Document Detail


The long-term effectiveness of a lifestyle intervention in severely obese individuals.
MedLine Citation:
PMID:  23410564     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Severe obesity (body mass index [BMI] ≥40 kg/m(2)) is a serious public health concern. Although bariatric surgery is an efficacious treatment approach, it is limited in reach; thus, nonsurgical treatment alternatives are needed. We examined the 4-year effects of an intensive lifestyle intervention on body weight and cardiovascular disease risk factors among severely obese, compared with overweight (25 ≤BMI <30), class I (30 ≤BMI <35), and class II obese (35 ≤BMI <40) participants.
METHODS: There were 5145 individuals with type 2 diabetes (45-76 years, BMI ≥25 kg/m(2)) randomized to an intensive lifestyle intervention or diabetes support and education. The lifestyle intervention group received a behavioral weight loss program that included group and individual meetings, a ≥10% weight loss goal, calorie restriction, and increased physical activity. Diabetes support and education received a less intense educational intervention. Four-year changes in body weight and cardiovascular disease risk factors were assessed.
RESULTS: Across BMI categories, 4-year changes in body weight were significantly greater in lifestyle participants compared with diabetes support and education (Ps <.05). At year 4, severely obese lifestyle participants lost 4.9%±8.5%, which was similar to class I (4.8%±7.2%) and class II obese participants (4.4%±7.6%), and significantly greater than overweight participants (3.4%±7.0%; P <.05). Four-year changes in low-density-lipoprotein cholesterol, triglycerides, diastolic blood pressure, HbA(1c), and blood glucose were similar across BMI categories in lifestyle participants; however, the severely obese had less favorable improvements in high-density-lipoprotein cholesterol (3.1±0.4 mg/dL) and systolic blood pressure (-1.4±0.7 mm Hg) compared with the less obese (Ps <.05).
CONCLUSION: Lifestyle interventions can result in important long-term weight losses and improvements in cardiovascular disease risk factors among a significant proportion of severely obese individuals.
Authors:
Jessica L Unick; Daniel Beavers; Dale S Bond; Jeanne M Clark; John M Jakicic; Abbas E Kitabchi; William C Knowler; Thomas A Wadden; Lynne E Wagenknecht; Rena R Wing;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, N.I.H., Intramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The American journal of medicine     Volume:  126     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-15     Completed Date:  2013-04-11     Revised Date:  2014-06-02    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  236-42, 242.e1-2     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00017953
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Glucose / analysis
Blood Pressure
Body Mass Index
Cholesterol, LDL / blood
Combined Modality Therapy
Diabetes Mellitus, Type 2 / complications
Diet, Reducing
Exercise Therapy
Female
Humans
Male
Middle Aged
Obesity / complications,  diet therapy,  therapy*
Risk Reduction Behavior*
Treatment Outcome
Triglycerides / blood
Weight Loss
Grant Support
ID/Acronym/Agency:
DK 046204/DK/NIDDK NIH HHS; DK56990/DK/NIDDK NIH HHS; DK56992/DK/NIDDK NIH HHS; DK57002/DK/NIDDK NIH HHS; DK57008/DK/NIDDK NIH HHS; DK57078/DK/NIDDK NIH HHS; DK57131/DK/NIDDK NIH HHS; DK57135/DK/NIDDK NIH HHS; DK57136/DK/NIDDK NIH HHS; DK57149/DK/NIDDK NIH HHS; DK57151/DK/NIDDK NIH HHS; DK57154/DK/NIDDK NIH HHS; DK57171/DK/NIDDK NIH HHS; DK57177/DK/NIDDK NIH HHS; DK57178/DK/NIDDK NIH HHS; DK57182/DK/NIDDK NIH HHS; DK57219/DK/NIDDK NIH HHS; M01RR000056/RR/NCRR NIH HHS; M01RR00051/RR/NCRR NIH HHS; M01RR0021140/RR/NCRR NIH HHS; M01RR01066/RR/NCRR NIH HHS; M01RR01346/RR/NCRR NIH HHS; M01RR02719/RR/NCRR NIH HHS; P30 DK48520/DK/NIDDK NIH HHS; U01 DK056992/DK/NIDDK NIH HHS; U01 DK057131/DK/NIDDK NIH HHS; U01 DK057135/DK/NIDDK NIH HHS; U01 DK057136/DK/NIDDK NIH HHS; UL1 RR 024153/RR/NCRR NIH HHS; UL1 TR000005/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
0/Blood Glucose; 0/Cholesterol, LDL; 0/Triglycerides
Investigator
Investigator/Affiliation:
Frederick L Brancati / ; Lee Swartz / ; Lawrence Cheskin / ; Jeanne M Clark / ; Kerry Stewart / ; Richard Rubin / ; Jean Arceci / ; Suzanne Ball / ; Jeanne Charleston / ; Danielle Diggins / ; Mia Johnson / ; Joyce Lambert / ; Kathy Michalski / ; Dawn Jiggetts / ; Chanchai Sapun / ; George A Bray / ; Kristi Rau / ; Allison Strate / ; Frank L Greenway / ; Donna H Ryan / ; Donald Williamson / ; Brandi Armand / ; Jennifer Arceneaux / ; Amy Bachand / ; Michelle Begnaud / ; Betsy Berhard / ; Elizabeth Caderette / ; Barbara Cerniauskas / ; David Creel / ; Diane Crow / ; Crystal Duncan / ; Helen Guay / ; Carolyn Johnson / ; Lisa Jones / ; Nancy Kora / ; Kelly LaFleur / ; Kim Landry / ; Missy Lingle / ; Jennifer Perault / ; Cindy Puckett / ; Mandy Shipp / ; Marisa Smith / ; Elizabeth Tucker / ; Cora E Lewis / ; Sheikilya Thomas / ; Monika Safford / ; Vicki DiLillo / ; Charlotte Bragg / ; Amy Dobelstein / ; Stacey Gilbert / ; Stephen Glasser / ; Sara Hannum / ; Anne Hubbell / ; Jennifer Jones / ; DeLavallade Lee / ; Ruth Luketic / ; L Christie Oden / ; Janet Raines / ; Cathy Roche / ; Janet Truman / ; Nita Webb / ; Casey Azuero / ; Jane King / ; Andre Morgan / ; David M Nathan / ; Enrico Cagliero / ; Kathryn Hayward / ; Heather Turgeon / ; Linda Delahanty / ; Ellen Anderson / ; Laurie Bissett / ; Valerie Goldman / ; Virginia Harlan / ; Theresa Michel / ; Mary Larkin / ; Christine Stevens / ; Kylee Miller / ; Jimmy Chen / ; Karen Blumenthal / ; Gail Winning / ; Rita Tsay / ; Helen Cyr / ; Maria Pinto / ; Edward S Horton / ; Sharon D Jackson / ; Osama Hamdy / ; A Enrique Caballero / ; Sarah Bain / ; Elizabeth Bovaird / ; Barbara Fargnoli / ; Jeanne Spellman / ; Ann Goebel-Fabbri / ; Lori Lambert / ; Sarah Ledbury / ; Maureen Malloy / ; Kerry Ovalle / ; George Blackburn / ; Christos Mantzoros / ; Ann McNamara / ; Kristina Spellman / ; James O Hill / ; Marsha Miller / ; Brent Van Dorsten / ; Judith Regensteiner / ; Ligia Coelho / ; Paulette Cohrs / ; Susan Green / ; April Hamilton / ; Jere Hamilton / ; Eugene Leshchinskiy / ; Lindsey Munkwitz / ; Loretta Rome / ; Terra Worley / ; Kirstie Craul / ; Sheila Smith / ; John P Foreyt / ; Rebecca S Reeves / ; Henry Pownall / ; Ashok Balasubramanyam / ; Peter Jones / ; Michele Burrington / ; Chu-Huang Chen / ; Allyson Clark Gardner / ; Molly Gee / ; Sharon Griggs / ; Michelle Hamilton / ; Veronica Holley / ; Jayne Joseph / ; Julieta Palencia / ; Jennifer Schmidt / ; Carolyn White / ; Karen C Johnson / ; Carolyn Gresham / ; Stephanie Connelly / ; Amy Brewer / ; Mace Coday / ; Lisa Jones / ; Lynne Lichtermann / ; Shirley Vosburg / ; J Lee Taylor / ; Abbas E Kitabchi / ; Ebenezer Nyenwe / ; Helen Lambeth / ; Amy Brewer / ; Debra Clark / ; Andrea Crisler / ; Debra Force / ; Donna Green / ; Robert Kores / ; Robert W Jeffery / ; Carolyn Thorson / ; John P Bantle / ; J Bruce Redmon / ; Richard S Crow / ; Scott Crow / ; Susan K Raatz / ; Kerrin Brelje / ; Carolyne Campbell / ; Jeanne Carls / ; Tara Carmean-Mihm / ; Julia Devonish / ; Emily Finch / ; Anna Fox / ; Elizabeth Hoelscher / ; La Donna James / ; Vicki A Maddy / ; Therese Ockenden / ; Birgitta I Rice / ; Tricia Skarphol / ; Ann D Tucker / ; Mary Susan Voeller / ; Cara Walcheck / ; Xavier Pi-Sunyer / ; Jennifer Patricio / ; Stanley Heshka / ; Carmen Pal / ; Lynn Allen / ; Lolline Chong / ; Marci Gluck / ; Diane Hirsch / ; Mary Anne Holowaty / ; Michelle Horowitz / ; Nancy Rau / ; Dori Brill Steinberg / ; Thomas A Wadden / ; Barbara J Maschak-Carey / ; Robert I Berkowitz / ; Seth Braunstein / ; Gary Foster / ; Henry Glick / ; Shiriki Kumanyika / ; Stanley S Schwartz / ; Michael Allen / ; Yuliis Bell / ; Johanna Brock / ; Susan Brozena / ; Ray Carvajal / ; Helen Chomentowski / ; Canice Crerand / ; Renee Davenport / ; Andrea Diamond / ; Anthony Fabricatore / ; Lee Goldberg / ; Louise Hesson / ; Thomas Hudak / ; Nayyar Iqbal / ; LaShanda Jones-Corneille / ; Andrew Kao / ; Robert Kuehnel / ; Patricia Lipschutz / ; Monica Mullen / ; John M Jakicic / ; David E Kelley / ; Jacqueline Wesche-Thobaben / ; Lewis H Kuller / ; Andrea Kriska / ; Amy D Otto / ; Lin Ewing / ; Mary Korytkowski / ; Daniel Edmundowicz / ; Monica E Yamamoto / ; Rebecca Danchenko / ; Barbara Elnyczky / ; David O Garcia / ; George A Grove / ; Patricia H Harper / ; Susan Harrier / ; Nicole L Helbling / ; Diane Ives / ; Juliet Mancino / ; Anne Mathews / ; Tracey Y Murray / ; Joan R Ritchea / ; Susan Urda / ; Donna L Wolf / ; Rena R Wing / ; Renee Bright / ; Vincent Pera / ; John Jakicic / ; Deborah Tate / ; Amy Gorin / ; Kara Gallagher / ; Amy Bach / ; Barbara Bancroft / ; Anna Bertorelli / ; Richard Carey / ; Tatum Charron / ; Heather Chenot / ; Kimberley Chula-Maguire / ; Pamela Coward / ; Lisa Cronkite / ; Julie Currin / ; Maureen Daly / ; Caitlin Egan / ; Erica Ferguson / ; Linda Foss / ; Jennifer Gauvin / ; Don Kieffer / ; Lauren Lessard / ; Deborah Maier / ; J P Massaro / ; Tammy Monk / ; Rob Nicholson / ; Erin Patterson / ; Suzanne Phelan / ; Hollie Raynor / ; Douglas Raynor / ; Natalie Robinson / ; Deborah Robles / ; Jane Tavares / ; Steven M Haffner / ; Helen P Hazuda / ; Maria G Montez / ; Carlos Lorenzo / ; Charles F Coleman / ; Domingo Granado / ; Kathy Hathaway / ; Juan Carlos Isaac / ; Nora Ramirez / ; Ronda Saenz / ; Steven Kahn / ; Brenda Montgomery / ; Robert Knopp / ; Edward Lipkin / ; Dace Trence / ; Terry Barrett / ; Joli Bartell / ; Diane Greenberg / ; Anne Murillo / ; Betty Ann Richmond / ; Jolanta Socha / ; April Thomas / ; Alan Wesley / ; William C Knowler / ; Paula Bolin / ; Tina Killean / ; Cathy Manus / ; Jonathan Krakoff / ; Jeffrey M Curtis / ; Justin Glass / ; Sara Michaels / ; Peter H Bennett / ; Tina Morgan / ; Shandiin Begay / ; Paul Bloomquist / ; Teddy Costa / ; Bernadita Fallis / ; Jeanette Hermes / ; Diane F Hollowbreast / ; Ruby Johnson / ; Maria Meacham / ; Julie Nelson / ; Carol Percy / ; Patricia Poorthunder / ; Sandra Sangster / ; Nancy Scurlock / ; Leigh A Shovestull / ; Janelia Smiley / ; Katie Toledo / ; Christina Tomchee / ; Darryl Tonemah / ; Anne Peters / ; Valerie Ruelas / ; Siran Ghazarian Sengardi / ; Kathryn Mandy Graves Hillstrom / ; Kati Konersman / ; Sara Serafin-Dokhan / ; Mark A Espeland / ; Judy L Bahnson / ; Lynne E Wagenknecht / ; David Reboussin / ; W Jack Rejeski / ; Alain G Bertoni / ; Wei Lang / ; Michael S Lawlor / ; David Lefkowitz / ; Gary D Miller / ; Patrick S Reynolds / ; Paul M Ribisl / ; Mara Vitolins / ; Haiying Chen / ; Delia S West / ; Lawrence M Friedman / ; Brenda L Craven / ; Kathy M Dotson / ; Amelia Hodges / ; Carrie C Williams / ; Andrea Anderson / ; Jerry M Barnes / ; Mary Barr / ; Daniel P Beavers / ; Tara Beckner / ; Cralen Davis / ; Thania Del Valle-Fagan / ; Patricia A Feeney / ; Candace Goode / ; Jason Griffin / ; Lea Harvin / ; Patricia Hogan / ; Sarah A Gaussoin / ; Mark King / ; Kathy Lane / ; Rebecca H Neiberg / ; Michael P Walkup / ; Karen Wall / ; Terri Windham / ; Michael Nevitt / ; Ann Schwartz / ; John Shepherd / ; Michaela Rahorst / ; Lisa Palermo / ; Susan Ewing / ; Cynthia Hayashi / ; Jason Maeda / ; Santica M Marcovina / ; Jessica Chmielewski / ; Vinod Gaur / ; Elsayed Z Soliman / ; Ronald J Prineas / ; Charles Campbell / ; Zhu-Ming Zhang / ; Teresa Alexander / ; Lisa Keasler / ; Susan Hensley / ; Yabing Li / ; Robert Moran / ; Richard Foushee / ; Nancy J Hall / ; Mary Evans / ; Barbara Harrison / ; Van S Hubbard / ; Susan Z Yanovski / ; Robert Kuczmarski / ; Lawton S Cooper / ; Peter Kaufman / ; Edward W Gregg / ; David F Williamson / ; Ping Zhang /
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