physical activity, and social support. These sessions provided information but not specific behavioral strategies for adopting the diet and physical activity recommen- dations. Participants who wanted more support in their effort to lose weight were told to speak with their primary care providers.


Intensive Lifestyle Intervention Group


Participants in the ILI group were provided with a comprehensive intervention that was expected to induce an average weight loss of more than 7% of initial weight across all 16 centers. Individual participants were given a goal of losing more than 10% of their initial weight to increase the likelihood that they would meet the 7% study-wide goal. The weight control intervention was adopted from the DPP and was delivered to participants in groups of 10 to 20 participants. Group sessions were led by lifestyle coaches, who included RDNs, behavioral psychologists, and exercise specialists. During the first 6 months, participants attended weekly group sessions of 60 to 75 minutes each for the first 3 weeks of each month. During the fourth week of each month, participants met one-on-one with their lifestyle coaches. During months 7 through 12, participants continued to have a monthly individual meeting with their lifestyle coach, but the number of group sessions was reduced from three to two per month. Dietary recommendations for participants in the ILI group were as follows:


ƒ Participants weighing less than 114 kg (250 lb) were prescribed an energy goal of 1,200 to 1,500 kcal/d; those weighing more than 114 kg were pre- scribed an energy goal of 1,500 to 1,800 kcal/d.


ƒ Participants were told that less than 30% of their daily energy intake should come from fat, and less than 10% should come from saturated fat.


ƒ During weeks 3 through 19, participants were prescribed a liquid-meal- replacement plan and instructed to replace two meals with a liquid shake and one snack with a bar and to eat one meal of conventional foods. They added fruits and vegetables to their diet until they met their daily energy goal.


The physical activity goal for ILI group participants was to engage in more


than 175 minutes of moderately intense activity per week. Persons who achieved this goal were encouraged to increase to more than 200 minutes of moderately intense exercise per week for months 7 through 12. Participants recorded their weekly activity in their food and activity diaries; only bouts of more than 10 min- utes counted toward the weekly goal.


One-Year Results


At the 1-year mark, the average weight loss was more than 12 times greater in the ILI group than in the DSE group, as shown in Figure 10.4.18


In addition, ILI partic-


ipants reported engaging in brisk physical activity an average of 136.7 ± 110.4 min- utes per week during the first year.18 As in the DPP study, the principal finding in the Look AHEAD study at 1 year was


that the intensive lifestyle intervention induced a clinically significant weight loss in all subsets of a demographically and ethnically diverse population. Participant weight loss was related to adherence to the study’s treatment recommendations. Of the three measures of adherence, physical activity most strongly correlated with weight loss. Participants in the highest quartile of self-reported physical activity lost 11.9% of their initial weight, compared with only 4.4% for those in the lowest quartile. More frequent attendance at treatment sessions and greater consumption


176 SECTION 3: Interventions for the Treatment of Overweight and Obesity


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