Pfeiffer and Klein refer readers to the initial publications of the Look AHEAD Study (1, 2) and write: “In the Look AHEAD (Action for Health in Diabetes) trial, intensive lifestyle modification was tested against conventional diabetes support and education in a group of 5000 diabetic patients over a period of four years; intensive training brought about a mean weight loss of 4.5 kg compared with conventional training. The extent of weight loss was directly correlated with reductions in the HbA1c fraction (by 0.3–1%), triglyceride concentrations, and systolic and diastolic blood pressure, as well as with a rise in the HDL cholesterol level.”
Unfortunately Pfeiffer and Klein do not explain what they mean by “intensive lifestyle modification.” From the original articles (1, 2), readers will find out that patients received weekly counseling in the first 6 months, and three times per month in the subsequent 6 months, in individual and group sessions, from dieticians, behavioral counselors, and exercise specialists. In the following 3 years patients were seen at least once a month and additionally contacted by telephone or email. It is obvious that such an intervention strategy is completely removed from any reality of treatment.
The benefit described by Pfeiffer and Klein is pronounced only in the first year and then continuously tails off. At the end of the fourth year, the surrogates of the intervention group hardly differ from those in the control group.
The study was terminated prematurely after 9.6 years (3) because in spite of intensive lifestyle modification, the rate of clinically relevant end points (cardiovascular death, myocardial infarction, stroke, admission to hospital for angina pectoris) was not reduced.
This negative result does, of course, not mean that patients should not receive detailed advice. But the chances of success are limited. Doctors as well as patients should be aware of this in order to avoid being put under pressure.
Footnotes
Conflict of interest statement
The author declares that no conflict of interest exists.
References
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