title: Long-term impact of behavioral weight loss intervention on cognitive function.
abstract: BACKGROUND
  It is unknown whether intentional weight loss provides long-term benefits for cognitive function.
  
  
  METHODS
  An ancillary study to a randomized controlled clinical trial was conducted in overweight and obese individuals (N = 978), aged 45-76 years at enrollment, with type 2 diabetes. An intensive behavioral intervention designed to promote and maintain weight loss through caloric restriction and increased physical activity was compared with diabetes support and education. Standardized assessments of cognitive function were collected an average of 8.1 years after trial enrollment.
  
  
  RESULTS
  Participants assigned to intensive lifestyle intervention lost a mean (SE) 11.1% (0.4%) and 7.2% (0.5%) of weight at Years 1 and 8, respectively, compared with 1.0% (0.2%) and 3.3% (0.5%) in the control group (p < .001). Covariate-adjusted mean composite cognitive function test scores were similar for the two groups (p = .69), and no significant differences were found for any individual cognitive test. There was some evidence of a differential effect (nominal interaction p = .008) for a prespecified comparison: Intensive lifestyle intervention was associated with a relative mean benefit for composite cognitive function of 0.276 (95% confidence interval: 0.033, 0.520) SDs among individuals with body mass index less than 30 kg/m(2) at baseline compared with a relative mean deficit of 0.086 (-0.021, 0.194) SDs among individuals with body mass more than or equal to 30 kg/m(2).
  
  
  CONCLUSIONS
  Eight years of intensive lifestyle intervention did not alter cognitive function in obese adults with type 2 diabetes; however, there was evidence for benefit among overweight but not obese individuals. Changes in cognition were not assessed in this cross-sectional study.
authors.affiliation: Department of Biostatistical Sciences and mespelan@wakehealth.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Espeland
authors.affiliation: Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Rapp
authors.affiliation: Pennington Biomedical Research Center, Louisiana State University, Baton Rouge.
authors.forename: George A
authors.initials: GA
authors.lastname: Bray
authors.affiliation: Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Denise K
authors.initials: DK
authors.lastname: Houston
authors.affiliation: Department of Preventive Medicine and.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Johnson
authors.affiliation: Department of Medicine, University of Tennessee Health Science Center, Memphis.
authors.forename: Abbas E
authors.initials: AE
authors.lastname: Kitabchi
authors.affiliation: Department of Physical Therapy, University of Pittsburgh, Pennsylvania.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Hergenroeder
authors.affiliation: Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Kulynych Center for Memory and Cognition Research, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Jeff
authors.initials: J
authors.lastname: Williamson
authors.affiliation: Department of Health and Physical Activity, University of Pittsburgh, Pennsylvania.
authors.forename: John M
authors.initials: JM
authors.lastname: Jakicic
authors.affiliation: Colorado Center for Behavioral Medicine, Denver.
authors.forename: Brent
authors.initials: B
authors.lastname: van Dorsten
authors.affiliation: Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Kritchevsky
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003071:Cognition / Q000502:physiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000628:therapy*; D050177:Overweight / Q000628:therapy*; D061217:Weight Reduction Programs
keywords: Clinical trials.; Cognition; Diabetes; Obesity