Evaluation of Early Weight Loss Thresholds for Identifying Nonresponders to an Intensive Lifestyle Intervention

Overview

Journal Obesity (Silver Spring)

Specialties Endocrinology
Nutritional Sciences
Physiology

Date 2014 Apr 29

PMID 24771618

Citations 80

Authors

Jessica L Unick

Patricia E Hogan

Rebecca H Neiberg

Lawrence J Cheskin

Gareth R Dutton

Gina Evans-Hudnall

Robert Jeffery

Abbas E Kitabchi

Julie A Nelson

F Xavier Pi-Sunyer

Delia Smith West

Rena R Wing

Affiliations

Soon will be listed here.

Abstract

Objective: Weight losses in lifestyle interventions are variable, yet prediction of long-term success is difficult. The utility of using various weight loss thresholds in the first 2 months of treatment for predicting 1-year outcomes was examined.

Methods: Participants included 2327 adults with type 2 diabetes (BMI:35.8 ± 6.0) randomized to the intensive lifestyle intervention (ILI) of the Look AHEAD trial. ILI included weekly behavioral sessions designed to increase physical activity and reduce caloric intake. 1-month, 2-month, and 1-year weight changes were calculated.

Results: Participants failing to achieve a ≥2% weight loss at Month 1 were 5.6 (95% CI:4.5, 7.0) times more likely to also not achieve a ≥10% weight loss at Year 1, compared to those losing ≥2% initially. These odds were increased to 11.6 (95% CI:8.6, 15.6) when using a 3% weight loss threshold at Month 2. Only 15.2% and 8.2% of individuals failing to achieve the ≥2% and ≥3% thresholds at Months 1 and 2, respectively, go on to achieve a ≥10% weight loss at Year 1.

Conclusions: Given the association between initial and 1-year weight loss, the first few months of treatment may be an opportune time to identify those who are unsuccessful and utilize rescue efforts.

Trial Registration: clinicaltrials.gov Identifier: NCT00017953.

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References

Wing R, Hamman R, Bray G, Delahanty L, Edelstein S, Hill J . Achieving weight and activity goals among diabetes prevention program lifestyle participants. Obes Res. 2004; 12(9):1426-34. PMC: 2505058. DOI: 10.1038/oby.2004.179. View

Nackers L, Ross K, Perri M . The association between rate of initial weight loss and long-term success in obesity treatment: does slow and steady win the race?. Int J Behav Med. 2010; 17(3):161-7. PMC: 3780395. DOI: 10.1007/s12529-010-9092-y. View

Carels R, Wott C, Young K, Gumble A, Darby L, Oehlhof M . Successful weight loss with self-help: a stepped-care approach. J Behav Med. 2009; 32(6):503-9. PMC: 3533369. DOI: 10.1007/s10865-009-9221-8. View

Blackburn G . Effect of degree of weight loss on health benefits. Obes Res. 1995; 3 Suppl 2:211s-216s. DOI: 10.1002/j.1550-8528.1995.tb00466.x. View

Elfhag K, Rossner S . Initial weight loss is the best predictor for success in obesity treatment and sociodemographic liabilities increase risk for drop-out. Patient Educ Couns. 2010; 79(3):361-6. DOI: 10.1016/j.pec.2010.02.006. View

Barte J, ter Bogt N, Bogers R, Teixeira P, Blissmer B, Mori T . Maintenance of weight loss after lifestyle interventions for overweight and obesity, a systematic review. Obes Rev. 2010; 11(12):899-906. DOI: 10.1111/j.1467-789X.2010.00740.x. View

Jakicic J, Marcus B, Lang W, Janney C . Effect of exercise on 24-month weight loss maintenance in overweight women. Arch Intern Med. 2008; 168(14):1550-9. PMC: 2829743. DOI: 10.1001/archinte.168.14.1550. View

Brownell K . Public health approaches to obesity and its management. Annu Rev Public Health. 1986; 7:521-33. DOI: 10.1146/annurev.pu.07.050186.002513. View

Wadden T, West D, Neiberg R, Wing R, Ryan D, Johnson K . One-year weight losses in the Look AHEAD study: factors associated with success. Obesity (Silver Spring). 2009; 17(4):713-22. PMC: 2690396. DOI: 10.1038/oby.2008.637. View

10.

Carels R, Cacciapaglia H, Douglass O, Rydin S, OBrien W . The early identification of poor treatment outcome in a women's weight loss program. Eat Behav. 2004; 4(3):265-82. DOI: 10.1016/S1471-0153(03)00029-1. View

11.

. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. Obes Res. 1998; 6 Suppl 2:51S-209S. View

12.

Jakicic J, Tate D, Lang W, Davis K, Polzien K, Rickman A . Effect of a stepped-care intervention approach on weight loss in adults: a randomized clinical trial. JAMA. 2012; 307(24):2617-26. PMC: 4132634. DOI: 10.1001/jama.2012.6866. View

13.

Elfhag K, Rossner S . Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev. 2005; 6(1):67-85. DOI: 10.1111/j.1467-789X.2005.00170.x. View

14.

Pi-Sunyer X, Blackburn G, Brancati F, Bray G, Bright R, Clark J . Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care. 2007; 30(6):1374-83. PMC: 2665929. DOI: 10.2337/dc07-0048. View

15.

Carels R, Darby L, Cacciapaglia H, Douglass O, Harper J, Kaplar M . Applying a stepped-care approach to the treatment of obesity. J Psychosom Res. 2005; 59(6):375-83. DOI: 10.1016/j.jpsychores.2005.06.060. View

16.

Wing R, Lang W, Wadden T, Safford M, Knowler W, Bertoni A . Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011; 34(7):1481-6. PMC: 3120182. DOI: 10.2337/dc10-2415. View

17.

Carels R, Young K, Coit C, Darby L, Clayton A, Spencer A . The failure of therapist assistance and stepped-care to improve weight loss outcomes. Obesity (Silver Spring). 2008; 16(6):1460-2. DOI: 10.1038/oby.2008.49. View

18.

Wadden T, Neiberg R, Wing R, Clark J, Delahanty L, Hill J . Four-year weight losses in the Look AHEAD study: factors associated with long-term success. Obesity (Silver Spring). 2011; 19(10):1987-98. PMC: 3183129. DOI: 10.1038/oby.2011.230. View

19.

Flegal K, Carroll M, Kit B, Ogden C . Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012; 307(5):491-7. DOI: 10.1001/jama.2012.39. View