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Binge eating (BE) is common in overweight and obese individuals with type 2 diabetes yet little is known about how BE affects weight loss in this population.
To determine whether BE was related to 1-year weight losses in overweight and obese individuals with type 2 diabetes participating in an ongoing clinical trial.
Look AHEAD is a randomized controlled trial examining the long-term effect of intentional weight loss on CVD in overweight and obese adults with type 2 diabetes.
Overweight and obese individuals, 45–76 years old, with type 2 diabetes (n=5145).
Participants were randomly assigned to an intensive lifestyle intervention (ILI) or to enhanced usual care (DSE).
At baseline and 1-year, participants had their weight measured and completed a fitness test and self-report measures of BE and dietary intake. Four groups were created based on BE status at baseline and 1-year (Yes/Yes, No/No, Yes/No, No/Yes). Analyses controlled for baseline differences between binge eaters and non-binge eaters.
Most individuals (85.4%) did not report BE at baseline or 1-year, 7.5% reported BE only at baseline, 3.7% reported BE at both times, and 3.4% reported BE only at 1-year, with no differences between ILI and DSE conditions (p=.14). Across ILI and DSE, greater weight losses were observed in participants who stopped BE at 1-year (5.3±.4 kg) and in those who reported no BE at either time point (4.8±.1 kg) than in those who continued to BE (3.1±.6 kg) and those who began BE at 1-year (3.0±.6 kg) (p=.0003). Post hoc analyses suggested these differences were due to changes in caloric intake.
Overweight and obese individuals with type 2 diabetes who stop binge eating appear just as successful at weight loss as non-binge eaters after one year of treatment.
Binge eating is common among overweight and obese individuals seeking weight loss treatment1,2 and there is some indication it is associated with poor treatment compliance.3–6 Some have suggested that binge eating needs to be addressed prior to weight loss,7,8 yet empirical support for this recommendation is lacking. Research indicates that behavioral weight loss treatment does not exacerbate or precipitate binge eating,9,10 that binge eating status is not associated with weight loss outcomes,5,11,12 and that binge eating may in fact improve with weight loss treatment.13,14
Binge eating is prevalent in overweight and obese individuals with type 2 diabetes,13,15,16 with rates of binge eating disorder (BED) in this population ranging from 1.4% to 9%.17–19 A recent study examining 845 overweight and obese individuals with type 2 diabetes seeking entry into weight loss treatment found that 5.6% of individuals reported 8 or more objective binge episodes in the prior month and 1.4% met full diagnostic criteria for BED.17 Despite the frequency of binge eating in overweight and obese individuals with type 2 diabetes, little is known about how this behavior affects weight loss outcomes in this high-risk population. Gaining a better understanding of this relationship is clinically relevant and may have implications for future treatment recommendations.
The Look AHEAD (Action for Health in Diabetes) trial provides a unique opportunity to examine binge eating in overweight and obese individuals with type 2 diabetes because of its large and demographically diverse patient population. Look AHEAD is a randomized controlled trial examining the long-term effects of interventions designed to produce weight loss on cardiovascular morbidity and mortality in over 5000 individuals with type 2 diabetes, followed for up to 11.5 years.20 In the present study, we examined whether Look AHEAD participants who reported binge eating at study entry differed from those who did not on baseline demographics, anthropometrics, health-related and lifestyle variables, and psychosocial factors. We examined the stability of binge eating and whether weight loss treatment was associated with the development of binge eating during the first year of study participation. We also assessed whether one-year weight loss outcomes were related to baseline binge eating status or changes in binge eating status over the first year of treatment.
The Look AHEAD trial design and study participants have been described in detail elsewhere.20 Briefly, individuals with type 2 diabetes interested in weight loss were recruited from 16 clinical centers in the United States. To participate, individuals had to be 45–76 years old and have a BMI ≥ 25 kg/m2 (≥27 kg/m2 if on insulin). Individuals with inadequate diabetes control (i.e., HbA1c > 11%) or with factors likely to impact intervention adherence, safety (e.g., underlying serious medical or psychological conditions) or retention (e.g., plans to move out of the area) were excluded from the trial. All participants provided informed consent, as approved by each site’s Institutional Review Board.
Eligible participants (n=5145) were randomly assigned to an intensive lifestyle intervention (ILI) or to a diabetes support and education control condition (DSE). The ILI was modeled after the Diabetes Prevention Program lifestyle intervention.21 The goals of the intervention were to produce a mean weight loss of ≥ 7% of initial weight through caloric restriction (i.e., diet of 1200 – 1500 kcal/day) and increased physical activity (≥ 175 minutes per week of moderately intense activity).22 To achieve these goals, ILI participants received 3 group meetings and 1 individual meeting each month during months 1–6 and 2 group meetings and 1 individual session per month during months 7–12. DSE participants were offered 3 group meetings per year and were given basic information on diabetes, nutrition, and physical activity.
Binge eating was assessed via a self-report questionnaire based on the Questionnaire on Eating and Weight Patterns.23 We identified participants who indicated having any episode(s) of eating a large amount of food in a short amount of time, reported feeling out of control, and who denied any compensatory behaviors (n=559; 10.9%) during the past six months. For the comparison group, we identified participants who reported no binge episodes or compensatory behaviors (n=4222; 82.1%). Individuals who reported compensatory behaviors (i.e., purging, excessive exercise; n=332; 6.5%) or who were missing data on the items used to determine binge eating behavior (n=32; 0.6%) were excluded. We chose to examine binge eating behavior as opposed to full-criteria BED as defined by the DSM-IV for several reasons. First, many more participants reported binge eating behavior (11.7%) than met DSM-IV criteria for BED (1.6%) allowing for more power to complete analyses. In addition, very little research has examined the effects of these behaviors (in the absence of an eating disorder) in the context of a behavioral weight study among type 2 diabetics. Also, examining binge eating behavior, which is easily assessed via self-report, rather than a diagnosis of BED, which is best done via structured interview, may have more clinical applications among health care professionals.
Participants completed the following assessments.
Participants provided basic demographic information regarding gender, race/ethnicity, marital status, and educational background at baseline. Weight was measured at baseline and 1-year on a digital scale in light weight clothing. Height was measured at baseline on a wall-mounted stadiometer.
At baseline, participants indicated the number of years since being diagnosed with diabetes and their current diabetes treatment regimen (i.e., diet only, oral medications without insulin, or insulin). Plasma was collected at baseline and glycosylated hemoglobin (HbA1c; measured by a dedicated ion exchange high-performance liquid chromatography instrument, Biorad Variant 11) was used as a measure of glycemic control over the past three-month period.
Reported dietary intake was assessed on a subsample of the Look Ahead participants (n=2411) using a self-administered 130-item food frequency questionnaire, modified from the Insulin Resistance Atherosclerosis Study24 that assessed usual consumption over the prior six-month period. We examined reported daily intake of energy as well as percent energy intake from fat, protein, and carbohydrate for those participants included in the subsample at baseline and 1-year.
Participants completed a graded exercise test that was designed to elicit a maximal effort at baseline and submaximal effort at 1-year.25 Peak exercise capacity expressed as METS (metabolic equivalents) was estimated from treadmill speed and grade.
At baseline, participants indicated the number of times (0, 1–2, 3–4, 5–6, or 7 or more times) they had intentional weight losses of 5–9 lb, 10–19 lb, 20–49 lb, 50–79 lb, 80–99 lb, and 100 lb or more. We examined the number of previous weight loss attempts (using the lower end of the frequency intervals, summed across categories) and the total amount of past intentional weight loss (defined as the frequency of weight loss attempts multiplied by the amount of weight loss achieved, using the lower end of the frequency and amount intervals and summing across categories).26
The Beck Depression Inventory-II (BDI-II) was used to measure depressive symptomatology.26 The BDI-II has been shown to have high internal consistency, test-retest reliability, and construct validity.27 The Short Form (SF) 36 version 2, a widely used validated measure, was used to assess general health28 and participants also reported the number of prescription medications they were currently taking. These measures were assessed at baseline.
Tobacco and alcohol use was assessed at baseline and 1-year by self-report. Participants indicated whether they were a current smoker, a former smoker, or had never smoked cigarettes. Participants also reported how many alcoholic drinks (including wine, beer, and hard liquor) they typically consume per week. Binge drinking was assessed with a single item that asked participants how many days during the past month they had five or more drinks on the same occasion.
Baseline characteristics were compared between binge eaters and non-binge eaters with the use of t-tests for continuous variables and chi-square tests for categorical variables. To examine change in self-reported binge eating status over time, participants were classified according to binge eating status at baseline and 1-year, yielding four categories: those who indicated no binge eating at both time points (No/No), those who reported binge eating at baseline but not at 1-year (Yes/No), those who indicated no binge eating at baseline and reported it at 1-year (No/Yes) and those who reported binge eating at both time points (Yes/Yes). Multiple logistic regression was employed to examine the relationship between binge eating at 1-year and treatment group assignment. We determined the odds ratio (OR) and 95% confidence interval (95% CI) of binge eating at 1-year associated with treatment group assignment, controlling for baseline binge eating separately and in combination with age, race, gender, education level, baseline weight, number of previous weight loss attempts, total amount of weight lost, depressive symptoms, self-reported general health, number of prescription medications, and binge drinking.
Multiple linear regression was used to model the effect of binge eating status on weight loss at one year, controlling for age, race/ethnicity, gender, education level, baseline weight, number of previous weight loss attempts, total amount of weight lost, depressive symptoms, self-reported general health, number of prescription medications, maximum METS, and binge drinking. Models were fitted for the overall cohort (also controlling for intervention group) and separately by treatment group assignment. In addition, the same models were fitted controlling for dietary covariates (reported caloric intake, percent fat intake, and percent carbohydrate intake) for the sub-sample of participants furnishing baseline dietary data. To further explore the weight loss differences detected among the binge eating status groups, we modeled the effect of binge eating status on change in total reported caloric intake and change in fitness controlling for the same variables noted above.
We also ran the primary model examining the association between binge eating status and weight loss outcomes using DSM-IV BED criteria, rather than binge eating behavior. The patterns of weight losses were identical between the two models; however, because of reduced sample size the BED model was not significant (p=.09) and the data are not presented. Additionally, among those reporting binge eating at baseline, we used the primary model to determine the relationship between baseline binge eating frequency and weight loss at one year as well as the relationship between baseline binge eating frequency and change in reported caloric intake.
Statistical analyses were performed with SAS statistical software, version 9 (SAS Institute Inc., Cary, NC).
At baseline, 11.7% of our cohort reported having one or more episodes in the past 6 months when they ate a large amount of food in a short period of time and felt they could not control what or how much they were eating. Of those who reported binge episodes, 41.3% did so less than one day per week, 49.6% reported binge episodes on 1–3 days per week, and 9.2% reported binge episodes on 4 or more days per week in the past 6 months. Only 1.6% (n=80) of the full sample met DSM-IV criteria for binge eating disorder based on self-report.
Individuals who reported any episodes of binge eating at baseline were younger (p<0.0001), more likely to be female (p<0.01), Caucasian (p<0.0001), and college educated (p<0.01) than their non-binge eating counterparts (Table 1). Individuals who reported binge eating were also heavier (p<0.0001) at entry into Look AHEAD and had a more extensive weight loss history, both in terms of number of weight loss attempts (p<0.0001) and total amount lost (p<0.0001) (Table 2). Baseline dietary intake differed between the two groups, with binge eaters reporting a higher daily caloric intake (p<0.0001) and a greater percentage of calories from fat (p<0.05). Fitness levels did not differ between the groups (Table 2).
Individuals reporting binge eating drank fewer alcoholic beverages per week (p=0.02) and were less likely to report binge drinking (p=0.02) than individuals who indicated no binge eating. Individuals reporting binge eating at baseline also had higher levels of depressive symptoms (p<0.0001), reported worse general health (p<0.0001), and were taking more medications than individuals who indicated no binge eating (p<0.05), but there were no group differences in HBA1c levels, number of years since diabetes diagnosis, or current diabetes treatment regimen (Table 3).
At one year, weight data was available on 96.4% of participants and weight and questionnaire data were available on 88.3% of participants. Individuals reporting binge eating at baseline were less likely to complete the full one-year assessment (weight and questionnaire data) compared to non-binge eaters (85.2% vs. 88.7%, p<0.02).
Most individuals (85.4% overall; 84.9% ILI, 85.9% DSE) reported no binge eating at baseline or 1-year (No/No), 7.5% reported binge eating at baseline but not at 1-year (Yes/No; 8.3% ILI, 6.8% DSE), 3.7% reported binge eating at both time points (Yes/Yes; 4.0% ILI, 3.5% DSE), and 3.4% did not report binge eating at baseline but did at 1-year (No/Yes; 2.9% ILI, 3.8% DSE). These patterns did not differ between the ILI and DSE conditions (p=0.14). Overall, of those individuals who reported binge eating at baseline, the majority (66.8% overall; 67.6% ILI, 65.9% DSE) did not report the behavior at 1-year. The frequency of binge eating behavior at baseline (less than 2 days per week vs. 2 or more days per week) was not associated with whether binge eating continued at 1-year (p=0.12).
Participants randomly assigned to ILI were no more likely to be binge eating at 1-year than those randomized to DSE (OR for ILI compared to DSE, 0.85; 95% CI, 0.66–1.09; p=0.20), controlling for baseline binge eating. After adjusting for additional covariates, ILI participants were marginally less likely to be binge eating at 1-year compared to DSE (OR, 0.77; 95% CI, 0.59–1.01; p=0.06). As expected, baseline binge eating was the most important predictor of behavior at 1-year (p< 0.0001).
As shown in Figure 1, after controlling for baseline differences between binge eaters and non-binge eaters, there were statistically significant differences in one-year weight losses based on binge eating behavior over time (p=0.0002; Table 4). Specifically, individuals who were binge eating at baseline but had stopped at 1-year (Yes/No) and individuals who reported no binge eating at either time point (No/No) had significantly better weight losses than those who continued to binge (Yes/Yes) and those who began binge eating by 1-year (No/Yes) (p<0.0001). There were no weight loss differences between those who reported no binge eating at either time point and those that reported binge eating at baseline but not at 1-year (p=0.21). Similar patterns were observed when looking separately at the ILI and DSE conditions.
Given the differences in weight loss across the binge eating status groups, post hoc analyses were conducted to examine group differences in self-reported caloric change from baseline to 1-year in the subsample (N=1954) who completed the dietary measure. As shown in Figure 2, participants who reported no binge eating at either time point (No/No) and those participants who reported binge eating at baseline but not at 1-year (Yes/No) reported greater decreases in caloric intake from baseline to 1-year than those who were binge eating at both time points (Yes/Yes) or those who were not binge eating at baseline but were at 1-year (No/Yes) (p<0.0001 for specific contrast and over all; Table 4). The pattern was similar when looking separately at the ILI and DSE conditions, although some of the comparisons between binge eating categories were no longer significant. In addition to dietary data, we also conducted post hoc analyses to examine whether there were group differences in changes in fitness levels; however, no group differences were observed (p=0.43; Table 4).
Among those who reported binge eating at baseline, there was a significant association showing that higher frequencies of self-reported binge episodes were associated with smaller one-year weight losses (p=0.029); this pattern held true when examining the ILI condition separately (p=0.048) but was not found in the DSE condition (p=0.620). In the subsample providing dietary intake information, there was also a trend for higher baseline binge eating frequency to be associated with greater caloric declines over the one year period among those reporting baseline binge eating (p=0.054). This trend was more evident in the ILI condition (p=0.044) than in the DSE condition (p=0.35).
Finally, because of the influence substance use can have on weight, we examined whether the binge eating groups differed at 1-year in tobacco and alcohol use. There were no differences among the binge eating status groups at 1-year in the percentage of individuals who were currently smoking (p=0.40) or who reported binge drinking in the past month (p=0.19).
Approximately 1 in 10 overweight and obese individuals with type 2 diabetes participating in the Look AHEAD trial reported having 1 or more episodes of binge eating in the 6 months prior to study entry. These individuals were younger and more likely to be female, Caucasian, and college educated than their non-binge eating counterparts; demographic differences that are consistent with prior reports of binge eating in individuals with type 2 diabetes.13,15,16 As reported by others,5,15 individuals reporting binge eating at study entry had more difficulties with weight control and were heavier and had more extensive weight loss histories. They also consumed a diet higher in total calories and fat, replicating prior work by Yanovski and colleagues.29,30
Individuals reporting binge eating in our sample reported higher levels of depressive symptomatology, again consistent with the existing binge eating literature;5,13,16 however, depression levels in this sample were quite low even among individuals reporting binge eating. Binge drinking was also infrequent in this sample. Of interest, however, is that at study entry we found significantly lower rates of binge drinking in binge eaters compared to non-binge eaters, a finding that supports a recent report that obese individuals are less likely to suffer from substance use disorders than non-obese individuals.31 While concerns have been raised about “shifting addictions” or symptom substitution, such that the dietary restrictions accompanying weight loss may lead to increases in substance use32, our study suggests that the modest weight losses produced by a behavioral intervention are not associated with increases in either alcohol or tobacco use.
Individuals reporting binge eating at study entry had worse physical health, both by self-report and by medication usage, than non-binge eaters, yet there were no differences in HBA1c, years since diabetes diagnosis, or diabetes treatment regimens. Studies to date examining the connection between binge eating and glycemic control have found mixed results.13,15,16 The present study, which examines this relationship in a much larger and more demographically diverse sample, indicates that while overall physical health may be affected by binge eating, diabetes control per se is not.
Fewer than 4% of participants in either the intensive lifestyle intervention or diabetes support and education groups who reported no binge eating at baseline reported the behavior at 1-year follow-up, suggesting as others have found9,14 that behavioral weight loss treatment does not generally lead to initiation of binge eating behavior. In fact, those who participated in the intensive lifestyle intervention were marginally less likely to be engaging in binge eating behavior at 1-year than those completing the diabetes support and education groups. In addition, in both conditions, the majority of individuals (66.8%) who reported binge eating at baseline were no longer engaging in the behavior at 1-year. The reason for the instability of binge eating behavior is not clear. It could reflect a true improvement in binge eating as a result of participating in a structured program or it could mirror the natural course of binge eating, which has been shown to remit without treatment in many individuals in community samples.33,34
Perhaps most interesting is that 1-year weight losses were equivalent in individuals who indicated no binge eating at either baseline or 1-year and in individuals who reported binge eating at baseline but had ceased binge eating at 1-year. Weight losses in both of these groups were significantly better than in individuals who reported binge eating at both time points or who started binge eating over the 1-year period, suggesting that binge eating is only problematic if it persists, or starts, during treatment. The differences in weight loss between those who stopped binge eating and those who continued or started binge eating, while relatively small (2 kg), may have important health implications, particularly if maintained long term. These improved weight losses appear to be explained by greater decreases in caloric intake in those did not binge eat and those who stopped during treatment. Many prior studies have assessed binge eating at the start of treatment only, perhaps accounting for some of the mixed weight loss results reported in the literature. Our findings confirm current recommendations14 that individuals who binge eat should not be discouraged from entering behavioral weight loss programs. It also supports other studies that suggest abstinence from binge eating is associated with better weight loss outcomes at one year compared with those who continue binge eating35. Given that individuals who continued to binge eat and those who started to binge eating during treatment did not fare as well, it would appear useful to assess binge eating throughout treatment, not simply at entry into a program, and provide additional support as needed.
A limitation of this study is that we relied on a self-report measure of binge eating behavior. The gold standard for the assessment of binge eating is the Eating Disorder Examination interview36. Self-report measures of binge eating are most appropriately utilized as a screening measure for binge eating behavior as opposed to a diagnostic tool. However, the brevity and minimal cost of the self-report tool used in the present study increases the likelihood that screening for binge eating could be conducted in primary care settings or repeatedly throughout a weight loss program. In addition, self-reported binge eating has been shown to be consistent with the EDE interview in overweight individuals who binge eat.37,38 It is also important to note that our sample was comprised entirely of overweight individuals with type 2 diabetes who were seeking help to lose weight and were willing and able to participate in a long-term study. These individuals were likely very motivated to change their eating behaviors to improve their health and may not be representative of overweight individuals with type 2 diabetes as a whole. Moreover, because of the Look AHEAD trial’s focus on cardiovascular outcomes, participants were required to be between the ages of 45–76, a group that may be less prone to binge eating than younger individuals16, 39. These individuals had also been diagnosed with diabetes on average 7 years prior to study entry and may differ from newly diagnosed patients in eating habits and diabetes management. Our results should be interpreted with these limitations in mind.
This study adds to the literature by showing that binge eating still occurs with some frequency in older, overweight and obese adults with type 2 diabetes. Although individuals reporting binge eating also reported a more depressed mood and worse physical health than their non-binge eating peers, their diabetes control and management did not differ. Most individuals who reported binge eating at baseline stopped by 1-year and these individuals were just as successful at weight loss as those individuals who reported no binge eating on both occasions. Also, few individuals started binge eating during the one year period. This study lends further support to the recommendation that binge eating is not exacerbated by behavioral weight loss treatment and in fact may be improved by participating in a structured weight loss program targeting lifestyle changes.
This paper represents the collective efforts of the authors and the Look AHEAD Research Group whose members are listed below.
The Johns Hopkins Medical Institutions Frederick L. Brancati, MD, MHS1; Jeff Honas, MS2; Lawrence Cheskin, MD3; Jeanne M. Clark, MD, MPH3; Kerry Stewart, EdD3; Richard Rubin, PhD3; Jeanne Charleston, RN; Kathy Horak, RD
Pennington Biomedical Research Center George A. Bray, MD1; Kristi Rau2; Allison Strate, RN2; Brandi Armand, LPN2; Frank L. Greenway, MD3; Donna H. Ryan, MD3; Amy Bachand; Michelle Begnaud; Betsy Berhard; Elizabeth Caderette; Barbara Cerniauskas; David Creel; Diane Crow; Helen Guay; Nancy Kora; Kelly LaFleur; Kim Landry; Missy Lingle; Jennifer Perault; Mandy Shipp, RD; Marisa Smith; Elizabeth Tucker
The University of Alabama at Birmingham Cora E. Lewis, MD, MSPH1; Sheikilya Thomas MPH2; Monika Safford, MD3; Charlotte Bragg, MS, RD, LD; Amy Dobelstein; Stacey Gilbert, MPH; Stephen Glasser, MD; Sara Hannum, MA; Anne Hubbell, MS; Jennifer Jones, MA; DeLavallade Lee; Ruth Luketic, MA, MBA, MPH; Karen Marshall; L. Christie Oden; Janet Raines, MS; Cathy Roche, RN, BSN; Janet Truman; Nita Webb, MA; Audrey Wrenn, MAEd
Massachusetts General Hospital: David M. Nathan, MD1; Heather Turgeon, RN, BS, CDE2; Kristina Schumann, BA2; Enrico Cagliero, MD3; Linda Delahanty, MS, RD3; Kathryn Hayward, MD3; Ellen Anderson, MS, RD3; Laurie Bissett, MS, RD; Richard Ginsburg, PhD; Valerie Goldman, MS, RD; Virginia Harlan, MSW; Charles McKitrick, RN, BSN, CDE; Alan McNamara, BS; Theresa Michel, DPT, DSc CCS; Alexi Poulos, BA; Barbara Steiner, EdM; Joclyn Tosch, BA
Joslin Diabetes Center: Edward S. Horton, MD1; Sharon D. Jackson, MS, RD, CDE2; Osama Hamdy, MD, PhD3; A. Enrique Caballero, MD3; Sarah Bain, BS; Elizabeth Bovaird, BSN, RN; Ann Goebel-Fabbri, PhD; Lori Lambert, MS, RD; Sarah Ledbury, MEd, RD; Maureen Malloy, BS; Kerry Ovalle, MS, RCEP, CDE
University of Colorado Health Sciences Center James O. Hill, PhD1; Marsha Miller, MS, RD2; JoAnn Phillipp, MS2; Robert Schwartz, MD3; Brent Van Dorsten, PhD3; Judith Regensteiner, PhD3; Salma Benchekroun MS; Ligia Coelho, BS; Paulette Cohrs, RN, BSN; Elizabeth Daeninck, MS, RD; Amy Fields, MPH; Susan Green; April Hamilton, BS, CCRC; Jere Hamilton, BA; Eugene Leshchinskiy; Michael McDermott, MD; Lindsey Munkwitz, BS; Loretta Rome, TRS; Kristin Wallace, MPH; Terra Worley, BA
Baylor College of Medicine John P. Foreyt, PhD1; Rebecca S. Reeves, DrPH, RD2; Henry Pownall, PhD3; Ashok Balasubramanyam, MBBS3; Peter Jones, MD3; Michele Burrington, RD; Chu-Huang Chen, MD, PhD; Allyson Clark, RD; Molly Gee, MEd, RD; Sharon Griggs; Michelle Hamilton; Veronica Holley; Jayne Joseph, RD; Patricia Pace, RD: Julieta Palencia, RN; Olga Satterwhite, RD; Jennifer Schmidt; Devin Volding, LMSW; Carolyn White
University of California at Los Angeles School of Medicine Mohammed F. Saad, MD1; Siran Ghazarian Sengardi, MD2; Ken C. Chiu, MD3; Medhat Botrous; Michelle Chan, BS; Kati Konersman, MA, RD, CDE; Magpuri Perpetua, RD
The University of Tennessee Health Science Center Karen C. Johnson, MD, MPH1; Helen Lambeth, RN, BSN2; Carolyn M. Gresham, RN2; Abbas E. Kitabchi, MD, PhD3; Stephanie A. Connelly, MD, MPH3; Lynne Lichtermann, RN, BSN
University of Minnesota Robert W. Jeffery, PhD1; Carolyn Thorson, CCRP2; John P. Bantle, MD3; J. Bruce Redmon, MD3; Richard S. Crow, MD3; Scott Crow, MD3; Susan K Raatz, PhD, RD3; Kerrin Brelje, MPH, RD; Carolyne Campbell; Jeanne Carls, MEd; Tara Carmean-Mihm, BA; Emily Finch, MA; Anna Fox, MA; Elizabeth Hoelscher, MPH, RD, CHES; La Donna James; Vicki A. Maddy, BS, RD; Therese Ockenden, RN; Birgitta I. Rice, MS, RPh CHES; Tricia Skarphol, BS; Ann D. Tucker, BA; Mary Susan Voeller, BA; Cara Walcheck, BS, RD
University of Pennsylvania Thomas A. Wadden, PhD1; Barbara J. Maschak-Carey, MSN, CDE2; Stanley Schwartz, MD3; Gary D. Foster, PhD3; Robert I. Berkowitz, MD3; Henry Glick, PhD3; Shiriki K. Kumanyika, PhD, RD, MPH3; Johanna Brock; Helen Chomentowski; Vicki Clark; Canice Crerand, PhD; Renee Davenport; Andrea Diamond, MS, RD; Anthony Fabricatore, PhD; Louise Hesson, MSN; Stephanie Krauthamer-Ewing, MPH; Robert Kuehnel, PhD; Patricia Lipschutz, MSN; Monica Mullen, MS, RD; Leslie Womble, PhD, MS; Nayyar Iqbal, MD
University of Pittsburgh David E. Kelley, MD1; Jacqueline Wesche-Thobaben, RN, BSN, CDE2; Lewis Kuller, MD, DrPH3; Andrea Kriska, PhD3; Janet Bonk, RN, MPH; Rebecca Danchenko, BS; Daniel Edmundowicz, MD3; Mary L. Klem, PhD, MLIS3; Monica E. Yamamoto, DrPH, RD, FADA 3; Barb Elnyczky, MA; George A. Grove, MS; Pat Harper, MS, RD, LDN; Janet Krulia, RN, BSN, CDE; Juliet Mancino, MS, RD, CDE, LDN; Anne Mathews, MS, RD, LDN; Tracey Y. Murray, BS; Joan R. Ritchea; Jennifer Rush, MPH; Karen Vujevich, RN-BC, MSN, CRNP; Donna Wolf, MS
The Miriam Hospital/Brown Medical School Rena R. Wing, PhD1; Renee Bright, MS2; Vincent Pera, MD3; John Jakicic, PhD3; Deborah Tate, PhD3; Kara Gallagher, PhD3; Amy Bach, PhD; Barbara Bancroft, RN, MS; Anna Bertorelli, MBA, RD; Richard Carey, BS; Tatum Charron, BS; Heather Chenot, MS; Kimberley Chula-Maguire, MS; Pamela Coward, MS, RD; Lisa Cronkite, BS; Julie Currin, MD; Maureen Daly, RN; Caitlin Egan, MS; Erica Ferguson, BS, RD; Linda Foss, MPH; Jennifer Gauvin, BS; Don Kieffer, PhD; Lauren Lessard, BS; Deborah Maier, MS; JP Massaro, BS; Tammy Monk, MS; Rob Nicholson, PhD; Erin Patterson, BS; Suzanne Phelan, PhD; Hollie Raynor, PhD, RD; Douglas Raynor, PhD; Natalie Robinson, MS, RD; Deborah Robles; Jane Tavares, BS
University of Washington/VA Puget Sound Health Care System Steven Kahn MB, ChB1; Brenda Montgomery, RN, MS, CDE2; Robert Knopp, MD3; Edward Lipkin, MD3; Matthew L. Maciejewski, PhD3; Dace Trence, MD3; Terry Barrett, BS; Joli Bartell, BA; Diane Greenberg, PhD; Anne Murillo, BS; Betty Ann Richmond, MEd; April Thomas, MPH, RD
Southwestern American Indian Center, Phoenix, Arizona and Shiprock, New Mexico William C. Knowler, MD, DrPH1; Paula Bolin, RN, MC2; Tina Killean, BS2; Cathy Manus, LPN; Jonathan Krakoff, MD3; Jeffrey M. Curtis, MD, MPH3; Justin Glass, MD3; Sara Michaels, MD3; Peter H. Bennett, MB, FRCP3; Tina Morgan3; Shandiin Begay, MPH; Bernadita Fallis RN, RHIT, CCS; Jeanette Hermes, MS, RD; Diane F. Hollowbreast; Ruby Johnson; Cathy Manus LPN; Maria Meacham, BSN, RN, CDE; Julie Nelson, RD; Carol Percy, RN; Patricia Poorthunder; Sandra Sangster; Nancy Scurlock, MSN, ANP-C, CDE; Leigh A. Shovestull, RD, CDE; Janelia Smiley; Katie Toledo, MS, LPC; Christina Tomchee, BA; Darryl Tonemah PhD
Wake Forest University Mark A. Espeland, PhD1; Judy L. Bahnson, BA2; Lynne Wagenknecht, DrPH3; David Reboussin, PhD3; W. Jack Rejeski, PhD3; Alain Bertoni, MD, MPH3; Wei Lang, PhD3; Gary Miller, PhD3; David Lefkowitz, MD3; Patrick S. Reynolds, MD3; Paul Ribisl, PhD3; Mara Vitolins, DrPH3; Michael Booth, MBA2; Kathy M. Dotson, BA2; Amelia Hodges, BA2; Carrie C. Williams, BS2; Jerry M. Barnes, MA; Patricia A. Feeney, MS; Jason Griffin, BS; Lea Harvin, BS; William Herman, MD, MPH; Patricia Hogan, MS; Sarah Jaramillo, MS; Mark King, BS; Kathy Lane, BS; Rebecca Neiberg, MS; Andrea Ruggiero, MS; Christian Speas, BS; Michael P. Walkup, MS; Karen Wall, AAS; Michelle Ward; Delia S. West, PhD; Terri Windham
Central Resources Centers
DXA Reading Center, University of California at San Francisco Michael Nevitt, PhD1; Susan Ewing, MS; Cynthia Hayashi; Jason Maeda, MPH; Lisa Palermo, MS, MA; Michaela Rahorst; Ann Schwartz, PhD; John Shepherd, PhD
Central Laboratory, Northwest Lipid Research Laboratories Santica M. Marcovina, PhD, ScD1; Greg Strylewicz, MS
ECG Reading Center, EPICARE, Wake Forest University School of Medicine
Ronald J. Prineas, MD, PhD1; Teresa Alexander; Lisa Billings; Charles Campbell, AAS, BS; Sharon Hall; Susan Hensley; Yabing Li, MD; Zhu-Ming Zhang, MD
Diet Assessment Center, University of South Carolina, Arnold School of Public Health, Center for Research in Nutrition and Health Disparities Elizabeth J Mayer-Davis, PhD1; Robert Moran, PhD
Hall-Foushee Communications, Inc.
Richard Foushee, PhD; Nancy J. Hall, MA
National Institute of Diabetes and Digestive and Kidney Diseases: Barbara Harrison, MS; Van S. Hubbard, MD PhD; Susan Z. Yanovski, MD, Mary Evans, PhD
National Heart, Lung, and Blood Institute: Lawton S. Cooper, MD, MPH; Jeffrey Cutler, MD, MPH; Eva Obarzanek, PhD, MPH, RD
Centers for Disease Control and Prevention: Edward W. Gregg, PhD; David F. Williamson, PhD; Ping Zhang, PhD
Funding sources: This study is supported by the Department of Health and Human Services through the following cooperative agreements from the National Institutes of Health: DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135, and DK56992. The following federal agencies have contributed support: National Institute of Diabetes and Digestive and Kidney Diseases; National Heart, Lung, and Blood Institute; National Institute of Nursing Research; National Center on Minority Health and Health Disparities; Office of Research on Women’s Health; and the Centers for Disease Control and Prevention. This research was supported in part by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases.
Additional support was received from The Johns Hopkins Medical Institutions Bayview General Clinical Research Center (M01RR02719); the Massachusetts General Hospital Mallinckrodt General Clinical Research Center (M01RR01066); the University of Colorado Health Sciences Center General Clinical Research Center (M01RR00051) and Clinical Nutrition Research Unit (P30 DK48520); the University of Tennessee at Memphis General Clinical Research Center (M01RR0021140); the University of Pittsburgh General Clinical Research Center (M01RR000056 44) and NIH grant (DK 046204); and the University of Washington/VA Puget Sound Health Care System Medical Research Service, Department of Veterans Affairs; Frederic C. Bartter General Clinical Research Center (M01RR01346)
The following organizations have committed to make major contributions to Look AHEAD: Federal Express; Health Management Resources; Johnson & Johnson, LifeScan Inc.; Optifast-Novartis Nutrition; Roche Pharmaceuticals; Ross Product Division of Abbott Laboratories; and Slim-Fast Foods Company.
Presented at the Society of Behavioral Medicine’s Annual Conferece, San Diego, CA, March 2008
All other Look AHEAD staff are listed alphabetically by site.
Amy A. Gorin, Department of Psychology, Center for Health, Intervention and Prevention, University of Connecticut, 2006 Hillside Road, Unit 1248, Storrs, CT 06269-1248, Email: firstname.lastname@example.org.
Heather M. Niemeier, Brown Medical School, The Miriam Hospital, 196 Richmond Street, Providence, RI 02903, Email: gro.napsefil@reiemeinh.
Patricia Hogan, Department of Biostatistical Sciences, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1063, Email: ude.cmbufw@nagohp.
Mace Coday, Department of Preventive Medicine, The University of Tennessee Health Science Center, 66 N. Pauline Street, Memphis, TN 38163, Email: ude.memtu@yadocm.
Cralen Davis, Department of Biostatistical Sciences, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1063, Email: ude.cmbufw@sivadc.
Vicki G. DiLillo, Department of Psychology, Ohio Wesleyan University, 61 S. Sandusky St., 43015”, Email: ude.uwo@llilidgv.
Marci E. Gluck, Obesity & Diabetes Clinical Research Section, NIH/NIDDK, 4212 North 16th Street, Phoenix, AZ 85016, Email: vog.hin.kddin@icramg.
Thomas A. Wadden, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104-2648, Email: ude.nnepu.dem.liam@neddaw.
Delia S. West, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham St, #820, Little Rock, AR 72205, Email: ude.smau@1tsewsd..
Donald Williamson, Pennington Biomedical Research Center, Louisiana State University, 6400 Perkins Road, Baton Rouge, LA 70808, Email: ude.crbp@adailliw.
Susan Z. Yanovski, Division of Digestive Diseases and Nutrition, NIDDK/NIH/DHHS, Bethesda, MD 20892-5450, Email: vog.hin@f92ys.