First long-range look at the effects of weight-loss on type 2 diabetes

Rena Wing, professor of psychiatry and human behavior at Brown University, is co-directing a new 12-year, $180-million nationwide study of how weight loss affects people with type 2 diabetes. Wing is also directing a study site at The Miriam Hospital in Providence, where she is based.

PROVIDENCE, R.I. — A Brown Medical School researcher began today the first long-term, nationwide study of whether weight loss in people with type 2 diabetes decreases the risk for heart disease, stroke and even death.

“There is a lot of evidence showing that weight loss has beneficial effects on diabetes and heart disease in the short-term, but there is almost no data on the long-term effects of weight loss,” said study co-director Rena Wing, professor of psychiatry and human behavior at Brown University.

“Some studies have found that diabetics who lose weight live longer, yet other studies suggest they die sooner,” said Wing, who is based at The Miriam Hospital in Providence, one of the project’s 16 study sites. “Results of previous studies may be inconsistent because we don’t know why or how people lost this weight.”

The 12-year, $180-million project is the largest study on the effects of weight-loss interventions ever funded by the National Institutes of Health. Type 2 diabetes has reached epidemic status in the United States due primarily to the increasing incidence of obesity and the aging of the American population.

Wing and colleagues intend to recruit 5,000 people nationwide. Individuals between ages 45 and 75 who have type 2 diabetes and are considered overweight or obese are eligible. Study leaders hope to enroll equal numbers of men and women, with one-third from ethnic minority groups. A disproportionate number of minorities are affected by diabetes.

Wing intends to recruit 315 individuals for the clinical research site at The Miriam Hospital. People interested in the study may call (401) 793-5599 or visit www.LookAHEADstudy.org.

People who qualify for the study will be assigned at random to either an intensive weight loss program or to a diabetes support and education program. The weight loss program uses diet and exercise to help participants lose at least 7- to 10-percent of their initial weight. Participants in the diabetes support and education program will attend sessions on nutrition and physical activity and meet in support groups with others who have diabetes.

Individuals will be followed up to 11.5 years. The researchers will examine how the interventions affect diabetes control, heart attack, stroke and cardiovascular disease, which are the primary illnesses associated with being overweight, and other markers of general health. Quality of life indicators, such as job and home-life satisfaction, will also be examined.

All interventions and associated medical tests will be given free of charge. Results will be provided to participants and their physicians.

Between 1976 and 1994, the incidence of diabetes among middle-aged people increased by 38 percent nationwide. About 80 percent of type 2 diabetics are overweight or obese. More than 50 percent of Americans are overweight. Twenty-two percent of Americans are obese. About 40,000 people in Rhode Island have type 2 diabetes.

Short-term weight loss has been shown to have beneficial effects on diabetes and cardiovascular disease. However some studies have suggested that the repeated gaining and losing of weight may actually increase deaths due to cardiovascular and other associated disease. Almost no data exist on long-tem benefits of weight loss. No randomized trials have been undertaken to date because it is difficult for people to lose weight and to keep the pounds off.

“Getting people to lose weight is talked about as the best treatment for both preventing diabetes in people who are overweight and for treating individuals who already have the disease,” Wing said. “If the long-term data from the study support these approaches, it will make it easier to go to patients, insurance companies and public-policy makers and say, ‘Yes, weight loss works over the long run.’”

Wing directs the Weight Control and Diabetes Research Center at The Miriam Hospital. She is also a professor of psychiatry, psychology and epidemiology at the University of Pittsburgh.

The study’s other co-director is F. Xavier Pi-Sunyer, M.D. He directs the Obesity Research Center at St. Luke’s-Roosevelt Hospital Center in New York and the New York Obesity and Nutrition Research Center.

Primary funding for the study comes from NIH’s National Institute of Diabetes and Digestive and Kidney Diseases. Other sponsors include National Heart, Lung and Blood Institute; National Institute of Nursing Research; National Center for Minority Health and Health Disparities; Office of Research on Women’s Health; and Centers for Disease Control and Prevention.