BACKGROUND: It is unknown whether intentional weight loss provides long-term benefits for cognitive function. METHODS: An ancillary study to a randomized controlled clinical trial was conducted in overweight and obese individuals (n = 978), aged 45 to 76 years at enrollment, with type 2 diabetes. An intensive behavioral intervention designed to promote and maintain weight loss through caloric restriction and increased physical activity was compared with diabetes support and education. Standardized assessments of cognitive function were collected an average of 8.1 years after trial enrollment. RESULTS: Participants assigned to intensive lifestyle intervention lost a mean (SE) 11.1% (0.4%) and 7.2% (0.5%) of weight at years 1 and 8, respectively, compared with 1.0% (0.2%) and 3.3% (0.5%) in the control group (p < 0.001). Covariate-adjusted mean composite cognitive function test scores were similar for the two groups (p = 0.69), and no significant differences were found for any individual cognitive test. There was some evidence of a differential effect (nominal interaction p = 0.008) for a prespecified comparison: Intensive lifestyle intervention was associated with a relative mean benefit for composite cognitive function of 0.276 (95% confidence interval 0.033 to 0.520) SDs among individuals with body mass index less than 30 kg/m2 at baseline compared with a relative mean deficit of 0.086 (-0.021 to 0.194) SDs among individuals with body mass more than or equal to 30 kg/m2. CONCLUSIONS: Eight years of intensive lifestyle intervention did not alter cognitive function in obese adults with type 2 diabetes; however, there was evidence for benefit among overweight but not obese individuals. Changes in cognition were not assessed in this cross-sectional study.
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