Two Contrasting Views of Look AHEAD

Two contrasting views of results from the landmark Look AHEAD study surfaced this week to offer considerable food for thought. Look AHEAD is a long-term study of the effectiveness intensive behavioral therapy for people with excess weight and type-2 diabetes to prevent heart attacks, strokes, and other major cardiovascular events.

  1. Meager results in a highly-motivated population receiving an über-intensive lifestyle intervention is how Morgan Downey summed up his thorough analysis in the widely-read Downey Obesity Report.
  2. Long-term benefits for long-term treatment sums up a very complete presentation by John Foreyt at the Consensus Conference on Obesity convened by the American Association of Clinical Endocrinologists and the American College of Endocrinology. Foreyt is a principal investigator in the Look AHEAD study.

The Look AHEAD study was planned to follow 5,145 patients for up to 13.5 years who were randomized to receive either intensive lifestyle intervention to achieve and maintain weight loss or to receive just diabetes support and education. The study was stopped after a mean of 9.6 years of follow-up because an independent monitoring board found that continuing the controlled trial was unlikely to show any difference in cardiovascular events between the treatment and control groups.

Downey points out that the lifestyle intervention in Look AHEAD was at least twice as intensive as the intensive lifestyle intervention for obesity that Medicare covers. The Medicare program was modeled after an earlier trial that involved many of the same investigators — the Diabetes Prevention Program (DPP).

Given how intensive the Look AHEAD program was, Downey says, “These results should be the starting point for a broad re-assessment of behavioral lifestyle interventions (whether über-, or intensive or moderate intensity).” He asks, “Should über or intensive or simple lifestyle changes be recommended as the first line treatment when they offer so little?”

In the discussion that followed Foreyt’s presentation at the Consensus Conference on Obesity, George Bray summed up an enthusiastic view of the Look AHEAD results, saying:

All drugs for diabetes treatment are now required to prove they do no cardiovascular harm. Look AHEAD provided the best possible outcomes against those criteria — improvements in important cardiovascular risk factors and everything else, without any deaths.”

These two contrasting views deserve careful thought.

“To raise new questions, new possibilities, to regard old problems from a new angle, requires creative imagination and marks real advance in science.” — Albert Einstein

Click here to read the commentary by Morgan Downey, here for the publication of Look AHEAD results in the New England Journal of Medicine, and here for an editorial on those results in Obesity.

Contrast, photograph © Juan Salmoral / flickr

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2 Responses to “Two Contrasting Views of Look AHEAD”

  1. March 24, 2014 at 10:31 am, John Foreyt said:

    Thanks Ted! Great seeing you and catching up.

    • March 24, 2014 at 4:08 pm, Ted said:

      I owe you all the thanks, John. Great presentation!