Impact of intensive lifestyle intervention on depression and health-related quality of life in type 2 diabetes: the Look AHEAD Trial

Richard R Rubin, Thomas A Wadden, Judy L Bahnson, George L Blackburn, Frederick L Brancati, George A Bray, Mace Coday, Scott J Crow, Jeffrey M Curtis, Gareth Dutton, Caitlin Egan, Mary Evans, Lin Ewing, Lucy Faulconbridge, John Foreyt, Sarah A Gaussoin, Edward W Gregg, Helen P Hazuda, James O Hill, Edward S HortonVan S Hubbard, John M Jakicic, Robert W Jeffery, Karen C Johnson, Steven E Kahn, William C Knowler, Wei Lang, Cora E Lewis, Maria G Montez, Anne Murillo, David M Nathan, Jennifer Patricio, Anne Peters, Xavier Pi-Sunyer, Henry Pownall, W Jack Rejeski, Renate H Rosenthal, Valerie Ruelas, Katie Toledo, Brent Van Dorsten, Mara Vitolins, Donald Williamson, Rina R Wing, Susan Z Yanovski, Ping Zhang, Look AHEAD Research Group

Research output: Contribution to journalArticlepeer-review

157 Scopus citations


OBJECTIVE: We examined the effects of an intensive lifestyle intervention (ILI), compared with a diabetes support and education (DSE) control intervention, on long-term changes in depression symptoms, antidepressant medication (ADM) use, and health-related quality of life (HRQoL) in overweight/obese individuals with type 2 diabetes.

RESEARCH DESIGN AND METHODS: Look AHEAD was a multisite randomized controlled trial of 5,145 overweight/obese participants assigned to ILI (designed to produce weight loss) or DSE and followed for a median of 9.6 years. The Beck Depression Inventory (BDI) was administered at baseline, annually at years 1-4, and again at year 8. Mean BDI scores and incidence of BDI scores ≥10, indicative of likely mild or greater depression, were examined. Annually through year 10, participants reported their ADM use and completed the Medical Outcomes Study Short Form 36 (SF-36) questionnaire, which yields physical component summary (PCS) and mental component summary (MCS) scores.

RESULTS: ILI significantly reduced the incidence of mild or greater depression symptoms (BDI scores ≥10) compared with DSE (hazard ratio [HR] = 0.85; 95% CI 0.75-0.97; P = 0.0145). Although SF-36 PCS scores worsened over time in both groups, ILI participants reported better physical function than DSE throughout the first 8 years (all P values <0.01). There were no significant differences between treatment arms in the proportion of participants who used ADMs or in SF-36 MCS scores.

CONCLUSIONS: ILI for overweight/obese patients with type 2 diabetes may reduce the risk of developing clinically significant symptoms of depression and preserve physical HRQoL. These findings should be considered when evaluating the potential benefits of ILIs.

Original languageEnglish (US)
Pages (from-to)1544-53
Number of pages10
JournalDiabetes care
Issue number6
StatePublished - Jun 2014


  • Antidepressive Agents
  • Depression
  • Diabetes Mellitus, Type 2
  • Female
  • Humans
  • Life Style
  • Male
  • Middle Aged
  • Obesity
  • Overweight
  • Quality of Life
  • Surveys and Questionnaires
  • Treatment Outcome
  • Weight Loss


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