Why Look AHEAD failed

Why Look AHEAD failed looks at some aspects of the lifestyle study that failed so miserably to achieve permanent goals for those with metabolic syndrome.

Conferences, Expert Panel debates and Research projects blandly state that the Look AHEAD study clearly shows that lifestyle management does not permanently reduce weight loss and the morbidity associated with type 2 diabetes. And it's true that the it was abandoned after 13 years.

Shall we look at more deeply into why Look AHEAD failed?

Complex

Let's acknowledge up front that there is nothing simple about the management of obesity and the associated type 2 obesity. Those looking for some little feature that they can easily tack onto their lifestyles had best look elsewhere; the new drugs like the GLP-1 agonists perhaps.

But if you are one of those who really wants to be healthy without medicines, read on.

I say this with confidence as a person who has permanently lost 10kg and got my blood glucose entirely under control; and I might say without a great deal of difficulty and pain. My A1_c is now a very healthy 5.4.

It can be done; but whatever changes you make must be for ever. Caloric restriction or a daily walk for a few months or even a year or two is doomed to fail. The same is true of weight loss drugs.

Make no changes that you are not absolutely determined to do for the rest of your life. Many studies clearly show that repeated cycles of weight loss and gain are far more detrimental than if you made no lifestyle or drug alterations.

Caloric restriction

So why did the Look AHEAD intervention study fail so miserably? The changes looked so simple and desirable; just restrict your calories and start walking. Then everything will be hunkydory, the pounds will fall off and you can stop taking all those meds.

The pounds did fall off but they came roaring right back; so much so that the study was abandoned.

The first reason why Look AHEAD failed is that one of the cornerstones of the programme was caloric restriction; that leaves you constantly famished. And one study after another clearly shows that these diets fail dismally in the long run; they simply are not sustainable.

In fact caloric restriction was what got America into trouble in the first place. When Radley Keys crooked the books some fifty years ago, convincing the world that fats were the cause of heart disease, obesity very quickly became a major problem.

And in fact we are still flirting with the false belief that cutting out high caloric foods is the way to lose weight. Fats provide satiety; any diet that restricts them is doomed to fail.

Any diet that leaves you constantly hungry will fail.

The fat in eggs, cheese and meat is what provides satiety; and the protein too, of course. Restricting them leaves you constantly thinking about food. Look AHEAD was doomed to fail from the very beginning; if only the proponents first read up on their own research.

Butter, cream and coconut oil remain more controversial. My own belief is that the dilemma is resolved by whatever else you are eating. Those enjoying meals centred on whole grains and many coloured foods need have no fear of cholesterol. If is after all fundamental in the structure of every cell in your body.

Brisk walking or similar aerobic activity

It sounds so good; just walk briskly, get on your bicycle or into the swimming pool for more than 175 minutes per week. That is a little over half an hour a day.

And it is good but it doesn't go far enough. That brisk walk must be taken after any starchy meal; and ten minutes would probably suffice.

It came as a rude shock to me. Freshly-squeezed OJ from citrus in our own garden, without using the strainer, put my blood glucose into orbit. We are great believers in using the pulp in fruit, that's where more than half of the goodness is, so it upset my theory no end.

Equally astonishing was that followed by a brisk ten minute walk, my BG did not even rise by a small iota; all those sugars were turned into glycogen, not blood glucose.

A three-hour hike on Saturday would fail dismally in lowering chronically raised blood glucose. So would a half hour brisk walk on getting home after work; that exercise needs to be taken after your starchy meals.

And it didn't take me long to discover that wasn't just my experience; it has been confirmed by strong evidence published in Medicine & Science in SPORTS and EXERCISE^[2].

After dinner

Interestingly for reasons unknown that short brisk walk is most effective after dinner in the evening.

So that is another reason why Look AHEAD failed; it did not specify that exercise should be taken after meals.

Another reason is that walking is not enough at any time of the day. There is clear evidence that high-intensity resistance exercise is even more effective in the "overall glucose management and attenuation of insulin levels^[2]."

Fiber

Another clear reason why look AHEAD failed was that the only dietary recommendation was caloric restriction. There was no acknowledgement of the way that fiber acts exactly like the GLP-1 drugs by stimulating the cells that release the incretin hormones; they slow gastric emptying, send signals to the hypothalamus achieving early satiety and messages to the pancreas.

Ultra-processed food

The research is fundamentally clear; ultra-processed foods are at the very epicentre of today's chronic degenerative diseases like type 2 diabetes.

So another reason why the Look AHEAD protocol failed was that its insistence on two banquets and one snack of "liquid meal replacement" each and every day; simply awful unsustainable ultra-processed food.

High protein meal replacement products like protein bars, whey powders and various shakes just substitute one poor diet with another. They simply are not sustainable; and are completely unnecessary. It's not difficult to see why look AHEAD failed.

What should be priority in managing early diabetes

The debate at the 2024 American Diabetes Association Scientific Session between four top doctors was robust and impassioned. Their opinions^[1] ranged widely from "treat obesity first" to "it's about the glucose, stupid."

They emphasised the potentially fatal complications of diabetes ranging from blindness, amputation of a limb to cardiovascular disease.

The underlying belief was that we are unable to give up sugar and other refined carbs; only medication can save us from fatal heart attacks, strokes and kidney failure.

There was no discussion why Look AHEAD failed, only that "intensive lifestyle weight loss intervention" shows no significant benefit. Despite the side effects, those that can afford it must take the medication for the rest of their lives.

Are you one of them? Then read further.

• Bernie's scientifically proven weight loss program.

A transforming read

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"This was supposed to be a diary of my first two months on the diabetes drug recently recast as a miracle shortcut to weight loss; and a catalogue of its excruciating side effects.

But it became something else entirely. This is a story about realising I’d lived a false life as a slim person for years; and to finally admitting to my obesity, then dealing with it.^[3]"

Doctor: "Why don’t you tell me how you reached this weight; how do you believe it happened?"

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Why Look AHEAD failed

Understanding why Look AHEAD failed is fundamental for those wanting permanent weight loss through lifestyle management without the use of medication.

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