Impact of a weight management program on health-related quality of life in overweight adults with Type 2 diabetes

Health Psychology Department, Pennington Biomedical Research Center, Louisiana State University System, 6400 Perkins Rd, Baton Rouge, LA 70808-4124, USA.
Archives of internal medicine (Impact Factor: 17.33). 02/2009; 169(2):163-71. DOI: 10.1001/archinternmed.2008.544
Source: PubMed


Inconsistent findings have been reported regarding improved health-related quality of life (HRQOL) after weight loss. We tested the efficacy of a weight management program for improving HRQOL in overweight or obese adults diagnosed as having type 2 diabetes mellitus.
We conducted a randomized multisite clinical trial at 16 outpatient research centers with 2 treatment arms and blinded measurements at baseline and the end of year 1. A total of 5145 participants (mean [SD] age, 58.7 [6.9] years; mean [SD] body mass index [calculated as weight in kilograms divided by height in meters squared], 36.0 [5.9]; 59.5% women; 63.1% white) were randomized to an intensive lifestyle intervention (ILI) or to diabetes support and education (DSE). Main outcome measures included the 36-Item Short-Form Health Survey physical component summary (PCS) and mental health component summary (MCS) scores and Beck Depression Inventory II (BDI-II) scores. Baseline mean (SD) scores were 47.9 (7.9) for PCS, 54.0 (8.1) for MCS, and 5.7 (5.0) for BDI-II.
Improved HRQOL was demonstrated by the PCS and BDI-II scores (P < .001) in the ILI arm compared with the DSE arm. The largest effect was observed for the PCS score (difference, -2.91; 99% confidence interval, -3.44 to -2.37). The greatest HRQOL improvement occurred in participants with the lowest baseline HRQOL levels. Mean (SD) changes in weight (ILI, -8.77 [8.2] kg and DSE, -0.86 [5.0] kg), improved fitness, and improved physical symptoms mediated treatment effects associated with the BDI-II and PCS.
Overweight adults diagnosed as having type 2 diabetes experienced significant improvement in HRQOL by enrolling in a weight management program that yielded significant weight loss, improved physical fitness, and reduced physical symptoms. Identifier: NCT00017953.

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    • "In the context of the endemic state of obesity in Western countries, these results are relevant in a public health perspective, given that an obese phenotype, independently of the other cardiovascular risk factors, increases the risks of cardiovascular diseases, CAD, death from CAD, congestive heart failure, and diabetes (Hubert et al., 1983; Wilson et al., 2007). The Look AHEAD investigators previously showed that among overweight-to-obese diabetic patients, a an intensive lifestyle intervention including a caloric-restriction diet and regular MICET, with the aim of a 7% weight loss or more, is associated with a modest increase in partial remission of diabetes (Gregg et al., 2012), and an improvement of health-related quality of life (Williamson et al., 2009). More recently, however, they failed to show an improvement of major cardiovascular events rates (compared to the control group) after a median followup of 9.6 years (Group, T.L.A.R., 2013). "
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    ABSTRACT: Objectives: To analyze the effects of a long-term intensive lifestyle intervention including high-intensity interval training (HIIT) and Mediterranean diet (MedD) counseling on glycemic control parameters, insulin resistance and β-cell function in obese subjects. Methods: The glycemic control parameters (fasting plasma glucose, glycated hemoglobin), insulin resistance, and β-cell function of 72 obese subjects (54 women; mean age = 53 ± 9 years) were assessed at baseline and upon completion of a 9-month intensive lifestyle intervention program conducted at the cardiovascular prevention and rehabilitation center of the Montreal Heart Institute, from 2009 to 2012. The program included 2-3 weekly supervised exercise training sessions (HIIT and resistance exercise), combined to MedD counseling. Results: Fasting plasma glucose (FPG) (mmol/L) (before: 5.5 ± 0.9; after: 5.2 ± 0.6; P < 0.0001), fasting insulin (pmol/L) (before: 98 ± 57; after: 82 ± 43; P = 0.003), and insulin resistance, as assessed by the HOMA-IR score (before: 3.6 ± 2.5; after: 2.8 ± 1.6; P = 0.0008) significantly improved, but not HbA1c (%) (before: 5.72 ± 0.55; after: 5.69 ± 0.39; P = 0.448), nor β-cell function (HOMA-β, %) (before: 149 ± 78; after: 144 ± 75; P = 0.58). Conclusion: Following a 9-month intensive lifestyle intervention combining HIIT and MedD counseling, obese subjects experienced significant improvements of FPG and insulin resistance. This is the first study to expose the effects of a long-term program combining HIIT and MedD on glycemic control parameters among obese subjects.
    Full-text · Article · Apr 2015
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    • "intake of low-glycemic and protein-rich foods) [45,46]. Recently published results showed that weight loss and lifestyle interventions were associated with HRQOL in patients with Type 2 Diabetes Mellitus (T2DM) [47]. Other research has reported associations between high protein diets and improvements in body weight and metabolic risk factors; and between soy protein and improvements in cognitive function and mood, brain function and memory [46,48-53]. "
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    ABSTRACT: In addition to an increased risk for chronic illnesses, obese individuals suffer from social stigmatization and discrimination, and severely obese people may experience greater risk of impaired psychosocial and physical functioning. Lower health-related quality of life (HRQOL) has been reported among obese persons seeking intensive treatment for their disease. To aid in the treatment of obesity, meal replacements have been recommended as an effective therapeutic strategy for weight loss, particularly when consumed in the beginning of an intervention. Hence, the objective of this study was to assess the impact of two 12-month weight reduction interventions (one arm including a meal replacement) on changes in HRQOL among obese females. This controlled trial compared two versions of a standardized 12-month weight reduction intervention: the weight-reduction lifestyle program without a meal replacement (LS) versus the same lifestyle program with the addition of a soy-based meal replacement product (LSMR). 380 women (LS: n = 190, LSMR: n = 190) were matched by age, gender, and weight (51.4 +/- 7.0 yrs., 35.5 +/- 3.03 kg/m2). This sample of women all completed the 12-month lifestyle intervention that was part of a larger study. The lifestyle intervention included instruction on exercise/sport, psychology, nutrition, and medicine in 18 theoretical and 40 practical units. Led by a sport physiologist, participants engaged in group-based exercise sessions once or twice a week. To evaluate HRQOL, all participants completed the SF-36 questionnaire pre- and post-intervention. Anthropometric, clinical, physical performance (ergometric stress tests), and self-reported leisure time physical activity (hours/day) data were collected. The LSMR sample showed lower baseline HRQOL scores compared to the LS sample in six of eight HRQOL dimensions, most significant in vitality and health perception (p < 0.01). After the intervention, body weight was reduced in both lifestyle intervention groups (LS: -6.6+/-6.6 vs. LSMR -7.6+/-7.9 kg), however, weight loss and HRQOL improvements were more pronounced in the LSMR sample (LSMR: seven of eight, LS: four of eight dimensions). Our results show that HRQOL may improve among middle-aged obese females during a standardized lifestyle weight reduction program and may be enhanced by consuming a soy-based meal replacement product.Trial registration: NCT00356785.
    Full-text · Article · Mar 2014 · BMC Women's Health
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    • "Previous studies have shown that lifestyle modification programs incorporating dietary weight loss and exercise training (EX) improve QOL and emotional wellbeing in overweight and obese patients including patients with type 2 diabetes3. Other studies have also shown that EX alone, independent of weight loss6 and weight loss achieved by caloric restriction9, separately improve QOL in type 2 diabetes, suggesting that the addition of EX to a dietary weight loss program might be superior to diet alone in improving QOL outcomes. "
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    ABSTRACT: Aims/IntroductionTo evaluate the effects of a caloric restricted weight loss program with or without supervised resistance exercise training (EX) on diabetes-related emotional distress and quality of life (QOL) in overweight and obese patients with type 2 diabetes. Materials and Methods In a parallel design, 106 men and women with type 2 diabetes were randomized to a prescriptive 16-week caloric restricted diet (D; 6,000–7,000 kJ/day), with (n = 65) or without (n = 41) EX (three times per week). Bodyweight, glycated hemoglobin, diabetes-specific emotional distress (Problem Areas in Diabetes [PAID] questionnaire) and QOL (Diabetes-39 [D-39] questionnaire) was assessed pre- and post-intervention. ResultsA total of 84 participants completed the study (D n = 33, D + EX n = 51). Weight loss was significantly greater in D + EX compared with D (−11.4 ± 5.8 vs −8.8 ± 5.8 kg, P = 0.04 time × diet). Overall, there were significant improvements in glycated hemoglobin, PAID total score and the D-39 dimensions of ‘diabetes control’, ‘anxiety and worry’, ‘sexual functioning’, ‘energy and mobility’, ‘overall rating of QOL’ and ‘severity of diabetes’ (P ≤ 0.01 for time). The D-39 dimension, ‘social burden’, did not change (P = 0.07 for time). There was no difference between groups in the response for any of these variables (P ≥ 0.10). ConclusionA structured caloric restricted diet with or without EX improves emotional distress and QOL in overweight and obese patients with type 2 diabetes. This trial was registered with Australian New Zealand Clinical Trials Registry (; ACTR No: ACTRN12608000206325).
    Full-text · Article · Feb 2014
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