Evaluation of Early Weight Loss Thresholds for Identifying Nonresponders to an Intensive Lifestyle Intervention

Objective: Weight losses in lifestyle interventions are variable, yet prediction of long-term success is difficult. The utility of using various weight loss thresholds in the first 2 months of treatment for predicting 1-year outcomes was examined. Methods: Participants included 2327 adults with type 2 diabetes (BMI:35.8 +/- 6.0) randomized to the intensive lifestyle intervention (ILI) of the Look AHEAD trial. ILI included weekly behavioral sessions designed to increase physical activity and reduce caloric intake. 1-month, 2-month, and 1-year weight changes were calculated. Results: Participants failing to achieve a >= 2% weight loss at Month 1 were 5.6 (95% CI:4.5, 7.0) times more likely to also not achieve a >= 10% weight loss at Year 1, compared to those losing >= 2% initially. These odds were increased to 11.6 (95% CI:8.6, 15.6) when using a 3% weight loss threshold at Month 2. Only 15.2% and 8.2% of individuals failing to achieve the >= 2% and >= 3% thresholds at Months 1 and 2, respectively, go on to achieve a >= 10% weight loss at Year 1. Conclusions: Given the association between initial and 1-year weight loss, the first few months of treatment may be an opportune time to identify those who are unsuccessful and utilize rescue efforts.