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Cited by 14Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Treatment and ManagementDiabetes Management and Education

Weight Change During the Postintervention Follow-up of Look AHEAD

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Wing, Rena R., Neiberg, Rebecca H., Bahnson, Judy L., Clark, Jeanne M., Espeland, Mark A., Hill, James O., Johnson, Karen C., Knowler, William C. +218 more·2022·Diabetes Care
DOI 10.2337/dc21-1990

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Abstract

OBJECTIVE: Patients with type 2 diabetes are encouraged to lose weight, but excessive weight loss in older adults may be a marker of poor health and subsequent mortality. We examined weight change during the postintervention period of Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) with diabetes support and education (DSE) (control) in overweight/obese individuals with type 2 diabetes and sought to identify predictors of excessive postintervention weight loss and its association with mortality. RESEARCH DESIGN AND METHODS: These secondary analyses compared postintervention weight change (year 8 to final visit; median 16 years) in ILI and DSE in 3,999 Look AHEAD participants. Using empirically derived trajectory categories, we compared four subgroups: weight gainers (n = 307), weight stable (n = 1,561), steady losers (n = 1,731), and steep losers (n = 380), on postintervention mortality, demographic variables, and health status at randomization and year 8. RESULTS: Postintervention weight change averaged −3.7 ± 9.5%, with greater weight loss in the DSE than the ILI group. The steep weight loss trajectory subgroup lost on average 17.7 ± 6.6%; 30% of steep losers died during postintervention follow-up versus 10–18% in other trajectories (P < 0001). The following variables distinguished steep losers from weight stable: baseline, older, longer diabetes duration, higher BMI, and greater multimorbidity; intervention, randomization to control group and less weight loss in years 1–8; and year 8, higher prevalence of frailty, multimorbidity, and depressive symptoms and lower use of weight control strategies. CONCLUSIONS: Steep weight loss postintervention was associated with increased risk of mortality. Older individuals with longer duration of diabetes and multimorbidity should be monitored for excessive unintentional weight loss.

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  1. Simpson FR, Pajewski NM, Nicklas B, et al.; Look AHEAD Research Group. J Gerontol 2020;75: 1921-1927

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Authors
Wing, R. R., Neiberg, R. H., Bahnson, J. L., Clark, J. M., Espeland, M. A., Hill, J. O., Johnson, K. C., Knowler, W. C., Olson, K., Steinburg, H., Pi-Sunyer, X., Wadden, T. A., Wyatt, H., Clark, J. M., Swartz, L., Jiggetts, D., Charleston, J., Cheskin, L., Maruthur, N. M., Pilla, S. J., Diggins, D., Johnson, M., Bray, G. A., Greenway, F. L., Ryan, D. H., Champagne, C., Myers, V., Keller, J., Stewart, T., Arceneaux, J., Boley, K., Fry, G., Jones, L., Landry, K., Lingle, M., Smith, M., Lewis, C. E., Thomas, S., Glasser, S., Dutton, G., Dobelstein, A., Hannum, S., Hubbell, A., Lee, D., Millhouse, P., Oden, L. C., Roche, C., Grant, J., Turman, J., Nathan, D. M., Goldman, V., Delahanty, L., Larkin, M., Dalton, K., Singh, R., Ruazol, M., Munshi, M. N., Jackson, S. D., Middelbeek, R. J. W., Caballero, A. E., Rodriguez, A., Blackburn, G., Mantzoros, C., McNamara, A., Wyatt, H., Hill, J. O., Breen, J. A., Miller, M., Bochert, D., Bossart, S., Cohrs, P., Green, S., Hamilton, A., Leshchinskiy, E., Rome, L., Foreyt, J. P., Gee, M., Pownall, H., Balasubramanyam, A., Chen, C.-H., Jones, P., Burrington, M., Gardner, A. C., Griggs, S., Hamilton, M., Holley, V., Lee, S., Liscum, S. L., Cantu-Lumbreras, S., Palencia, J., Schmidt, J., Thomas, J., White, C., Wright, C., Alvarez, M., Johnson, K. C., Griffin, B., Coday, M., Valenski, D., Jones, L., Johnson, K., Johnson, K. C., Steinburg, H., Jeffery, R. W., Skarphol, T., Bantle, J. P., Redmon, J. B., Brelje, K., Campbell, C., Forseth, M. A., Uccellini, S., Voeller, M. S., Laferrère, B., Pi-Sunyer, X., Patricio, J., Luchsinger, J., Palta, P., Lyon, S., Kelly, K., Wadden, T. A., Maschak-Carey, B. J., Berkowitz, R. I., Chao, A., Davenport, R., Gruber, K., Leonard, S., Walsh, O., Jakicic, J. M., Wesche-Thobaben, J., Ewing, L., Hergenroeder, A., Korytkowski, M., Copelli, S., Danchenko, R., Ives, D., Mancino, J., Martich, L., McGuire, M., Murray, T. Y., Semler, L., Williams, K., Wing, R. R., Egan, C., Jelalian, E., McCaffery, J., McDermott, K. D., Unick, J., Annis, K., DaCruz, J., Rafanelli, A., Hazuda, H. P., Isaac, J. C., Hernandez, P., Kahn, S. E., Boyko, E. J., Tsai, E., Wright, L., Atkinson, K., Morgan-Taggart, I., Socha, J., Urquhart, H., Knowler, W. C., Bolin, P., Anderson, H., Michaels, S., Johnson, R., Poorthunder, P., Smiley, J., Peters, A. L., Ghazarian, S., Beale, E., Ramirez, E., Rodriguez, G., Ruelas, V., Serafin-Dokhan, S., Walker, M., Perez, M., Espeland, M. A., Wagenknecht, L. E., Bahnson, J. L., Reboussin, D., Miller, M. E., Brubaker, P., Pajewski, N., Bancks, M., Ding, J., Deep, G., Hayden, K., Rapp, S. R., Simpson, F., Chen, H., Sachs, B. C., Houston, D., Chen, S.-H., Anderson, A., Barnes, J. M., Barr, M., Beckner, T. D., Cook, D. R., Williams, C. C., Evans, J., Garcia, K., Gaussoin, S. A., Kittel, C., Harvin, L., Howard, M., Lovato, J., Neiberg, R. H., Pierce, J., Steinberg, D., Webb, C., Walker, J., Walkup, M. P., Watkins, C., Marcovina, S. M., Hurting, J., Albers, J. J., Gaur, V., Nevitt, M., Schwartz, A., Shepherd, J., Rahorst, M., Palermo, L., Ewing, S., Hayashi, C., & Maeda, J.
Affiliations
  • Brown University (US)
  • Johns Hopkins University (US)
  • University of Tennessee Health Science Center (US)
  • University of Pennsylvania (US)
  • Wake Forest University Health Sciences (US)
  • University of Alabama at Birmingham (US)
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2022-04-14
Volume
45
Issue
6
Pages
1306-1314
ISSN
0149-5992 (ISSN-L)
DOI
10.2337/dc21-1990
OpenAlex
W4225590531
Cited by
14
References
35
Citations by year
2026: 3 · 2024: 3 · 2023: 5 · 2022: 3
FWCI
2.04
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/content/license (vor)
Locations
Diabetes Care (publishedVersion)
Funders
  • National Institute on Aging (R01AG058571)
  • National Institute of Diabetes and Digestive and Kidney Diseases (U01DK057149, U01DK057151, U01DK057135, U01DK057131, U01DK056990, U01DK057136, U01DK057178, K23DK124578, U01DK057182, U01DK057078, U01DK057154, U01DK057008, U01DK057171, U01DK057002, U01DK057219, U01DK056992, U01DK057177)
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 › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
type 2 diabetes, weight change, excessive weight loss, mortality, Look AHEAD trial, intensive lifestyle intervention, diabetes support and education, weight loss trajectories, multimorbidity, frailty, depressive symptoms, weight control strategies, older adults, obesity

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