August 4, 2013
John DiTraglia MD
This week’s New England Journal of Medicine introduces a fly in the ointment of lifestyle interventions designed to foster exercise and weight loss. (1) In this ongoing multi-center project conducted by the Look AHEAD (Action for Health in Diabetes) research group, half of 5145 overweight or obese people with type 2 diabetes, managed, by diet and exercise and exhortation, an average of 8.6 percent weight loss at one year and 6 percent by the study end at almost 10 years. But when compared with the control group who by study end had lost 3.5 percent, there was no improvement of outcome of death from heart attack or nonfatal heart attack, nonfatal stroke or hospitalization for chest pain, even though the weight loss from lifestyle intervention did result in better diabetes control and fitness and improvement of most risk factors for heart disease. The weight loss also improved many quality of life issues and made it easier to control the diabetes and cardiovascular risk factors with fewer medications.
This contradiction to cherished beliefs provoked an editorial in this issue. (2) Maybe it takes longer to show a benefit. But this is the longest follow up study of this question available to date and the study was stopped early because the authors determined that by their interim analysis it was very unlikely that further follow-up would yield a different result. Maybe you need to lose even more weight and keep more of it off. But this is very hard and this study accomplished a very respectable weight loss and weight loss maintenance. Maybe it’s worth it for the other benefits and the benefit of having to take less medicine. But maybe using medication is easier than intensive life style interventions. Maybe someday we will have even better pills that are as good as exercise. Then we will look back on these days and think that all the pain of dieting and exercising was barbaric, like the gory games of ancient Rome.
1. The Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013;369:145-54.
2. Gerstein HC. Do lifestyle changes reduce serious outcomes in diabetes? N Engl J Med 2013;369:189-90