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Original Research

Benefits of Modest Weight Loss in Improving Cardiovascular Risk Factors in Overweight and Obese Individuals With Type 2 Diabetes

  1. Rena R. Wing, PHD1⇓,
  2. Wei Lang, PHD2,
  3. Thomas A. Wadden, PHD3,
  4. Monika Safford, MD4,
  5. William C. Knowler, MD, DRPH5,
  6. Alain G. Bertoni, MD6,
  7. James O. Hill, PHD7,
  8. Frederick L. Brancati, MD8,
  9. Anne Peters, MD9,
  10. Lynne Wagenknecht, DRPH6 and
  11. the Look AHEAD Research Group*
  1. 1Department of Psychiatry & Human Behavior, Brown Medical School, The Miriam Hospital, Providence, Rhode Island
  2. 2Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
  3. 3Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
  4. 4Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
  5. 5Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
  6. 6Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
  7. 7Centers for Human Nutrition, University of Colorado Health Sciences Center, Denver, Colorado
  8. 8Department of Medicine, Johns Hopkins University, Baltimore, Maryland
  9. 9Roybal Comprehensive Health Center, Los Angeles, California
  1. Corresponding author: Rena R. Wing, rwing{at}lifespan.org.
Diabetes Care 2011 Jul; 34(7): 1481-1486. https://doi.org/10.2337/dc10-2415
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    Figure 1

    Change in risk factors by weight loss categories for the Look AHEAD cohort. Data in all figures are presented as least square means and 95% CIs adjusted for clinical sites, age, sex, race/ethnicity, baseline weight, baseline measurement of the outcome variable, and treatment group assignment.

Tables

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  • Table 1

    Baseline characteristics by weight change category

    Total sampleGained >2%Stable Gained ≤2 or lost <2%Lost ≥2 to <5%Lost ≥5 to <10%Lost ≥10 to <15%Lost ≥15%P
    n5,1456831,2899141,000601412
    ILI group50.1 (2,570)12.6 (86)21.2 (273)47.4 (433)74.9 (749)90.9 (546)94.2 (388)<0.0001*
    Male40.5 (2,082)35.9 (245)43.0 (554)39.2 (358)38.7 (387)41.4 (249)47.6 (196)0.0311*
    Ethnicity0.1106*
     African American15.6 (804)15.7 (107)17.1 (220)17.8 (163)17.2 (172)11.8 (71)7.0 (29)
     American Indian5.0 (258)6.3 (43)6.6 (85)6.0 (55)5.1 (51)3.0 (18)0.2 (1)
     Hispanic13.2 (680)13.9 (95)11.4 (147)14.9 (136)12.2 (122)15.2 (91)9.2 (38)
     White63.2 (3,253)60.3 (412)61.8 (797)58.1 (531)62.7 (627)67.7 (406)81.6 (336)
     Asian/Pacific Islander/other/mixed2.9 (149)3.8 (26)3.1 (40)3.2 (29)2.8 (28)2.3 (14)1.9 (8)
    Age58.7 ± 6.857.9 ± 6.958.6 ± 6.958.9 ± 6.758.7 ± 6.859.6 ± 7.058.8 ± 6.70.0009†
    Height (cm)167.2 ± 9.7166.1 ± 9.7167.9 ± 9.9167.0 ± 9.8167.0 ± 9.5167.1 ± 9.8168.7 ± 9.70.0001†
    Baseline BMI (kg/m2)36.0 ± 5.936.3 ± 5.835.8 ± 5.935.8 ± 6.035.8 ± 6.135.7 ± 5.936.7 ± 5.60.0028†
    Baseline weight (kg)100.7 ± 19.3100.1 ± 18.1101.0 ± 19.0100.1 ± 19.5100.2 ± 20.399.8 ± 18.7104.7 ± 19.1<0.0001†
    • Data are % (n) or means ± SD.

    • ↵*P value for the Mantel-Haenszel χ2 test for trend.

    • ↵†P value for the Kruskal-Wallis test.

  • Table 2

    Changes in CVD risk factors and association with percentage weight change for the Look AHEAD cohort

    BaselineChange from baseline to year 1Spearman correlation of association with percentage weight loss
    nMean ± SDnMean ± SDTotal cohortILI subjectsDSE subjects
    Weight (kg)5,145100.71 ± 19.264,899−4.77 ± 7.57*
    SBP (mmHg)5,082128.84 ± 17.174,837−4.76 ± 17.05*0.20*0.19*0.14*
    DBP (mmHg)5,08270.15 ± 9.574,837−2.40 ± 8.62*0.12*0.13*0.08*
    Glucose4,999153.19 ± 45.664,603−14.32 ± 46.08*0.27*0.21*0.14*
    HbA1c (%)4,9997.28 ± 1.174,606−0.39 ± 1.02*0.34*0.24*0.16*
    HDL cholesterol (mg/dL)4,99943.48 ± 11.834,6032.39 ± 6.97*−0.23*−0.26*−0.08*
    LDL cholesterol (mg/dL)4,998112.31 ± 32.244,602−5.47 ± 28.63*−0.0040.0008−0.02
    Trigylcerides (mg/dL)†4,999153 (108–219)4,603−12.0 (−52 to 21)*0.26*0.31*0.16*
    • ↵*P < 0.0001.

    • ↵†For change in triglycerides, data are median (interquartile range). The signed-rank test was used to test whether the change from baseline to year 1 was different from 0.

  • Table 3

    Odds ratio (95% CI) for the percentage of Look AHEAD cohort achieving clinically meaningful changes in CVD risk factors

    Clinical criteriaGained >2%Stable Gained ≤2 or lost <2%Lost ≥2 to <5%Lost ≥5 to <10%Lost ≥10 to <15%Lost ≥15%
    5 mmHg decrease in SBP0.86 (0.70–1.06)1.01.24 (1.02–1.50)1.56 (1.27–1.91)2.29 (1.79–2.93)2.65 (2.00–3.50)
    5 mmHg decrease in DBP1.03 (0.83–1.28)1.01.05 (0.86–1.28)1.48 (1.20–1.82)1.60 (1.25–2.06)2.39 (1.81–3.16)
    20 mg/dL decrease in glucose1.13 (0.87–1.46)1.01.75 (1.40–2.19)3.24 (2.57–4.09)4.07 (3.09–5.36)7.92 (5.78–10.85)
    0.05% decrease in HbA1c1.17 (0.91–1.50)1.01.80 (1.44–2.24)3.52 (2.81–4.40)5.44 (4.15–7.13)10.02 (7.31–13.73)
    5 mg/dL increase in HDL0.88 (0.71–1.11)1.01.13 (0.93–1.39)1.69 (1.37–2.07)2.30 (1.80–2.93)4.34 (3.30–5.72)
    5 mg/dL increase in HDL (not on medications)0.79 (0.54–1.15)1.00.99 (0.71–1.39)1.52 (1.08–2.15)2.54 (1.68–3.82)5.27 (3.36–8.27)
    10 mg/dL decrease in LDL1.17 (0.95–1.45)1.01.05 (0.86–1.29)1.34 (1.09–1.64)1.26 (0.98–1.62)1.34 (1.02–1.78)
    10 mg/dL decrease in LDL (not on medications)1.39 (0.97–1.99)1.00.97 (0.69–1.36)1.41 (1.00–2.00)1.28 (0.83–1.96)1.52 (0.96–2.41)
    40 mg/dL decrease in triglycerides0.80 (0.60–1.06)1.01.46 (1.14–1.87)2.20 (1.71–2.83)3.99 (2.97–5.35)7.18 (5.19–9.93)
    • Significant odds ratios are shown in boldface.

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Benefits of Modest Weight Loss in Improving Cardiovascular Risk Factors in Overweight and Obese Individuals With Type 2 Diabetes
Rena R. Wing, Wei Lang, Thomas A. Wadden, Monika Safford, William C. Knowler, Alain G. Bertoni, James O. Hill, Frederick L. Brancati, Anne Peters, Lynne Wagenknecht, the Look AHEAD Research Group
Diabetes Care Jul 2011, 34 (7) 1481-1486; DOI: 10.2337/dc10-2415

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Benefits of Modest Weight Loss in Improving Cardiovascular Risk Factors in Overweight and Obese Individuals With Type 2 Diabetes
Rena R. Wing, Wei Lang, Thomas A. Wadden, Monika Safford, William C. Knowler, Alain G. Bertoni, James O. Hill, Frederick L. Brancati, Anne Peters, Lynne Wagenknecht, the Look AHEAD Research Group
Diabetes Care Jul 2011, 34 (7) 1481-1486; DOI: 10.2337/dc10-2415
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