title: The long-term effectiveness of a lifestyle intervention in severely obese individuals.
abstract: 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).
  
  
  CONCLUSIONS
  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: Weight Control and Diabetes Research Center, The Miriam Hospital and Warren Alpert Medical School at Brown University, Providence, RI 02903, USA. junick@lifespan.org
authors: Jessica L
authors: JL
authors: Unick
authors: Daniel
authors: D
authors: Beavers
authors: Dale S
authors: DS
authors: Bond
authors: Jeanne M
authors: JM
authors: Clark
authors: John M
authors: JM
authors: Jakicic
authors: Abbas E
authors: AE
authors: Kitabchi
authors: William C
authors: WC
authors: Knowler
authors: Thomas A
authors: TA
authors: Wadden
authors: Lynne E
authors: LE
authors: Wagenknecht
authors: Rena R
authors: RR
authors: Wing
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D015992:Body Mass Index; D008078:Cholesterol, LDL / Q000097:blood; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D004038:Diet, Reducing; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000178:diet therapy / Q000628:therapy*; D040242:Risk Reduction Behavior; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D008078:Cholesterol, LDL; D014280:Triglycerides