Intensive weight loss intervention in older individuals: results from the Action for Health in Diabetes Type 2 diabetes mellitus trial
Open accessAbstract
Objectives: To compare the effects of 4 years of intensive lifestyle intervention on weight, fitness, and cardiovascular disease risk factors in older and younger individuals. Design: Randomized controlled clinical trial. Setting: Sixteen U . S . clinical sites. Participants: Individuals with type 2 diabetes mellitus: 1,053 aged 65 to 76 and 4,092 aged 45 to 64. Interventions: An intensive behavioral intervention designed to promote and maintain weight loss through caloric restriction and increased physical activity was compared with diabetes mellitus support and education. Measurements: Standardized assessments of weight, fitness (based on graded exercise testing), and cardiovascular disease risk factors. Results: Over 4 years, older individuals had greater intervention‐related mean weight losses (6.2%) than younger participants (5.1%; interaction P = .006) and comparable relative mean increases in fitness (0.56 vs 0.53 metabolic equivalents; interaction P = .72). These benefits were seen consistently across subgroups of older adults formed according to many demographic and health factors. Of a panel of age‐related health conditions, only self‐reported worsening vision was associated with poorer intervention‐related weight loss in older individuals. The intensive lifestyle intervention produced mean increases in high‐density lipoprotein cholesterol (2.03 mg/dL; P < .001) and decreases in glycated hemoglobin (0.21%; P < .001) and waist circumference (3.52 cm; P < .001) over 4 years that were at least as large in older as in younger individuals. Conclusion: Intensive lifestyle intervention targeting weight loss and increased physical activity is effective in overweight and obese older individuals to produce sustained weight loss and improvements in fitness and cardiovascular risk factors.
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In age-stratified analyses of Look AHEAD, older adults in the trial (60 to early 70s) had similar benefits compared with younger people.
“In age-stratified analyses, older adults in the trial (60 to early 70s) had similar benefits compared with younger people (83,84).”
From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [84]
The Introduction identifies the older Look AHEAD group as ages 65–76, compared with ages 45–64. The Discussion reports comparable or slightly larger benefits in weight and fitness for older participants, supporting the main comparison, but the claim’s parenthetical age range (‘60 to early 70s’) does not accurately describe the group studied. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIn age-stratified analyses of Look AHEAD, older adults in the trial (60 to early 70s) had similar benefits compared with younger people.
“In age-stratified analyses, older adults in the trial (60 to early 70s) had similar benefits compared with younger people (90,91).”
From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [91]
The Discussion reports that older Look AHEAD participants had weight-loss and fitness benefits comparable to or slightly larger than those of younger participants. But the Introduction defines the older cohort as ages 65–76 and the younger cohort as 45–64, so the claim’s description of the older group as ‘60 to early 70s’ is imprecise. Page numbers were not provided in the passages. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAge-stratified analyses showed that older adults in the Look AHEAD trial (aged 60-70 years) experienced benefits similar to those seen for younger participants.
“Age-stratified analyses showed that older adults in the trial (aged 60–70 years) experienced benefits similar to those seen for younger participants”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [102]
The Introduction and Discussion (page numbers not provided) describe age-stratified analyses and benefits for older participants that were comparable to or greater than those for younger participants. The stated age range is inaccurate: the paper defines the older group as ages 65–76, not 60–70. (LLM, conf=0.90)
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- Authors
- Espeland, M. A., Rejeski, W. J., West, D. S., Bray, G. A., Clark, J. M., Peters, A. L., Chen, H., Johnson, K. C., Horton, E. S., Hazuda, H. P., & for the Action for Health in Diabetes Research Group
- Affiliations
- Wake Forest University (US)
- University of Arkansas for Medical Sciences (US)
- Pennington Biomedical Research Center (US)
- Johns Hopkins University (US)
- University of Southern California (US)
- University of Tennessee Health Science Center (US)
- Joslin Diabetes Center (US)
- The University of Texas at San Antonio Health Science Center (US)
- Corresponding author
- Espeland, Mark A.
- ORCID
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2013-05-13
- Volume
- 61
- Issue
- 6
- Pages
- 912-922
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC4123658
- OpenAlex
- W2096732985
- Cited by
- 66
- References
- 35
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 4 · 2023: 4 · 2022: 4 · 2021: 4 · 2020: 4 · 2019: 5 · 2018: 9 · 2017: 4 · 2016: 3 · 2015: 9 · 2014: 10 · 2013: 3
- FWCI
- 6.57
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Health and Human Services
- New York City Department of Health and Mental Hygiene
- National Institutes of Health (UL1TR000170, 5p30dk046204-15)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK-57171, DK 57136, DK57149, DK 57002, DK57182, DK56990, (DK 046204, DK57177, DK 57078, DK57219, U01DK057149, DK-57178, U01DK057151, U01DK057135, U01DK057131, U01DK056990, DK-57135, U01DK057136, DK-56992, DK57154, U01DK057178, U01DK057182, U01DK057078, U01DK057154, U01DK057008, U01DK057171, DK57131, U01DK057002, U01DK057219, U01DK056992, U01DK057177, P30DK017047, P30DK048520, DK 57151, P30-DK046204, P30-DK 48520)
- National Center for Research Resources (M01-RR-0021140, M01RR-00051, M01RR002719, M01RR000056, M01RR01346, M01RR000051, M01RR001066, M01RR001346, UL1RR024153, M0-1-RR-02719, M01-RR01066)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- type 2 diabetes, intensive lifestyle intervention, weight loss, older adults, caloric restriction, physical activity, cardiovascular risk factors, fitness, HDL cholesterol, HbA1c, waist circumference, diabetes support and education, age differences
- MeSH terms
- Aged, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Exercise Test, Health Status, Humans, Life Style, Middle Aged, Obesity, Patient Education as Topic, Physical Fitness, Risk Factors, United States, Incidence, Treatment Outcome, Caloric Restriction, Weight Reduction Programs
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