Four‐Year Weight Losses in the Look AHEAD Study: Factors Associated With Long‐Term Success
TL;DR: Results provide critical evidence that a comprehensive lifestyle intervention can induce clinically significant weight loss (i.e., ≥5%) in overweight/obese participants with type 2 diabetes and maintain this loss in more than 45% of patients at 4 years.
Abstract: This report provides a further analysis of the year 4 weight losses in the Look AHEAD (Action for Health in Diabetes) study and identifies factors associated with long-term success. A total of 5,145 overweight/obese men and women with type 2 diabetes were randomly assigned to an intensive lifestyle intervention (ILI) or a usual care group, referred to as Diabetes Support and Education (DSE). ILI participants were provided approximately weekly group or individual treatment in year 1; continued but less frequent contact was provided in years 2-4. DSE participants received three group educational sessions in all years. As reported previously, at year 4, ILI participants lost an average of 4.7% of initial weight, compared with 1.1% for DSE (P < 0.0001). More ILI than DSE participants lost ≥ 5% (46% vs. 25%, P < 0.0001) and ≥ 10% (23% vs. 10%, P < 0.0001) of initial weight. Within the ILI, achievement of both the 5% and 10% categorical weight losses at year 4 was strongly related to meeting these goals at year 1. A total of 887 participants in ILI lost ≥ 10% at year 1, of whom 374 (42.2%) achieved this loss at year 4. Participants who maintained the loss, compared with those who did not, attended more treatment sessions and reported more favorable physical activity and food intake at year 4. These results provide critical evidence that a comprehensive lifestyle intervention can induce clinically significant weight loss (i.e., ≥ 5%) in overweight/obese participants with type 2 diabetes and maintain this loss in more than 45% of patients at 4 years.
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TL;DR: This research presents a state-of-the-art online learning system that automates the very labor-intensive and therefore time-heavy and expensive and expensive process of manually cataloging and cataloging students' academic records.
Abstract: Harmon S. Jordan, ScD, Karima A. Kendall, PhD, Linda J. Lux, Roycelynn Mentor-Marcel, PhD, MPH, Laura C. Morgan, MA, Michael G. Trisolini, PhD, MBA, Janusz Wnek, PhD
Jeffrey L. Anderson, MD, FACC, FAHA, Chair , Jonathan L. Halperin, MD, FACC, FAHA, Chair-Elect , Nancy M. Albert, PhD, CCNS, CCRN,
3,259 citations
Cites background from "Four‐Year Weight Losses in the Look..."
...or more following the start of behavioral intervention (201,203,204) (204)....
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...percent of initial body weight at year 4 (204)....
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...criteria and were eligible for inclusion in the CQ4 evidence base (20,198-206)....
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...trials (72 articles) were rated good or fair quality (20,46,184-187,199-206,274-331) and included...
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TL;DR: This data indicates that overweight and obesity in adults over the age of 40 is more likely to be a risk factor for adverse events than the other factors, including smoking, diet, and physical activity.
Abstract: Loria, Barbara E. Millen, Cathy A. Nonas, F. Xavier Pi-Sunyer, June Stevens, Victor J. Stevens, Karen A. Donato, Frank B. Hu, Van S. Hubbard, John M. Jakicic, Robert F. Kushner, Catherine M. Michael D. Jensen, Donna H. Ryan, Caroline M. Apovian, Jamy D. Ard, Anthony G. Comuzzie, Practice Guidelines and The Obesity Society Report of the American College of Cardiology/American Heart Association Task Force on 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Print ISSN: 0009-7322. Online ISSN: 1524-4539 Copyright © 2013 American Heart Association, Inc. All rights reserved. is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Circulation published online November 12, 2013; Circulation. http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437739.71477.ee.citation World Wide Web at: The online version of this article, along with updated information and services, is located on the http://circ.ahajournals.org/content/suppl/2013/11/07/01.cir.0000437739.71477.ee.DC1.html Data Supplement (unedited) at:
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TL;DR: Eleven evidence-based recommendations for the non-pharmacological core management of hip and knee OA were developed, concerning the following nine topics: assessment, general approach, patient information and education, lifestyle changes, exercise, weight loss, assistive technology and adaptations, footwear and work.
Abstract: The objective was to develop evidence -based recommendations and a research and educational agenda for the non-pharmacological management of hip and knee osteoarthritis (OA). The multidisciplinary task force comprised 21 experts: nurses, occupational therapists, physiotherapists, rheumatologists, orthopaedic surgeons, general practitioner, psychologist, dietician, clinical epidemiologist and patient representatives. After a preliminary literature review, a first task force meeting and five Delphi rounds, provisional recommendations were formulated in order to perform a systematic review. A literature search of Medline and eight other databases was performed up to February 2012. Evidence was graded in categories I-IV and agreement with the recommendations was determined through scores from 0 (total disagreement) to 10 (total agreement). Eleven evidence-based recommendations for the non-pharmacological core management of hip and knee OA were developed, concerning the following nine topics: assessment, general approach, patient information and education, lifestyle changes, exercise, weight loss, assistive technology and adaptations, footwear and work. The average level of agreement ranged between 8.0 and 9.1. The proposed research agenda included an overall need for more research into non-pharmacological interventions for hip OA, moderators to optimise individualised treatment, healthy lifestyle with economic evaluation and long-term follow-up, and the prevention and reduction of work disability. Proposed educational activities included the required skills to teach, initiate and establish lifestyle changes. The 11 recommendations provide guidance on the delivery of non-pharmacological interventions to people with hip or knee OA. More research and educational activities are needed, particularly in the area of lifestyle changes.
1,029 citations
TL;DR: The final recommendations recognize that obesity is a complex, adiposity-based chronic disease, where management targets both weight-related complications and adiposity to improve overall health and quality of life.
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TL;DR: In this paper, the authors compared a lifestyle intervention with metformin to prevent or delay the development of Type 2 diabetes in nondiabetic individuals. And they found that the lifestyle intervention was significantly more effective than the medication.
Abstract: Background Type 2 diabetes affects approximately 8 percent of adults in the United States. Some risk factors — elevated plasma glucose concentrations in the fasting state and after an oral glucose load, overweight, and a sedentary lifestyle — are potentially reversible. We hypothesized that modifying these factors with a lifestyle-intervention program or the administration of metformin would prevent or delay the development of diabetes. Methods We randomly assigned 3234 nondiabetic persons with elevated fasting and post-load plasma glucose concentrations to placebo, metformin (850 mg twice daily), or a lifestyle modification program with the goals of at least a 7 percent weight loss and at least 150 minutes of physical activity per week. The mean age of the participants was 51 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 34.0; 68 percent were women, and 45 percent were members of minority groups. Results The average follow-up was 2.8 years. The incidence of diabetes was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin, and lifestyle groups, respectively. The lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was significantly more effective than metformin. To prevent one case of diabetes during a period of three years, 6.9 persons would have to participate in the lifestyle-intervention program, and 13.9 would have to receive metformin. Conclusions Lifestyle changes and treatment with metformin both reduced the incidence of diabetes in persons at high risk. The lifestyle intervention was more effective than metformin.
17,333 citations
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01 Jan 2005TL;DR: Haug, Sorensen, Gruber, Song, Relapse Prevention for Opioid Dependence, and Wheeler, George, Stoner, Enhancing the Relapse prevention model for Sex Offenders: Adding Recidivism Risk Reduction Therapy to Target Offenders' Dynamic Risk Needs.
Abstract: Marlatt, Witkiewitz, Relapse Prevention for Alcohol and Drug Problems. Blume, de la Cruz, Relapse Prevention among Diverse Populations. Kadden, Cooney, Treating Alcohol Problems. Shiffman, Kassel, Gwaltney, McChargue, Relapse Prevention for Smoking. Carroll, Rawson, Relapse Prevention for Stimulant Dependence. Haug, Sorensen, Gruber, Song, Relapse Prevention for Opioid Dependence. Roffman, Stephens, Relapse Prevention for Cannabis Abuse and Dependence. Kilmer, Cronce, Palmer, Relapse Prevention for Abuse of Club Drugs, Hallucinogens, Inhalants, and Steroids. Collins, Relapse Prevention for Eating Disorders and Obesity. Shaffer, LaPlante, Treatment of Gambling Disorders. Wheeler, George, Stoner, Enhancing the Relapse Prevention Model for Sex Offenders: Adding Recidivism Risk Reduction Therapy to Target Offenders' Dynamic Risk Needs. Zawacki, Stoner, George, Relapse Prevention for Sexually Risky Behaviors.
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TL;DR: Ex-varsity athletes retained lower risk only if they maintained a high physical activity index as alumni, and peak exertion as strenuous sports play enhanced the effect of total energy expenditure.
Abstract: Risk of first heart attack was found to be related inversely to energy expenditure reported by 16,936 Harvard male alumni, aged 35-74 years, of whom 572 experienced heart attacks in 117,680 person-years of followup. Stairs climbed, blocks walked, strenuous sports played, and a composite physical activity index all opposed risk. Men with index below 2000 kilocalories per week were at 64% higher risk than classmates with higher index. Adult exercise was independent of other influences on heart attack risk, and peak exertion as strenuous sports play enhanced the effect of total energy expenditure. Notably, alumni physical activity supplanted student athleticism assessed in college 16-50 years earlier. If it is postulated that varsity athlete status implies selective cardiovascular fitness, such selection alone is insufficient to explain lower heart attack risk in later adult years. Ex-varsity athletes retained lower risk only if they maintained a high physical activity index as alumni.
1,994 citations
"Four‐Year Weight Losses in the Look..." refers methods in this paper
...Second, physical activity was measured in a subset of ~1,189 participants at baseline and during the assessment visits at years 1 and 4 using the Paffenbarger Activity Questionnaire (36), which provides an estimate of weekly calorie expenditure from moderately vigorous physical activity....
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...On the Paffenbarger Activity Questionnaire, mean (±s.d) calorie expenditure per week (kcal/week) from physical activity at baseline, year 1, and year 4 was 861.5 ± 1107.0 (N = 1189), 1737.8 ± 1604.6 (N = 1136), and 1245.4 ± 1485.6 kcal/day (N = 1181), respectively....
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Wake Forest University1, Mount Sinai St. Luke's and Mount Sinai Roosevelt2, Harvard University3, Johns Hopkins University4, Pennington Biomedical Research Center5, Miriam Hospital6, American Indian Center7, Baylor College of Medicine8, University of Southern California9, University of Texas Health Science Center at San Antonio10, University of Colorado Denver11, University of Tennessee Health Science Center12, University of Pittsburgh13, University of Alabama at Birmingham14, University of Pennsylvania15
TL;DR: At 1 year, ILI resulted in clinically significant weight loss in people with type 2 diabetes and was associated with improved diabetes control and CVD risk factors and reduced medicine use in ILI versus DSE.
Abstract: Objective: The effectiveness of intentional weight loss in reducing cardiovascular disease (CVD) events in type 2 diabetes is unknown. This report describes one-year changes in CVD risk factors in a trial designed to examine the long-term effects of an intensive lifestyle intervention on the incidence of major CVD events. Research Design and Methods: A multi-centered randomized controlled trial of 5,145 individuals with type 2 diabetes, aged 45-74 years, with body mass index >25 kg/m2 (>27 kg/m2 if taking insulin). An Intensive Lifestyle Intervention (ILI) involving group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity was compared to a Diabetes Support and Education (DSE) condition. Results: Participants assigned to ILI lost an average 8.6% of their initial weight versus 0.7% in DSE group (p Conclusions: At 1 year, ILI resulted in clinically significant weight loss in persons with type 2 diabetes. This was associated with improved diabetes control and CVD risk factors and reduced medicine use in ILI versus DSE. Continued intervention and follow-up will determine whether these changes are maintained and will reduce CVD risk. Trial Registration: clinicaltrials.gov Identifier: NCT00017953
1,487 citations