK-57135, M01RR-00051, U01DK057136, DK-56992, DK57154, U01DK057178, U01DK057182, U01DK057078, M01RR02719, U01DK057154, U01DK057008, M01RR01346, U01DK057171, DK57131, U01DK057002, U01DK057219, U01DK056992, U01DK057177, P30DK017047, P30DK048520, DK 57151, P30-DK046204, P30-DK 48520)
- National Center on Minority Health and Health Disparities (DK57136, M01RR01066, M01RR00051, DK57171, M01RR02719, DK57182, DK57154, DK57177, DK 046204, DK57135, M01RR0021140, DK57008, DK57178, DK57002, DK57151, P30 DK48520, DK56990, DK57078, DK56992, DK57149, M01RR01346, DK57219, DK57131)
- National Center for Research Resources (M01-RR-0021140, M01RR-00051, M01RR002719, M01RR000056, M01RR01346, M01RR000051, M01RR001066, M01RR001346, UL1RR024153, M0-1-RR-02719, M01-RR01066)
- Office of Research on Women's Health (M01RR02719, DK57008, DK57135, DK56990, DK57002, P30 DK48520, DK57177, DK56992, DK57182, DK57151, DK57149, DK57219, DK57078, M01RR000056, M01RR01346, DK57171, UL1 RR 024153, DK57178, M01RR01066, M01RR00051, DK57154, DK57136, DK57131, DK 046204, M01RR0021140)
- National Institute on Minority Health and Health Disparities
- 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 › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- weight loss, type 2 diabetes, intensive lifestyle intervention, weight loss maintenance, physical activity, dietary intake, treatment attendance, diabetes support and education
- MeSH terms
- Energy Intake, Diabetes Mellitus, Type 2, Diet, Female, Group Processes, Health Education, Humans, Life Style, Male, Middle Aged, Obesity, Weight Loss, Exercise, Treatment Outcome, Weight Reduction Programs
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