The long-term effectiveness of a lifestyle intervention in severely obese individuals

Jessica L. Unick, Daniel Beavers, Dale S. Bond, Jeanne M. Clark, John M. Jakicic, Abbas E. Kitabchi, William C. Knowler, Thomas A. Wadden, Lynne E. Wagenknecht, Rena R. Wing

Research output: Contribution to journalArticlepeer-review

76 Scopus citations


Objective: Severe obesity (body mass index [BMI] ≥40 kg/m2) 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/m2) 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, HbA1c, 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). Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)236-242.e2
JournalAmerican Journal of Medicine
Issue number3
StatePublished - Mar 2013


  • Cardiovascular disease risk
  • Diabetes
  • Lifestyle intervention
  • Severe obesity
  • Weight loss

ASJC Scopus subject areas

  • Medicine(all)


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