OBJECTIVE: To determine the effects of an intensive lifestyle intervention versus a comparison group on body composition in obese or overweight persons with type 2 diabetes at baseline and at 1, 4, and 8 years. METHODS: Body composition was measured by dual-energy x-ray absorptiometry in a subset of 1,019 Look AHEAD study volunteers randomized to intervention or comparison groups. The intervention was designed to achieve and maintain > 7% weight loss through increased physical activity and reduced caloric intake. The comparison group received social support and diabetes education. RESULTS: At 1 year, the intervention group lost fat (5.6 +/- 0.2 kg) and lean mass (2.3 +/- 0.1 kg) but regained fat (about 100%) and lost lean mass between years 1 and 8. Between baseline and year 8, weight loss was greater in intervention versus comparison groups (4.0 +/- 0.4 versus. 2.3 +/- 0.4 kg); comparison group weight loss was mostly lean mass (2.1 +/- 0.17 kg). Fat mass in the intervention group was lower than that of the comparison group at all post-baseline time points. CONCLUSIONS: Reduced fat mass may place the intervention group at a lower risk of obesity-linked sequelae, a hypothesis that can be tested by future studies of this cohort.

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