Whether older individuals with diabetes and obesity should be encouraged to lose weight remains controversial. Observational studies have suggested that weight loss in older adults may be associated with increased risk of mortality, but this conclusion may be due to unintentional weight loss. A randomized trial in which some individuals are assigned to a weight loss program is the best way to address the question of whether intentional efforts to lose weight are appropriate for older individuals who have diabetes and obesity. 

This was the rationale that led—in 1999—to NIH’s decision to launch Look AHEAD (Action for Health in Diabetes), a randomized trial comparing intensive lifestyle intervention (ILI) against a control group in 5,145 adults, age 45–76, who had type 2 diabetes and were overweight/obese. Look AHEAD was continued as a randomized trial for 10 years and was then converted to an observational study with an additional 10 years of follow-up. Dr. Rena Wing will review the design of the trial and its primary outcome on cardiovascular morbidity and mortality and discuss several possible explanations for these results, including issues related to eligibility criteria, provision of medical care, and the magnitude of the weight losses achieved. The presentation will also include new data on the long-term effects of randomization to the ILI on cognition, frailty, diabetes complications, health care utilization, and all-cause mortality, as these findings might relate to decisions regarding the risk:benefit ratio of weight loss in this population. 

Presentation Objectives:

1. Describe the state-of-the art intervention used in Look AHEAD and the initial and long-term weight losses achieved.
2. Be aware of the documented health effects of weight loss in this population and the subgroups most likely to benefit. 
3. Recognize that the ILI had no significant effects on several critical health problems and how these findings might relate to both initial design decisions and to recommendations for weight loss in older individuals with type 2 diabetes.

Dr. Rena Wing is well known for her research on behavioral treatment of obesity and particularly its application to type 2 diabetes. She has published over 200 peer-reviewed articles on these topics. Currently, she is the principal investigator on the Diabetes Prevention Program and has developed the lifestyle intervention being used in all 27 centers in that study. In addition, she is the principal investigator at The Miriam Hospital site for a 15-center trial entitled, Study of Health Outcomes of Weight Loss, and serves as chair of this multi-site study. Dr. Wing is a member of the council for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and serves on the NIDDK Task Force on the Prevention and Treatment of Obesity.