title: Intensive weight loss intervention in older individuals: results from the Action for Health in Diabetes Type 2 diabetes mellitus trial.
abstract: OBJECTIVE
  To compare the effects of 4 years of intensive lifestyle intervention on weight, fitness, and cardiovascular disease risk factors in older and younger individuals.
  
  
  METHODS
  Randomized controlled clinical trial.
  
  
  METHODS
  Sixteen U.S. clinical sites.
  
  
  METHODS
  Individuals with type 2 diabetes mellitus: 1,053 aged 65 to 76 and 4,092 aged 45 to 64.
  
  
  METHODS
  An intensive behavioral intervention designed to promote and maintain weight loss through caloric restriction and increased physical activity was compared with diabetes mellitus support and education.
  
  
  METHODS
  Standardized assessments of weight, fitness (based on graded exercise testing), and cardiovascular disease risk factors.
  
  
  RESULTS
  Over 4 years, older individuals had greater intervention-related mean weight losses (6.2%) than younger participants (5.1%; interaction P = .006) and comparable relative mean increases in fitness (0.56 vs 0.53 metabolic equivalents; interaction P = .72). These benefits were seen consistently across subgroups of older adults formed according to many demographic and health factors. Of a panel of age-related health conditions, only self-reported worsening vision was associated with poorer intervention-related weight loss in older individuals. The intensive lifestyle intervention produced mean increases in high-density lipoprotein cholesterol (2.03 mg/dL; P < .001) and decreases in glycated hemoglobin (0.21%; P < .001) and waist circumference (3.52 cm; P < .001) over 4 years that were at least as large in older as in younger individuals.
  
  
  CONCLUSIONS
  Intensive lifestyle intervention targeting weight loss and increased physical activity is effective in overweight and obese older individuals to produce sustained weight loss and improvements in fitness and cardiovascular risk factors.
authors.affiliation: Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Espeland
authors.affiliation: Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina.
authors.forename: W Jack
authors.initials: WJ
authors.lastname: Rejeski
authors.affiliation: College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Delia S
authors.initials: DS
authors.lastname: West
authors.affiliation: Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana.
authors.forename: George A
authors.initials: GA
authors.lastname: Bray
authors.affiliation: Departments of Medicine and Epidemiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Clark
authors.affiliation: Keck School of Medicine of University of Southern California, Los Angeles, California.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Peters
authors.affiliation: Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
authors.forename: Haiying
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Preventive Medicine, Health Science Center, University of Tennessee, Memphis, Tennessee.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Johnson
authors.affiliation: Joslin Diabetes Center, Boston, Massachusetts.
authors.forename: Edward S
authors.initials: ES
authors.lastname: Horton
authors.affiliation: Department of Medicine, University of Texas Health Science Center, San Antonio, Texas.
authors.forename: Helen P
authors.initials: HP
authors.lastname: Hazuda
mesh_terms: D000368:Aged; D031204:Caloric Restriction / Q000379:methods*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000534:rehabilitation*; D005080:Exercise Test; D006304:Health Status; D006801:Humans; D015994:Incidence; D008019:Life Style; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000534:rehabilitation*; D010353:Patient Education as Topic; D010809:Physical Fitness; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D061217:Weight Reduction Programs / Q000379:methods*