Should Older Adults with Diabetes and Obesity Lose Weight?

Robert S. Gordon Jr. Lecture | Wednesday, May 18, 2022 | 3:00 to 4:00 p.m. ET

Rena R. Wing, Ph.D.

Professor of Psychiatry and Human Behavior

Brown University

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Dr. Rena Wing is well known for her research on behavioral treatment of obesity and particularly its application to type 2 diabetes. She was one of the principal investigators on the Diabetes Prevention Program and developed the lifestyle intervention used in all 27 centers in that study. More recently, she was the principal investigator at The Miriam Hospital site for a 15-center trial entitled Look AHEAD, and served as chair of this multi-site study for over 20 years. Dr. Wing was a member of the council for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and served on the NIDDK Task Force on the Prevention and Treatment of Obesity. She has successfully mentored many of the next generation of researchers studying behavioral approaches to obesity.

Summary

Whether older individuals with diabetes and obesity should be encouraged to lose weight remains controversial. Observational studies have suggested that weight loss in older adults may be associated with increased risk of mortality, but this conclusion may be due to unintentional weight loss. A randomized trial in which some individuals are assigned to a weight loss program is the best way to address the question of whether intentional efforts to lose weight are appropriate for older individuals who have diabetes and obesity.

This was the rationale that led in 1999 to NIH’s decision to launch Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) and a control group in 5145 adults, age 45-76, who had type 2 diabetes and overweight/obesity. Look AHEAD was continued as a randomized trial for 10 years and was then converted to an observational study with an additional 10 years of follow-up. Dr. Wing will review the design of the trial and its primary outcome on cardiovascular morbidity and mortality and discuss several possible explanations for these results, including issues related to eligibility criteria, provision of medical care, and the magnitude of the weight losses achieved. The presentation will also include new data on the long-term effects of randomization to the intensive lifestyle intervention on cognition, frailty, diabetes complications, health care utilization and all-cause mortality, as these findings might relate to decisions regarding the risk:benefit ratio of weight loss in this population.