When Does Obesity Care Bring a Longer Life?

This is a big unresolved question for clinical researchers in obesity. When does obesity care bring a longer life? On one hand, it’s pretty clear that people live longer if they have bariatric surgery. But on the other hand, there’s the null result from the Look AHEAD study. It was a big, expensive study of intensive lifestyle changes to lose weight. After a little less than 10 years of follow-up, the trial stopped because it was plain that it would never show that this approach would prevent death or major cardiovascular events. Hopes were high, but researchers found no benefit for mortality.

One difference between these two approaches to obesity care is the degree of weight loss. Could it be that weight loss in the Look AHEAD study simply was not enough for an effect on mortality? A new analysis of data from Look AHEAD in Diabetes Care points to this possibility.

16.7 Years of Follow-Up

These new findings come from analysis of 16.7 years of follow-up data from the Look AHEAD study. Once again, even with eight additional years of data, the primary analysis did not find a mortality benefit for intensive lifestyle intervention. All that diet and exercise did not confer a longer life.

Hints of an Effect in People Who Lose More Weight

However, when researchers looked at a subset of patients who lost more than ten percent of their starting weight in the first year of the study, they got a different result. These persons enjoyed a 21 percent reduction in their risk of death.

Now remember, this is an exploratory analysis. This was not pre-specified in the plan for the study. It was not the main point of this study by any means. It simply gives us a clue for future research.

Getting Beyond Modest Efficacy in Obesity Care

We’re entering into an era where expectations of more than ten percent weight loss in obesity care might be more reasonable. This is true because of semaglutide and other new therapies in research. Tirzepatide comes to mind.

So we will be watching very closely for results from the SELECT study of cardiovascular outcomes with semaglutide. From this study, we may get results later this year or next to tell us that better obesity care effectiveness brings a longer life.

This is a story that is still unfolding. Stay tuned.

Click here for the analysis from Look AHEAD in Diabetes Care and here for further perspective.

Colorful Life, painting by Wassily Kandinsky / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.

May 9, 2022