Lifestyle Intervention Works, Even for Severe Obesity

New long-term data from people with severe obesity (BMI ≥40) and diabetes in the Look AHEAD study shows that lifestyle interventions can make a big difference. Compared to patients with lower BMI (25-29), those with severe obesity lost a significantly higher percent of their weight, 4.9%, after four years in the study. Patients with severe obesity improved their lipid profiles, blood pressure, and diabetes control.

These findings are worth noting because they provide a reminder that lifestyle interventions are worthwhile, even in patients with severe obesity. Certainly bariatric surgery can produce larger reductions in weight than seen in these patients, but for many patients, bariatric surgery is unacceptable. And lifestyle interventions are certainly necessary with bariatric surgery, as well.

The Look AHEAD trial was designed to look at death and major cardiovascular disease events, like stroke and heart attacks, in patients with modest weight loss. Patients were followed for up to 11 years, and last fall, the safety board concluded there was no impact on death or cardiovascular events. Investigators are continuing to follow patients from the study to identify longer-term effects of the intervention.

Commenting on the outcomes of Look AHEAD, the chair of the study, Rena Wing, said that the safety board “concluded that the study had reached its answer. There were no differences between the two groups in the number of participants with cardiovascular morbidity and mortality. The odds that a difference would be detected were very slight at this point.”

But, she said, “Both study arms had a much lower risk for developing heart disease than we expected. In both groups, these patients with type 2 diabetes were getting good medical management. Possibly this helped to reduce the risk.”

Click here to access the Look AHEAD publication in the new issue of the American Journal of Medicine.

Red Apple image © Abhijit Tembhekar / Wikimedia

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