Weight Change During the Postintervention Follow-up of Look AHEAD
Authors: Wing Rena R. , Neiberg Rebecca H. , Bahnson Judy L. , Clark Jeanne M. , Espeland Mark A. , Hill James O. , Johnson Karen C. , Knowler William C. , Olson KayLoni , Steinburg Helmut , Pi-Sunyer Xavier , Wadden Thomas A. , Wyatt Holly , Clark Jeanne M. , Swartz Lee , Jiggetts Dawn , Charleston Jeanne , Cheskin Lawrence , Maruthur Nisa M. , Pilla Scott J. , Diggins Danielle , Johnson Mia , Bray George A. , Greenway Frank L. , Ryan Donna H. , Champagne Catherine , Myers Valerie , Keller Jeffrey , Stewart Tiffany , Arceneaux Jennifer , Boley Karen , Fry Greta , Jones Lisa , Landry Kim , Lingle Melissa , Smith Marisa , Lewis Cora E. , Thomas Sheikilya , Glasser Stephen , Dutton Gareth , Dobelstein Amy , Hannum Sara , Hubbell Anne , Lee DeLavallade , Millhouse Phyllis , Oden L. Christie , Roche Cathy , Grant Jackie , Turman Janet , Nathan David M. , Goldman Valerie , Delahanty Linda , Larkin Mary , Dalton Kristen , Singh Roshni , Ruazol Melanie , Munshi Medha N. , Jackson Sharon D. , Middelbeek Roeland J.W. , Caballero A. Enrique , Rodriguez Anthony , Blackburn George , Mantzoros Christos , McNamara Ann , Wyatt Holly , Hill James O. , Breen Jeanne Anne , Miller Marsha , Bochert Debbie , Bossart Suzette , Cohrs Paulette , Green Susan , Hamilton April , Leshchinskiy Eugene , Rome Loretta , Foreyt John P. , Gee Molly , Pownall Henry , Balasubramanyam Ashok , Chen Chu-Huang , Jones Peter , Burrington Michele , Gardner Allyson Clark , Griggs Sharon , Hamilton Michelle , Holley Veronica , Lee Sarah , Liscum Sarah Lane , Cantu-Lumbreras Susan , Palencia Julieta , Schmidt Jennifer , Thomas Jayne , White Carolyn , Wright Charlyne , Alvarez Monica , Johnson Karen C. , Griffin Beate , Coday Mace , Valenski Donna , Jones Lisa , Johnson Karen , Johnson Karen C. , Steinburg Helmut , Jeffery Robert W. , Skarphol Tricia , Bantle John P. , Redmon J. Bruce , Brelje Kerrin , Campbell Carolyne , Forseth Mary Ann , Uccellini Soni , Voeller Mary Susan , Laferrère Blandine , Pi-Sunyer Xavier , Patricio Jennifer , Luchsinger Jose , Palta Priya , Lyon Sarah , Kelly Kim , Wadden Thomas A. , Maschak-Carey Barbara J. , Berkowitz Robert I. , Chao Ariana , Davenport Renee , Gruber Katherine , Leonard Sharon , Walsh Olivia , Jakicic John M. , Wesche-Thobaben Jacqueline , Ewing Lin , Hergenroeder Andrea , Korytkowski Mary , Copelli Susan , Danchenko Rebecca , Ives Diane , Mancino Juliet , Martich Lisa , McGuire Meghan , Murray Tracey Y. , Semler Linda , Williams Kathy , Wing Rena R. , Egan Caitlin , Jelalian Elissa , McCaffery Jeanne , McDermott Kathryn Demos , Unick Jessica , Annis Kirsten , DaCruz Jose , Rafanelli Ariana , Hazuda Helen P. , Isaac Juan Carlos , Hernandez Prepedigna , Kahn Steven E. , Boyko Edward J. , Tsai Elaine , Wright Lorena , Atkinson Karen , Morgan-Taggart Ivy , Socha Jolanta , Urquhart Heidi , Knowler William C. , Bolin Paula , Anderson Harelda , Michaels Sara , Johnson Ruby , Poorthunder Patricia , Smiley Janelia , Peters Anne L. , Ghazarian Siran , Beale Elizabeth , Ramirez Edgar , Rodriguez Gabriela , Ruelas Valerie , Serafin-Dokhan Sara , Walker Martha , Perez Marina , Espeland Mark A. , Wagenknecht Lynne E. , Bahnson Judy L. , Reboussin David , Miller Mike E. , Brubaker Peter , Pajewski Nicholas , Bancks Michael , Ding Jingzhong , Deep Gagan , Hayden Kathleen , Rapp Stephen R. , Simpson Felicia , Chen Haiying , Sachs Bonnie C. , Houston Denise , Chen Shyh-Huei , Anderson Andrea , Barnes Jerry M. , Barr Mary , Beckner Tara D. , Cook Delilah R. , Williams Carrie C. , Evans Joni , Garcia Katie , Gaussoin Sarah A. , Kittel Carol , Harvin Lea , Howard Marjorie , Lovato James , Neiberg Rebecca H. , Pierce June , Steinberg Debbie , Webb Christopher , Walker Jennifer , Walkup Michael P. , Watkins Carolyn , Marcovina Santica M. , Hurting Jessica , Albers John J. , Gaur Vinod , Nevitt Michael , Schwartz Ann , Shepherd John , Rahorst Michaela , Palermo Lisa , Ewing Susan , Hayashi Cynthia , Maeda Jason 
Published: April 2022

OBJECTIVE
Patients with type 2 diabetes are encouraged to lose weight, but excessive weight loss in older adults may be a marker of poor health and subsequent mortality. We examined weight change during the postintervention period of Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) with diabetes support and education (DSE) (control) in overweight/obese individuals with type 2 diabetes and sought to identify predictors of excessive postintervention weight loss and its association with mortality.

RESEARCH DESIGN AND METHODS
These secondary analyses compared postintervention weight change (year 8 to final visit; median 16 years) in ILI and DSE in 3,999 Look AHEAD participants. Using empirically derived trajectory categories, we compared four subgroups: weight gainers (n = 307), weight stable (n = 1,561), steady losers (n = 1,731), and steep losers (n = 380), on postintervention mortality, demographic variables, and health status at randomization and year 8.

RESULTS
Postintervention weight change averaged −3.7 ± 9.5%, with greater weight loss in the DSE than the ILI group. The steep weight loss trajectory subgroup lost on average 17.7 ± 6.6%; 30% of steep losers died during postintervention follow-up versus 10–18% in other trajectories (P &lt; 0001). The following variables distinguished steep losers from weight stable: baseline, older, longer diabetes duration, higher BMI, and greater multimorbidity; intervention, randomization to control group and less weight loss in years 1–8; and year 8, higher prevalence of frailty, multimorbidity, and depressive symptoms and lower use of weight control strategies.

CONCLUSIONS
Steep weight loss postintervention was associated with increased risk of mortality. Older individuals with longer duration of diabetes and multimorbidity should be monitored for excessive unintentional weight loss.