The Look AHEAD research Group by Tuguy Esgin

Describe the study population

tuguyesgin1 — 2020-10-08 04:39:02 UTC

overweight individuals with Type II Diabetes

Activity 1

tuguyesgin1 — 2020-10-08 04:40:40 UTC

Briefly describe the two interventions

tuguyesgin1 — 2020-10-08 04:41:08 UTC

i) Diabetes support & education group who receive medical care by their primary care physicians, 3 group educational sessions a year
ii) Lifestyle intervention group who receive medical care, intensive 4 year program designed to reduce wt and increase PA

What are the two goals of the ILI and why?

tuguyesgin1 — 2020-10-08 04:42:02 UTC

i) induce a mean loss of >7% of initial weight

ii) increase participant's moderately intense physical activity to <175min/week

What are the three components of the ILI?

tuguyesgin1 — 2020-10-08 04:51:42 UTC

i) Phase 1: weekly on site treatment (year 1)
ii) Phase 1: one on site visit per month, one telephone contact. Goal to maintain improvements made
iii) Phase 1: Monthly on site visits from years 5-10

Activity 2

tuguyesgin1 — 2020-10-08 04:52:16 UTC

Describe the treatment frequency and format during Phase I (months 1-6): • # of treatment sessions: 24 • Group sessions : 18 • Individual sessions: 6

tuguyesgin1 — 2020-10-08 04:53:31 UTC

Describe each of the three components and the rationale during Phase I (months 1-6)

tuguyesgin1 — 2020-10-08 04:55:56 UTC

i) Diet: calorie controlled diet between 1200-1500kcal for people under 114kg
ii) physical activity intervention: increase to 50min/ week, >125min/ week by week 16, >175min/ week by week 26
iii) behaviour modification curriculum: more steps, take the stairs (lifestyle changes)

What is the rationale for using meal replacements?

tuguyesgin1 — 2020-10-08 04:56:39 UTC

ii) PA
meal replacements are simple and decreased difficulty of tracking caloric intake, remembering foods etc. also obese individuals tend to underestimate caloric intake.
Meal replacement also showed in a study to significantly decrease weight more than when compared to isocaloric diets of conventional foods

What was one concern with prescribing meal replacements? Why was this disregarded?

tuguyesgin1 — 2020-10-08 04:56:53 UTC

high sugar content of some meal replacement products meal replacements might adversely affect glycemic control

What was the minimum duration of a bout to be counted towards the weekly goal?

tuguyesgin1 — 2020-10-08 04:58:25 UTC

iii) Behaviour
> or equal to 175min/week

What happened if participants were not compliant?

tuguyesgin1 — 2020-10-08 04:59:42 UTC

Considered to be ineligible to partake

Describe the study population

tuguyesgin1 — 2020-10-08 05:00:56 UTC

Type 2 diabetes, ages 45-76 years old had type 2 diabetes, were 45-76 years of age, and had a body mass index (BMI) 25 kg/m2 (or 27 kg/m2 if taking insulin).

Activity 1

tuguyesgin1 — 2020-10-08 05:01:47 UTC

Activity 1

tuguyesgin1 — 2020-10-08 05:01:50 UTC

Activity 1

tuguyesgin1 — 2020-10-08 05:01:55 UTC

Describe the study population

tuguyesgin1 — 2020-10-08 05:02:06 UTC

Overweight and obese individuals with T2D. Study started in 2001 and ended in 2012 with 5145 participants

Describe the study population

tuguyesgin1 — 2020-10-08 05:02:09 UTC

those individual suffering from type 2 diabetes

Briefly describe the two interventions

tuguyesgin1 — 2020-10-08 05:02:48 UTC

i) Lifestyle

ii) Enhanced usual care (education and diabetes support)

Briefly describe the two interventions

tuguyesgin1 — 2020-10-08 05:02:57 UTC

i) Lifestyle intervention - receives usual medical care, combined with an 4 years program to increase PA and reduce initial weight by 7%

ii) Diabetes support and education - receive their usual medical care, provided by their own primary care physicians, plus three group educational sessions per year for the first 4 years

Briefly describe the two interventions

tuguyesgin1 — 2020-10-08 05:03:09 UTC

i) usual care (education and diabetes support)

ii) Dietary/lifestyle Interventions: portion control, calorie restriction

What are the two goals of the ILI and why?

tuguyesgin1 — 2020-10-08 05:03:42 UTC

i) Induce a mean loss of >7% of initial weight

ii) increase participant's moderately intense physical activity to >175min/week

What are the two goals of the ILI and why?

tuguyesgin1 — 2020-10-08 05:03:45 UTC

i) induce weight loss

ii) maintaining duration of physical activity achieved in year 1

What are the two goals of the ILI and why?

tuguyesgin1 — 2020-10-08 05:03:46 UTC

i)to induce a mean loss 7% of initial

weight

ii)increase participants’ moderately intense physical activity to 175 min/wk

What are the three components of the ILI?

tuguyesgin1 — 2020-10-08 05:03:52 UTC

i) Treatment, frequency and format
ii) Diet and physical activity intervention
iii) Behaviour modification curriculum

What are the three components of the ILI?

tuguyesgin1 — 2020-10-08 05:03:55 UTC

i) Diet
ii) Exercise
iii) Behavioural intervention

What are the three components of the ILI?

tuguyesgin1 — 2020-10-08 05:03:56 UTC

i) behavioural intervention
ii) diet
iii) Treatment

Activity 2

tuguyesgin1 — 2020-10-08 05:06:17 UTC

Activity 2

tuguyesgin1 — 2020-10-08 05:06:19 UTC

Activity 2

tuguyesgin1 — 2020-10-08 05:06:20 UTC

Describe the treatment frequency and format during Phase I (months 7-12): • Group sessions: 12 • Individual sessions: 1

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Describe Phase III (year 5+): • Group sessions: • Individual sessions:

tuguyesgin1 — 2020-10-08 05:07:10 UTC

Group: encouraged to join 2 yearly refresher meetings or national campaigns which are on offer. Plus monthly open group sessions to weigh in.
Individual: Continue monthly, individual, onsite visits - which can be reduced if they are inconvenient. But minimum 2 a year

Why is there a decreased schedule?

tuguyesgin1 — 2020-10-08 05:07:16 UTC

Didn't want to burden participants with a compulsory weekly meeting but let participants maintain their weight loss.

Why did they implement this schedule?

tuguyesgin1 — 2020-10-08 05:07:19 UTC

Describe each of the three components and the rationale during Phase I (months 7-12):

tuguyesgin1 — 2020-10-08 05:10:01 UTC

i) Diet
Wk1: self selected diet, record intake
Wk2: similar diet but restricted intake
Wk3-19: portion controlled meal plan
Wk 20-22: back to 'normal' diet

Rationale for portion control - meal replacements increase weight loss, simplify food choices & portions, reduced fasting blood sugar

ii) PA
- initial exercise tolerance test
- 1st month: walking for at least 50min/wk
- Wk16: >125min/wk
- Wk26: >175min/wk

- lifestyle activity: stairs > elevators, walking > riding
to inc daily steps by 250/wk

iii) Behaviour
- group sessions discussing topics like: behavioural weight control, recording food intake + PA
- major topics had a h/w assignment
- total their calories each day/wk, report to group
- weight measured at each session

What happened if participants did not achieve the desired weight loss?

tuguyesgin1 — 2020-10-08 05:10:45 UTC

Participants are provided with intensive weight loss strategies known as " The Toolbox". This could include cooking classes to educate individuals about healthy food preparation.

Describe the treatment frequency and format during Phase II (year 2-4) • Group sessions: No longer required to attend group sessions •Individual sessions:

tuguyesgin1 — 2020-10-08 05:11:07 UTC

1 individual with minimum of 1 additional contact by phone, mail, or e‐mail

individualised calorie goals based on desire to maintain weight loss. All encouraged to exercise >200min/week, replace one meal/snack a day with a shake and to monitor weight weekly/more often

Why did they implement this schedule?

tuguyesgin1 — 2020-10-08 05:11:52 UTC

The intervention focused principally on maintaining the weight losses and duration of physical activity achieved during year 1, as well as helping unsuccessful individuals achieve the study goals. Lifestyle counselling was provided primarily in individual sessions to allow tailoring to participants’ specific treatment needs

Describe each of the three components and the rationale during Phase II (year 2-4):

tuguyesgin1 — 2020-10-08 05:12:09 UTC

i) Diet - one meal and snack replacement to reverse weight gain.

ii) PA - minimum 175 mins a week of moderate intensity activity and 10,000 steps per day (because there is a strong relationship between PA and lon
The activity program relied on unsupervised exercise that, for most, consisted of
brisk walking.

iii) Behaviour

What additional adherence strategies were implemented?

tuguyesgin1 — 2020-10-08 05:13:01 UTC

inclusion of dieticians, psychologists and exercise specialist as well as cognitive behavioural therapy (including elements of problem solving, motivational interviewing and cultural tailoring in their counseling)

Describe each of the three components and the rationale during Phase III (year 5+):

tuguyesgin1 — 2020-10-08 05:36:13 UTC

i) Diet
strategies with counselling of individuals to help in dietary and PA lapses as well as weight regain
ii) PA
renew commitment to 175min/wk of PA
iii) Behaviour
interviewing individuals to maintain or re-initiate motivation to abide by the intervention.

What additional adherence strategies were implemented?

tuguyesgin1 — 2020-10-08 05:39:42 UTC

Addressing the participants individual needs. Those who were highly motivated were selected to ensure that they could meet the study goals. Multidisciplinary team (nurse, psychologist, dietician, exercise scientist)

Activity 3

tuguyesgin1 — 2020-10-08 05:40:13 UTC

Read the attached paper and fill in the table for your group, and make note of any other interesting observations.

Activity 3

tuguyesgin1 — 2020-10-08 05:40:33 UTC

Read the attached paper and fill in the table for your group, and make note of any other interesting observations.

Activity 3

tuguyesgin1 — 2020-10-08 05:40:35 UTC

Read the attached paper and fill in the table for your group, and make note of any other interesting observations.

Activity 3

tuguyesgin1 — 2020-10-08 05:40:37 UTC

One-year results- Reduction in Weight and Cardiovascular Disease Risk Factors in Individuals With Type 2 Diabetes Diabetes Care Jun 2007, 30 (6) 1374-1383; DOI: 10.2337/dc07-0048

tuguyesgin1 — 2020-10-08 05:42:20 UTC

Four-year results - Long-term Effects of a Lifestyle Intervention on Weight and Cardiovascular Risk Factors in Individuals With Type 2 Diabetes MellitusFour-Year Results of the Look AHEAD Trial. Arch Intern Med. 2010;170(17):1566-1575. doi:10.1001/archinternmed.2010.334

tuguyesgin1 — 2020-10-08 05:42:44 UTC

Eight-year results - The Look AHEAD Research Group (2014), Eight-year weight losses with an intensive lifestyle intervention: The look AHEAD study. Obesity, 22: 5–13. doi:10.1002/oby.20662

tuguyesgin1 — 2020-10-08 05:42:58 UTC

Table

tuguyesgin1 — 2020-10-08 06:05:10 UTC

ILI #1=
DSE #1 =
ILI #4 =
DSE # 4 =
ILI #8 =
DSE #8 =

tuguyesgin1 — 2020-10-08 06:05:23 UTC

ILI (1year)= 8.5%
DSE (1year)= 0.6%
ILI (4 year)= 4.4%
DSE (4 year) = 0.7%
ILI (8 year)=4.7%
DSE (8 year)= 2.1%

The paper

tuguyesgin1 — 2020-10-08 06:15:14 UTC

ADA13: Weight loss, exercise didn't affect heart outcomes in Look AHEAD

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tuguyesgin1 — 2020-10-08 07:02:36 UTC