1 00:00:05,840 --> 00:00:08,520 MY NAME IS DAVID MURRAY, 2 00:00:08,520 --> 00:00:10,040 DIRECTOR OF THE OFFICE OF 3 00:00:10,040 --> 00:00:10,680 DISEASE PREVENTION. 4 00:00:10,680 --> 00:00:12,240 I'M PLEASED TO WELCOME YOU ALL 5 00:00:12,240 --> 00:00:15,680 TO THE 2022 ROBERT S. GORDON, 6 00:00:15,680 --> 00:00:19,440 JR. LECTURE IN EPIDEMIOLOGY. 7 00:00:19,440 --> 00:00:21,880 THE GORDON LECTURE IS AWARD EACH 8 00:00:21,880 --> 00:00:23,640 YEAR TO A SCIENTIST WHO'S MADE 9 00:00:23,640 --> 00:00:24,440 MAJOR CONTRIBUTIONS TO RESEARCH 10 00:00:24,440 --> 00:00:26,120 OR TRAINING IN THE FIELD OF 11 00:00:26,120 --> 00:00:27,560 EPIDEMIOLOGY OR IN THE CONDUCT 12 00:00:27,560 --> 00:00:33,240 OF CLINICAL TRIALS. 13 00:00:33,240 --> 00:00:35,120 THIS IS THE 27TH YEAR THAT THE 14 00:00:35,120 --> 00:00:38,280 ODP HAS SPONSORED THE GORDON 15 00:00:38,280 --> 00:00:38,920 LECTURE. 16 00:00:38,920 --> 00:00:41,200 THE AWARD WAS ESTABLISHED IN 17 00:00:41,200 --> 00:00:43,240 TRIB UNIT 18 00:00:43,240 --> 00:00:46,280 TRIBUTE TO ROBERT S. GORDON AND 19 00:00:46,280 --> 00:00:47,720 HIS DISTINGUISHED SERVICE TO 20 00:00:47,720 --> 00:00:47,960 NIH. 21 00:00:47,960 --> 00:00:51,560 OVER THE COURSE OF 30 YEARS, DRS 22 00:00:51,560 --> 00:00:52,760 SENIOR LEADERSHIP POSITIONS 23 00:00:52,760 --> 00:00:53,760 INCLUDING SPECIAL ASSISTANT TO 24 00:00:53,760 --> 00:00:55,480 THE DIRECTOR AND CHIEF ADVISOR 25 00:00:55,480 --> 00:00:56,920 FOR CLINICAL PRACTICE AND 26 00:00:56,920 --> 00:00:57,800 RESEARCH. 27 00:00:57,800 --> 00:00:58,880 DR. GORDON WAS AN EARLY 28 00:00:58,880 --> 00:01:00,520 ORGANIZER OF EFFORTS TO ADDRESS 29 00:01:00,520 --> 00:01:02,600 THE EMERGING PROBLEM OF HIV/AIDS 30 00:01:02,600 --> 00:01:04,040 AND HE BECAME A KEY COORDINATOR 31 00:01:04,040 --> 00:01:07,840 OF AIDS RESEARCH AT NIH. 32 00:01:07,840 --> 00:01:14,120 TODAY'S SPEAKER IS DR. RENA 33 00:01:14,120 --> 00:01:15,400 WELL-KNOWN ON HER RESEARCH ON 34 00:01:15,400 --> 00:01:17,040 TREATMENT OF OBESITY AND ITS 35 00:01:17,040 --> 00:01:18,160 APPLICATION IN TYPE 2 DIABETES. 36 00:01:18,160 --> 00:01:20,120 SHE HAS PUBLISHED HUNDREDS OF 37 00:01:20,120 --> 00:01:21,440 PEER REVIEWED ARTICLES ON THESE 38 00:01:21,440 --> 00:01:22,520 TOPICS, CURRENTLY SHE'S THE 39 00:01:22,520 --> 00:01:24,480 PRINCIPAL INVESTIGATOR ON THE 40 00:01:24,480 --> 00:01:27,120 DIABETES PREVENTION PROGRAM AND 41 00:01:27,120 --> 00:01:28,440 HAS DEVELOPED THE LIFESTYLE 42 00:01:28,440 --> 00:01:29,320 INTERVENTION BEING USED IN ALL 43 00:01:29,320 --> 00:01:32,600 THE CENTERS IN THAT STUDY. 44 00:01:32,600 --> 00:01:33,280 DR. WING IS A MEMBER OF THE 45 00:01:33,280 --> 00:01:34,480 COUNCIL FOR THE NATIONAL 46 00:01:34,480 --> 00:01:35,520 INSTITUTE FOR DIABETES AND 47 00:01:35,520 --> 00:01:38,160 DIGESTIVE AND KIDNEY DISEASES 48 00:01:38,160 --> 00:01:40,040 AND SERVES ON THE NIDDK TASK 49 00:01:40,040 --> 00:01:40,920 FORCE ON THE PREVENTION AND 50 00:01:40,920 --> 00:01:42,920 TREATMENT OF OBESITY. 51 00:01:42,920 --> 00:01:44,800 HER PRESENTATION IS ENTITLED 52 00:01:44,800 --> 00:01:46,120 "SHOULD OLDER ADULTS WITH 53 00:01:46,120 --> 00:01:48,760 DIABETES AND OBESITY LOSE 54 00:01:48,760 --> 00:01:49,040 WEIGHT?" 55 00:01:49,040 --> 00:01:52,000 PLEASE JOIN ME IN WELCOMING THE 56 00:01:52,000 --> 00:01:54,120 2022 ROBERT S. GORDON JUNIOR 57 00:01:54,120 --> 00:01:55,120 LECTURE AWARD RECIPIENT, 58 00:01:55,120 --> 00:01:56,320 DR. REENA WING. 59 00:01:56,320 --> 00:01:57,320 >>THANK YOU, DAVID. 60 00:01:57,320 --> 00:01:59,200 THAT WAS A VERY NICE 61 00:01:59,200 --> 00:01:59,520 INTRODUCTION. 62 00:01:59,520 --> 00:02:00,920 I WANT TO THANK DR. MURRAY AND 63 00:02:00,920 --> 00:02:03,960 THE OFFICE OF DISEASE PREVENTION 64 00:02:03,960 --> 00:02:05,440 FOR SELECTING ME TO GIVE THIS 65 00:02:05,440 --> 00:02:06,920 GORDON LECTURE IN EPIDEMIOLOGY 66 00:02:06,920 --> 00:02:10,640 FOR THE YEAR 2022. 67 00:02:10,640 --> 00:02:12,520 I'LL BE USING DATA FROM THE LOOK 68 00:02:12,520 --> 00:02:15,080 AHEAD STUDY TO ADDRESS THE 69 00:02:15,080 --> 00:02:16,080 QUESTION OF WHETHER OLDER ADULTS 70 00:02:16,080 --> 00:02:17,800 WITH DIABETES AND OBESITY SHOULD 71 00:02:17,800 --> 00:02:19,880 LOSE WEIGHT. 72 00:02:19,880 --> 00:02:24,040 FOR THE PAST 22 YEARS, THAT'S 73 00:02:24,040 --> 00:02:25,520 ALMOST A QUARTER OF A CENTURY, 74 00:02:25,520 --> 00:02:28,000 I'VE HAD THE OPPORTUNITY TO BE 75 00:02:28,000 --> 00:02:31,840 P.I. OF ONE OF THE SITES OF LOOK 76 00:02:31,840 --> 00:02:33,000 AHEAD AND CHAIRMAN OF THE LOOK 77 00:02:33,000 --> 00:02:35,480 AHEAD TRIAL. 78 00:02:35,480 --> 00:02:38,600 SO YOU IT'S A GREAT PRIVILEGEO 79 00:02:38,600 --> 00:02:40,240 HAVE THE CHANCE TO PRESENT TO 80 00:02:40,240 --> 00:02:41,760 YOU THE RESULTS FROM THIS KEY 81 00:02:41,760 --> 00:02:42,520 STUDY. 82 00:02:42,520 --> 00:02:44,480 IT TAKES A VILLAGE, REALLY, TO 83 00:02:44,480 --> 00:02:46,600 IMPLEMENT A STUDY SUCH AS THIS. 84 00:02:46,600 --> 00:02:48,600 SO IF I WERE TO MAKE A LIST OF 85 00:02:48,600 --> 00:02:50,240 ALL THE PEOPLE INVOLVED IN THE 86 00:02:50,240 --> 00:02:51,720 LOOK AHEAD TRIAL, WE WOULD NEVER 87 00:02:51,720 --> 00:02:53,040 GET TO ANY OF MY OTHER SLIDES. 88 00:02:53,040 --> 00:02:54,680 SO WHAT I WANT TO DO IS JUST 89 00:02:54,680 --> 00:02:55,400 ACKNOWLEDGE THE GROUPS OF PEOPLE 90 00:02:55,400 --> 00:02:56,760 WHO HAVE BEEN INVOLVED IN THE 91 00:02:56,760 --> 00:02:57,200 STUDY. 92 00:02:57,200 --> 00:02:59,720 SO IT INCLUDES THE P.I., THE 93 00:02:59,720 --> 00:03:01,600 COINVESTIGATORS AT EACH OF THE 94 00:03:01,600 --> 00:03:02,360 16 SITES. 95 00:03:02,360 --> 00:03:04,000 THE PROGRAM COORDINATORS WHO ARE 96 00:03:04,000 --> 00:03:05,920 OFTEN NURSES OR INTERVENTIONISTS 97 00:03:05,920 --> 00:03:07,680 AT EACH OF THE SITES WHO ARE 98 00:03:07,680 --> 00:03:08,840 REALLY RESPONSIBLE FOR RUNNING 99 00:03:08,840 --> 00:03:10,560 THE STUDY. 100 00:03:10,560 --> 00:03:12,680 THE EXECUTIVE COMMITTEE THAT MET 101 00:03:12,680 --> 00:03:17,480 ON PHONE CALLS EVERY WEEK FOR 22 102 00:03:17,480 --> 00:03:18,480 YEARS. 103 00:03:18,480 --> 00:03:19,760 NIH THAT WAS A PRIMARY SPONSOR 104 00:03:19,760 --> 00:03:23,080 OF THIS TRIAL, AND PARTICULARLY 105 00:03:23,080 --> 00:03:25,120 NIDDK, WHO PROVIDED MOST OF THE 106 00:03:25,120 --> 00:03:27,120 FUNDING FOR THE STUDY. 107 00:03:27,120 --> 00:03:28,200 I'VE ALSO SHOWN SOME OF THE 108 00:03:28,200 --> 00:03:30,160 OTHER GROUPS THAT WERE INVOLVED 109 00:03:30,160 --> 00:03:31,720 IN FUNDING THIS RESEARCH. 110 00:03:31,720 --> 00:03:33,480 THE CDC AND OTHER FUNDING 111 00:03:33,480 --> 00:03:36,000 AGENCIES WERE INVOLVED, AND IN 112 00:03:36,000 --> 00:03:37,640 PARTICULAR, I WANT TO THANK THE 113 00:03:37,640 --> 00:03:40,160 PARTICIPANTS IN THE TRIAL. 114 00:03:40,160 --> 00:03:41,440 THIS STUDY COULD NOT HAVE BEEN 115 00:03:41,440 --> 00:03:43,200 DONE WITHOUT THEM AND THEIR 116 00:03:43,200 --> 00:03:44,120 LOYAL PARTICIPATION FOR 22 117 00:03:44,120 --> 00:03:45,880 YEARS. 118 00:03:45,880 --> 00:03:47,480 WHAT I WANT TO DO IS FIRST COVER 119 00:03:47,480 --> 00:03:48,720 THE BACKGROUND TO LOOK AHEAD, 120 00:03:48,720 --> 00:03:49,600 THEN I'LL TALK ABOUT THE DESIGN 121 00:03:49,600 --> 00:03:51,800 OF THE TRIAL, THE PRIMARY 122 00:03:51,800 --> 00:03:53,200 OUTCOME AND SOME OF THE POSSIBLE 123 00:03:53,200 --> 00:03:56,160 EXPLANATIONS FOR THOSE RESULTS, 124 00:03:56,160 --> 00:03:57,360 I'LL THEN DEAL WITH OTHER 125 00:03:57,360 --> 00:03:58,560 OUTCOMES OF LOOK AHEAD AND COME 126 00:03:58,560 --> 00:04:03,840 TO CONCLUSIONS AND IMPLICATIONS. 127 00:04:03,840 --> 00:04:04,800 NOW WEIGHT LOSS IS RECOMMENDED 128 00:04:04,800 --> 00:04:05,960 FOR OVERWEIGHT AND OBESE ADULTS. 129 00:04:05,960 --> 00:04:10,640 ESPECIALLY FOR THOSE WITH TYPE . 130 00:04:10,640 --> 00:04:11,640 HOWEVER, OBSERVATIONAL STUDIES 131 00:04:11,640 --> 00:04:14,400 HAVE RAISED CONCERNS ABOUT THE 132 00:04:14,400 --> 00:04:15,040 EFFECTS OF WEIGHT LOSS ON 133 00:04:15,040 --> 00:04:17,360 MORTALITY IN OLDER ADULTS. 134 00:04:17,360 --> 00:04:20,000 IN FACT, IN SOME OF THESE 135 00:04:20,000 --> 00:04:21,880 STUDIES, WEIGHT LOSS NOT ONLY 136 00:04:21,880 --> 00:04:23,280 DIDN'T IMPROVE MORTALITY, IT 137 00:04:23,280 --> 00:04:27,320 ACTUALLY WORSENED MORTALITY. 138 00:04:27,320 --> 00:04:28,640 THESE NEGATIVE EFFECTS 139 00:04:28,640 --> 00:04:29,640 PERSISTED, EVEN AFTER 140 00:04:29,640 --> 00:04:30,840 CONTROLLING FOR SOMETHING SUCH 141 00:04:30,840 --> 00:04:35,120 AS SMOKING OR ILLNESSES SUCH AS 142 00:04:35,120 --> 00:04:36,200 CANCER. 143 00:04:36,200 --> 00:04:37,600 HOWEVER, OBSERVATIONAL STUDIES 144 00:04:37,600 --> 00:04:39,800 CANNOT REALLY DISTINGUISH 145 00:04:39,800 --> 00:04:41,600 INTENTIONAL VERSUS UNINTENTIONAL 146 00:04:41,600 --> 00:04:43,640 WEIGHT LOSS. 147 00:04:43,640 --> 00:04:44,840 THE BEST WAY TO DO THAT IS 148 00:04:44,840 --> 00:04:46,160 THROUGH A CLINICAL TRIAL IN 149 00:04:46,160 --> 00:04:48,120 WHICH SOME PEOPLE ARE RANDOMLY 150 00:04:48,120 --> 00:04:50,080 ASSIGNED TO LOSE WEIGHT 151 00:04:50,080 --> 00:04:51,320 INTENTIONALLY, AND THE OTHERS 152 00:04:51,320 --> 00:04:52,600 ARE FOLLOWED IN A CONTROL GROUP 153 00:04:52,600 --> 00:04:57,880 OR IN SOME OTHER GROUP OVER 154 00:04:57,880 --> 00:04:58,080 TIME. 155 00:04:58,080 --> 00:04:59,720 NOW PRIOR TO DOING LOOK AHEAD, 156 00:04:59,720 --> 00:05:02,040 THERE HAD BEEN ALSO MANY SMALL 157 00:05:02,040 --> 00:05:03,560 SHORT TERM CLINICAL TRIALS, 158 00:05:03,560 --> 00:05:06,080 WHICH SUGGESTED THAT INTENTIONAL 159 00:05:06,080 --> 00:05:08,720 WEIGHT LOSS HAS POSITIVE EFFECTS 160 00:05:08,720 --> 00:05:13,200 ON GLYCEMIC CONTROL AND CVD RISK 161 00:05:13,200 --> 00:05:13,440 FACTORS. 162 00:05:13,440 --> 00:05:15,960 THERE WAS A META ANALYSES OF 163 00:05:15,960 --> 00:05:17,160 THESE SMALL STUDIES THAT RAISED 164 00:05:17,160 --> 00:05:18,320 A SUGGESTION THERE MIGHT BE A 165 00:05:18,320 --> 00:05:19,320 POSITIVE EFFECT ON MORTALITY AS 166 00:05:19,320 --> 00:05:21,440 WELL. 167 00:05:21,440 --> 00:05:23,400 IT WAS CLEAR, THOUGH, THAT 168 00:05:23,400 --> 00:05:24,920 ANSWERING THE QUESTION WOULD 169 00:05:24,920 --> 00:05:27,440 REQUIRE A LARGE, LONG-TERM 170 00:05:27,440 --> 00:05:29,360 RANDOMIZED TRIAL OF INTENTIONAL 171 00:05:29,360 --> 00:05:33,880 WEIGHT LOSS IN OLDER ADULTS. 172 00:05:33,880 --> 00:05:35,640 BASED ON THE STRONG INCIDENCE OF 173 00:05:35,640 --> 00:05:37,840 OBESITY AND DIABETES, AND 174 00:05:37,840 --> 00:05:40,000 CONCERNS REGARDING THE BENEFITS 175 00:05:40,000 --> 00:05:41,880 OF WEIGHT LOSS, NIH DECIDED THAT 176 00:05:41,880 --> 00:05:43,160 A CLINICAL TRIAL WAS NEEDED ON 177 00:05:43,160 --> 00:05:45,040 THIS TOPIC AND THAT IT SHOULD BE 178 00:05:45,040 --> 00:05:47,440 DONE IN TYPE 2 DIABETICS WITH 179 00:05:47,440 --> 00:05:52,720 OVERWEIGHT AND OBESITY. 180 00:05:52,720 --> 00:05:54,000 NOW I DON'T WANT YOU TO HAVE THE 181 00:05:54,000 --> 00:05:55,360 FEELING THAT LOOK AHEAD JUST 182 00:05:55,360 --> 00:05:57,080 SUDDENLY CAME TO PASS. 183 00:05:57,080 --> 00:05:59,360 IT ACTUALLY STARTED IN THE YEAR 184 00:05:59,360 --> 00:06:02,320 1999 OR 2000, BUT THE FOUNDATION 185 00:06:02,320 --> 00:06:04,440 FOR THE TRIAL HAD BEEN LAID MANY 186 00:06:04,440 --> 00:06:06,600 YEARS BEFORE. 187 00:06:06,600 --> 00:06:08,920 IN THE 1980s AND 90s, THERE 188 00:06:08,920 --> 00:06:12,080 HAD BEEN MANY SMALL TRIALS 189 00:06:12,080 --> 00:06:14,280 TESTING COMPONENTS OF INTENSIVE 190 00:06:14,280 --> 00:06:14,760 LIFESTYLE INTERVENTION. 191 00:06:14,760 --> 00:06:16,800 FOR EXAMPLE, COMPARING DIET 192 00:06:16,800 --> 00:06:19,640 VERSUS DIET PLUS EXERCISE, OR 193 00:06:19,640 --> 00:06:21,000 JUST STUDIES SHOWING THE 194 00:06:21,000 --> 00:06:22,400 BENEFITS OF INCLUDING MEAL 195 00:06:22,400 --> 00:06:25,360 REPLACEMENT PRODUCTS AS PART OF 196 00:06:25,360 --> 00:06:27,320 THE DIETARY PRESCRIPTION. 197 00:06:27,320 --> 00:06:30,040 THE DIABETES PREVENTION PROGRAM, 198 00:06:30,040 --> 00:06:31,800 ANOTHER LARGE RANDOMIZED TRIAL 199 00:06:31,800 --> 00:06:35,800 FUNDED BY NIDDK, WAS CRITICAL IN 200 00:06:35,800 --> 00:06:37,640 PAVING THE WAY FOR LOOK AHEAD. 201 00:06:37,640 --> 00:06:41,760 THIS STUDY SHOWED THAT LIFESTYLE 202 00:06:41,760 --> 00:06:45,480 INTERVENTIONS CAN BE 203 00:06:45,480 --> 00:06:46,120 STANDARDIZED AND PRODUCE WEIGHT 204 00:06:46,120 --> 00:06:47,560 LOSS IN DIVERSE POPULATIONS, 205 00:06:47,560 --> 00:06:49,880 INCLUDING IN MINORITY GROUPS. 206 00:06:49,880 --> 00:06:51,600 AND PERHAPS MOST IMPORTANTLY, 207 00:06:51,600 --> 00:06:54,040 THE MODEST WEIGHT LOSSES CAN 208 00:06:54,040 --> 00:06:55,280 PRODUCE CLINICALLY SIGNIFICANT 209 00:06:55,280 --> 00:06:57,000 CHANGES IN HEALTH. 210 00:06:57,000 --> 00:06:58,080 I'D LIKE TO ILLUSTRATE THAT WITH 211 00:06:58,080 --> 00:06:59,680 A FEW SLIDES FROM THE DIABETES 212 00:06:59,680 --> 00:07:03,040 PREVENTION PROGRAM. 213 00:07:03,040 --> 00:07:05,640 THE DIABETES PREVENTION PROGRAM 214 00:07:05,640 --> 00:07:10,800 INVOLVED 3,000 INDIVIDUALS WITH 215 00:07:10,800 --> 00:07:12,880 PREDIABETES, SO AT HIGH RISK FOR 216 00:07:12,880 --> 00:07:13,520 DEVELOPING DIABETES. 217 00:07:13,520 --> 00:07:14,960 THESE INDIVIDUALS WERE RANDOMLY 218 00:07:14,960 --> 00:07:17,240 ASSIGNED TO LIFESTYLE, 219 00:07:17,240 --> 00:07:17,920 METFORMIN, WHICH IS A DRUG 220 00:07:17,920 --> 00:07:20,360 THAT'S USED TO TREAT DIABETES, 221 00:07:20,360 --> 00:07:24,520 OR TO PLACEBO. 222 00:07:24,520 --> 00:07:27,800 I WAS THE PI OF THE LIFESTYLE 223 00:07:27,800 --> 00:07:28,760 RESOURCE CORE. 224 00:07:28,760 --> 00:07:31,280 WE DESIGNED THE INTERVENTION, 225 00:07:31,280 --> 00:07:33,880 TRAIN THE INTERVENTIONISTS AND 226 00:07:33,880 --> 00:07:35,000 ENSURE FIDELITY OF THE 227 00:07:35,000 --> 00:07:39,360 INTERVENTION ACROSS THE SITES. 228 00:07:39,360 --> 00:07:40,520 I BELIEVE THE LIFESTYLE 229 00:07:40,520 --> 00:07:42,440 INTERVENTION GOALS WERE MODEST. 230 00:07:42,440 --> 00:07:44,200 THE GOAL WAS FOR EACH PERSON TO 231 00:07:44,200 --> 00:07:45,720 LOSE 7% OF THEIR BODY WEIGHT, 232 00:07:45,720 --> 00:07:46,960 WHICH FOR SOMEBODY STARTING OUT 233 00:07:46,960 --> 00:07:49,480 THE STUDY AT 200 POUNDS WAS JUST 234 00:07:49,480 --> 00:07:55,400 ABOUT A 7-KILOGRAM OR 14-POUND 235 00:07:55,400 --> 00:07:57,880 WEIGHT LOSS. 236 00:07:57,880 --> 00:07:59,520 THE CALORIE GOAL TO ACHIEVE THAT 237 00:07:59,520 --> 00:08:02,480 WAS PUT AT 1200 TO 1800 CALORIES 238 00:08:02,480 --> 00:08:04,680 A DAY WITH LESS THAN 25% FAT AND 239 00:08:04,680 --> 00:08:05,880 PARTICIPANTS WERE GRADUALLY 240 00:08:05,880 --> 00:08:07,200 ENCOURAGED TO INCREASE THEIR 241 00:08:07,200 --> 00:08:09,600 EXERCISE UNTIL THEY WERE DOING 242 00:08:09,600 --> 00:08:13,080 175 MINUTES PER WEEK OF BRISK 243 00:08:13,080 --> 00:08:14,080 ACTIVITY. 244 00:08:14,080 --> 00:08:15,600 THIS SLIDE SHOWS THE WEIGHT 245 00:08:15,600 --> 00:08:17,080 CHANGES THAT WERE ACHIEVED IN 246 00:08:17,080 --> 00:08:19,560 THE DIABETES PREVENTION PROGRAM. 247 00:08:19,560 --> 00:08:22,400 AS YOU CAN SEE, IT'S SIX MONTHS 248 00:08:22,400 --> 00:08:24,520 PARTICIPANTS HAD LOST ABOUT 249 00:08:24,520 --> 00:08:26,560 7 KILOGRAMS OR 7% OF THEIR BODY 250 00:08:26,560 --> 00:08:29,320 WEIGHT, SO RIGHT ON TARGET. 251 00:08:29,320 --> 00:08:30,760 THEY MAINTAIN THAT AT ONE YEAR 252 00:08:30,760 --> 00:08:32,560 AND THEN GRADUALLY REGAIN SOME 253 00:08:32,560 --> 00:08:33,680 WEIGHT OVER TIME. 254 00:08:33,680 --> 00:08:35,760 HOWEVER, THROUGHOUT THE FOUR 255 00:08:35,760 --> 00:08:37,000 YEARS, THEIR WEIGHT CHANGES IN 256 00:08:37,000 --> 00:08:38,400 THE LIFESTYLE ARM WERE 257 00:08:38,400 --> 00:08:39,480 SIGNIFICANTLY BETTER THAN THOSE 258 00:08:39,480 --> 00:08:42,880 IN PLACEBO. 259 00:08:42,880 --> 00:08:44,520 HOWEVER AS I EMPHASIZE BEFORE, 260 00:08:44,520 --> 00:08:45,720 THESE WEIGHT LOSSES I BELIEVE 261 00:08:45,720 --> 00:08:47,600 ARE QUITE MODEST AND YET THEY 262 00:08:47,600 --> 00:08:49,280 HAD A VERY ROBUST EFFECT ON THE 263 00:08:49,280 --> 00:08:53,760 INCIDENCE OF DIABETES. 264 00:08:53,760 --> 00:08:55,080 SO AT THE VERY BEGINNING OF THE 265 00:08:55,080 --> 00:08:56,520 TRIAL SHOWN ON THE LEFT OF THE 266 00:08:56,520 --> 00:08:57,720 SIDE, YOU CAN SEE NOBODY HAD 267 00:08:57,720 --> 00:08:59,240 DIABETES BECAUSE THEY WERE ALL 268 00:08:59,240 --> 00:09:00,440 AT RISK FOR DEVELOPING IT BUT 269 00:09:00,440 --> 00:09:02,840 NONE OF THEM HAD IT YET. 270 00:09:02,840 --> 00:09:07,200 EACH SIX MONTHS, AN ORAL GLUCOSE 271 00:09:07,200 --> 00:09:09,280 TOLERANCE TEST WAS CONDUCTED TO 272 00:09:09,280 --> 00:09:10,800 SEE WHO HAD CONVERTED TO HAVE 273 00:09:10,800 --> 00:09:11,360 DIABETES. 274 00:09:11,360 --> 00:09:12,480 YOU CAN SEE BY THE END OF THE 275 00:09:12,480 --> 00:09:14,440 FOUR YEARS, ABOUT 40% OF THE 276 00:09:14,440 --> 00:09:15,440 PLACEBO PARTICIPANTS HAD 277 00:09:15,440 --> 00:09:17,160 DEVELOPED DIABETES. 278 00:09:17,160 --> 00:09:19,840 COMPARED TO ABOUT 30% IN 279 00:09:19,840 --> 00:09:21,720 METFORMIN, OR 20% IN LIFESTYLE 280 00:09:21,720 --> 00:09:25,960 INTERVENTION. 281 00:09:25,960 --> 00:09:27,280 SO INTENSIVE LIFESTYLE 282 00:09:27,280 --> 00:09:29,120 INTERVENTION REDUCED THE RISK OF 283 00:09:29,120 --> 00:09:33,080 DEVELOPING DIABETES BY 58%. 284 00:09:33,080 --> 00:09:34,360 AND WAS NEARLY TWICE AS 285 00:09:34,360 --> 00:09:36,480 EFFECTIVE AS THE DRUG METFORMIN. 286 00:09:36,480 --> 00:09:38,760 SO I BELIEVE THAT DPP REALLY 287 00:09:38,760 --> 00:09:41,400 HELPED US ESTABLISH THAT WE CAN 288 00:09:41,400 --> 00:09:42,600 PRODUCE WEIGHT LOSS IN A LARGE 289 00:09:42,600 --> 00:09:45,560 TRIAL SUCH AS THIS AND EVEN A 290 00:09:45,560 --> 00:09:47,320 MODEST WEIGHT LOSS OF 14 POUNDS 291 00:09:47,320 --> 00:09:49,640 CAN HAVE A LARGE IMPACT ON 292 00:09:49,640 --> 00:09:52,240 HEALTH. 293 00:09:52,240 --> 00:09:54,200 I BELIEVE THAT'S WHAT LED NIH TO 294 00:09:54,200 --> 00:09:55,520 BE CONFIDENT THAT THEY COULD 295 00:09:55,520 --> 00:09:58,120 LAUNCH THE LOOK AHEAD TRIAL. 296 00:09:58,120 --> 00:09:59,560 IN WHICH WE WERE TRYING TO ASK 297 00:09:59,560 --> 00:10:01,000 THE QUESTION OF WHETHER 298 00:10:01,000 --> 00:10:01,960 LIFESTYLE INTERVENTION COULD 299 00:10:01,960 --> 00:10:04,040 REDUCE THE RISK EVER 300 00:10:04,040 --> 00:10:05,120 CARDIOVASCULAR MORBIDITY AND 301 00:10:05,120 --> 00:10:07,680 MORTALITY AND IN THOSE WHO ALY 302 00:10:07,680 --> 00:10:12,480 HAD TYPE 2 DIABETES. 303 00:10:12,480 --> 00:10:16,000 WE STARTED RECRUITMENT IN 2000 304 00:10:16,000 --> 00:10:17,400 AND RECRUITED GRADUALLY OVER THE 305 00:10:17,400 --> 00:10:18,600 NEXT COUPLE OF YEARS. 306 00:10:18,600 --> 00:10:20,440 ALL WERE RANDOMLY ASSIGNED TO 307 00:10:20,440 --> 00:10:21,520 EITHER INTENSIVE LIFESTYLE 308 00:10:21,520 --> 00:10:22,440 INTERVENTION WHICH I'LL DESCRIBE 309 00:10:22,440 --> 00:10:24,840 IN A MOMENT OR TO DIABETES 310 00:10:24,840 --> 00:10:26,400 SUPPORT AND EDUCATION, WHICH WAS 311 00:10:26,400 --> 00:10:30,640 THE CONTROL OR COMPARISON 312 00:10:30,640 --> 00:10:31,720 CONDITION. 313 00:10:31,720 --> 00:10:33,800 THE PRIMARY OUTCOME WAS A 314 00:10:33,800 --> 00:10:36,320 COMPOSITE MEASURE OF 315 00:10:36,320 --> 00:10:37,400 CARDIOVASCULAR MORBIDITY AND 316 00:10:37,400 --> 00:10:37,680 MORTALITY. 317 00:10:37,680 --> 00:10:39,120 NOW THE FIVE THOWN 145 318 00:10:39,120 --> 00:10:40,720 PARTICIPANTS WHO ENTERED THIS 319 00:10:40,720 --> 00:10:42,680 TRIAL CAME FROM 16 DIFFERENT 320 00:10:42,680 --> 00:10:43,600 CLINICAL SITES THROUGHOUT THE 321 00:10:43,600 --> 00:10:47,640 UNITED STATES. 322 00:10:47,640 --> 00:10:53,920 THEY ALL HAD TYPE 2 DIABETES, 323 00:10:53,920 --> 00:10:54,960 OVERWEIGHT AND OBESITY. 324 00:10:54,960 --> 00:10:56,840 THEY WERE AGE 45 TO 76 WITH A 325 00:10:56,840 --> 00:10:58,680 MEAN OF 59 YEARS. 326 00:10:58,680 --> 00:11:00,560 37% WERE FROM MINORITY 327 00:11:00,560 --> 00:11:01,040 ETHNIC/RACIAL GROUPS. 328 00:11:01,040 --> 00:11:02,560 THAT WAS VERY IMPORTANT TO US 329 00:11:02,560 --> 00:11:03,960 BECAUSE DIABETES 330 00:11:03,960 --> 00:11:04,840 DISPROPORTIONATELY AFFECTS 331 00:11:04,840 --> 00:11:06,120 MINORITY GROUPS SO WE WANTED OUR 332 00:11:06,120 --> 00:11:08,680 STUDY TO HAVE POPULATION -- 333 00:11:08,680 --> 00:11:09,880 SIMILAR TO THE POPULATION 334 00:11:09,880 --> 00:11:13,240 AFFECTED BY DIABETES. 335 00:11:13,240 --> 00:11:17,080 IN ADDITION, THEY HAD TO PASS A 336 00:11:17,080 --> 00:11:21,360 MAXIMUM CVD STRESS TEST. 337 00:11:21,360 --> 00:11:24,400 THESE PARTICIPANTS WERE RANDOMLY 338 00:11:24,400 --> 00:11:26,240 ASSIGNED TO DIABETES SUPPORT AND 339 00:11:26,240 --> 00:11:28,040 EDUCATION WHICH WA THE CONTROL 340 00:11:28,040 --> 00:11:29,520 GROUP OR INTENSIVE LIFESTYLE 341 00:11:29,520 --> 00:11:30,000 INTERVENTION. 342 00:11:30,000 --> 00:11:31,640 THE CONTROL GROUP ATTENDED THREE 343 00:11:31,640 --> 00:11:33,080 TO FOUR EDUCATIONAL SESSIONS PER 344 00:11:33,080 --> 00:11:34,920 YEAR RELATED TO DIET, EXERCISE, 345 00:11:34,920 --> 00:11:40,720 OR SOCIAL SUPPORT. 346 00:11:40,720 --> 00:11:41,840 THE INTERVENTION DWREUP WAS 347 00:11:41,840 --> 00:11:43,080 REALLY A VERY INTENSIVE 348 00:11:43,080 --> 00:11:43,480 INTERVENTION. 349 00:11:43,480 --> 00:11:45,200 THEY RECEIVED WEEKLY COUNSELING 350 00:11:45,200 --> 00:11:46,640 FOR THE FIRST YEAR, AND THEY HAD 351 00:11:46,640 --> 00:11:50,960 A GOAL OF LOSING 10% OF THEIR 352 00:11:50,960 --> 00:11:51,960 WEIGHT. 353 00:11:51,960 --> 00:11:53,960 A SOMEWHAT HIRE GOAL WE HAD IN 354 00:11:53,960 --> 00:11:54,160 DPP. 355 00:11:54,160 --> 00:11:55,200 THEY WERE ABLE TO ACCOMPLISH 356 00:11:55,200 --> 00:11:56,640 THAT BY EATING A LOWER CALORIE 357 00:11:56,640 --> 00:11:58,000 DIET AND THEY USED MEAL 358 00:11:58,000 --> 00:11:59,480 REPLACEMENT PRODUCTS WHICH AS I 359 00:11:59,480 --> 00:12:00,920 SAID HAD BEEN SHOWN TO IMPROVE 360 00:12:00,920 --> 00:12:03,440 WEIGHT LOSSES. 361 00:12:03,440 --> 00:12:04,480 AND THEY GRADUALLY WERE 362 00:12:04,480 --> 00:12:06,880 ENCOURAGED TO INCREASE THEIR 363 00:12:06,880 --> 00:12:07,680 EXERCISE TO 175 MINUTES PER WEEK 364 00:12:07,680 --> 00:12:12,400 OF PHYSICAL ACTIVITY. 365 00:12:12,400 --> 00:12:14,160 AS IN DPP IN LOOK AHEAD, THE 366 00:12:14,160 --> 00:12:15,360 INTERVENTION WAS STRONGLY 367 00:12:15,360 --> 00:12:16,800 BEHAVIORAL, INCLUDING STRATEGIES 368 00:12:16,800 --> 00:12:18,200 SUCH AS GOAL SETTING AND 369 00:12:18,200 --> 00:12:21,600 SELF-MONITORING. 370 00:12:21,600 --> 00:12:23,360 IN YEARS TWO TO FOUR, WE REDUCE 371 00:12:23,360 --> 00:12:24,560 THE AMOUNT OF CONTACT BUT THEY 372 00:12:24,560 --> 00:12:27,560 STILL HAD MONTHLY CONTACT AND IN 373 00:12:27,560 --> 00:12:29,480 YEARS FIVE ON, WE KEPT IT AT 374 00:12:29,480 --> 00:12:31,600 QUARTERLY CONTACT. 375 00:12:31,600 --> 00:12:32,880 BUT THROUGHOUT YEARS TWO TO THE 376 00:12:32,880 --> 00:12:35,800 END OF THE STUDY, THEY HAD 377 00:12:35,800 --> 00:12:37,280 REFRESHER SESSIONS AS NEEDED TO 378 00:12:37,280 --> 00:12:39,040 ENCOURAGE THEM TO STAY ON TRACK 379 00:12:39,040 --> 00:12:42,440 WITH THEIR DIET AND EXERCISE. 380 00:12:42,440 --> 00:12:43,840 THE INTERVENTION CONTINUED 381 00:12:43,840 --> 00:12:46,040 THROUGH THE YEAR 2012 SO THAT 382 00:12:46,040 --> 00:12:48,000 MEANS FOR NINE TO 11 YEARS, EACH 383 00:12:48,000 --> 00:12:49,120 PARTICIPANT WAS RECEIVING 384 00:12:49,120 --> 00:12:52,080 INTERVENTION. 385 00:12:52,080 --> 00:12:57,080 OF IN DESIGNING THE STUDY, WE 386 00:12:57,080 --> 00:12:58,520 MADE SERL DESIGN DECISIONS WHICH 387 00:12:58,520 --> 00:12:59,520 ARE IMPORTANT FOR YOU TO THINK 388 00:12:59,520 --> 00:13:02,360 ABOUT IN TERMS OF THE OUTCOMES 389 00:13:02,360 --> 00:13:04,080 WE ACHIEVED. 390 00:13:04,080 --> 00:13:05,800 ONE DECISION WE MADE WAS TO 391 00:13:05,800 --> 00:13:07,160 ENRICH THE SAMPLE WITH 392 00:13:07,160 --> 00:13:09,320 PARTICIPANTS WITH CVD HISTORY IN 393 00:13:09,320 --> 00:13:10,320 ORDER TO INCREASE THE POWER OF 394 00:13:10,320 --> 00:13:12,080 THE STUDY. 395 00:13:12,080 --> 00:13:16,000 THIS IS TYPICALLY DONE IN CBD 396 00:13:16,000 --> 00:13:18,280 STUDIES SO 14% OF OUR 397 00:13:18,280 --> 00:13:20,720 PARTICIPANTS HAD A CBD HISTORY. 398 00:13:20,720 --> 00:13:23,000 WE ALSO DECIDED AHEAD THAT 399 00:13:23,000 --> 00:13:23,680 PARTICIPANTS AND THEIR 400 00:13:23,680 --> 00:13:25,080 PHYSICIANS WERE TO BE GIVEN 401 00:13:25,080 --> 00:13:29,120 FEEDBACK ON THEIR ANNUAL BLOOD 402 00:13:29,120 --> 00:13:29,320 WORK. 403 00:13:29,320 --> 00:13:30,560 AND THAT THEIR MEDICATION 404 00:13:30,560 --> 00:13:31,760 ADJUSTMENTS WERE TO BE MADE BY 405 00:13:31,760 --> 00:13:33,320 THEIR OWN PHYSICIANS, NOT BY THE 406 00:13:33,320 --> 00:13:34,960 STUDY TRIAL. 407 00:13:34,960 --> 00:13:37,120 AND WE ALSO DECIDED AHEAD THAT 408 00:13:37,120 --> 00:13:39,080 ILI WOULD DECREASE IN INTENSITY 409 00:13:39,080 --> 00:13:41,240 OVER TIME AS I JUST SHOWED YOU. 410 00:13:41,240 --> 00:13:43,640 THE GOAL OF ILI WAS TO LOSE 411 00:13:43,640 --> 00:13:45,280 WEIGHT AS I SAID, 10% WEIGHT 412 00:13:45,280 --> 00:13:46,720 LOSS, AND TO INCREASE PHYSICAL 413 00:13:46,720 --> 00:13:47,720 ACTIVITY. 414 00:13:47,720 --> 00:13:49,480 THIS SLIDE SHOWS WE ACHIEVED OUR 415 00:13:49,480 --> 00:13:52,560 WEIGHT LOSS GOALS. 416 00:13:52,560 --> 00:13:55,400 INITIALLY, THE WEIGHT LOSS WAS 417 00:13:55,400 --> 00:13:56,720 8.5% AT YEAR ONE. 418 00:13:56,720 --> 00:14:00,000 NOT QUITE THE 10% BUT CLEARLY AN 419 00:14:00,000 --> 00:14:01,000 EXCELLENT WEIGHT LOSS AND EVEN 420 00:14:01,000 --> 00:14:04,160 GREATER THAN WE ACHIEVED IN DPP. 421 00:14:04,160 --> 00:14:06,880 OVER TIME, THERE WAS SOME 422 00:14:06,880 --> 00:14:08,720 REGAIN, BUT AS YOU CAN SEE HERE, 423 00:14:08,720 --> 00:14:11,320 ILI, WHICH IS SHOWN IN BLUE, HAD 424 00:14:11,320 --> 00:14:15,440 BETTER WEIGHT LOSSES THAN DSE 425 00:14:15,440 --> 00:14:16,640 SHOWN IN RED THROUGHOUT THE 426 00:14:16,640 --> 00:14:16,960 ENTIRE TRIAL. 427 00:14:16,960 --> 00:14:18,960 BY THE WAY, I'LL KEEP THAT COLOR 428 00:14:18,960 --> 00:14:20,240 SCHEME THROUGHOUT ALL MY SLIDES 429 00:14:20,240 --> 00:14:22,000 SO THAT HOPEFULLY YOU'LL BE ABLE 430 00:14:22,000 --> 00:14:24,200 TO FOLLOW THEM OVER TIME. 431 00:14:24,200 --> 00:14:25,960 SO THE NEXT SLIDE SHOWS THE 432 00:14:25,960 --> 00:14:31,440 CHANGES IN CARDIOVASCULAR 433 00:14:31,440 --> 00:14:34,920 FITNESS WHICH ACHIEVED WITH 434 00:14:34,920 --> 00:14:35,920 SUBMAXIMAL TESTS. 435 00:14:35,920 --> 00:14:37,560 THESE WERE CONDUCTED AT YEARS 436 00:14:37,560 --> 00:14:38,680 ONE, TWO AND FOUR, AND AS YOU 437 00:14:38,680 --> 00:14:42,280 CAN SEE HERE, THEIR FITNESS 438 00:14:42,280 --> 00:14:43,800 GREATLY IMPROVED IN ILI MUCH 439 00:14:43,800 --> 00:14:47,400 MORE SO THAN IN DSE. 440 00:14:47,400 --> 00:14:49,160 AGAIN, THOUGH, THE GREATEST 441 00:14:49,160 --> 00:14:50,800 INCREASE WAS AT YEAR ONE AND 442 00:14:50,800 --> 00:14:53,960 GRADUALLY DECREASED OVER TIME. 443 00:14:53,960 --> 00:14:56,120 ALTHOUGH WE DID NOT ASSESS 444 00:14:56,120 --> 00:14:57,800 FITNESS BEYOND YEAR 4, WE DID 445 00:14:57,800 --> 00:15:00,200 FIND PHYSICAL FUNCTION MEASURES 446 00:15:00,200 --> 00:15:03,080 SUCH AS GAIT SPEED REMAINED 447 00:15:03,080 --> 00:15:06,240 FASTER IN ILI THROUGHOUT THE 448 00:15:06,240 --> 00:15:08,640 TRIAL. 449 00:15:08,640 --> 00:15:10,200 THIS NEXT SLIDE SHOWS YOU THE 450 00:15:10,200 --> 00:15:14,360 IMPROVEMENTS IN HEMOGLOBIN A1C. 451 00:15:14,360 --> 00:15:16,760 AND AGAIN, THEY REALLY PARALLEL 452 00:15:16,760 --> 00:15:18,720 THE WEIGHT LOSSES I SHOWED YOU A 453 00:15:18,720 --> 00:15:22,120 MINUTE AGO, WHERE AGAIN, ILI HAS 454 00:15:22,120 --> 00:15:23,440 VERY BIG IMPROVEMENT INITIALLY, 455 00:15:23,440 --> 00:15:25,080 LESS OVER TIME BUT REMAINS 456 00:15:25,080 --> 00:15:26,520 SIGNIFICANTLY DIFFERENT THAN DSE 457 00:15:26,520 --> 00:15:28,880 THROUGHOUT. 458 00:15:28,880 --> 00:15:32,120 NOW, HAVING ACHIEVED OUR WEIGHT 459 00:15:32,120 --> 00:15:34,520 LOSSES AND OUR HEMOGLOBIN A1C 460 00:15:34,520 --> 00:15:36,680 IMPROVEMENTS AND OUR FITNESS 461 00:15:36,680 --> 00:15:38,000 CHANGES, WE EXPECTED OR HOPED 462 00:15:38,000 --> 00:15:40,080 THAT OUR CUMULATIVE HAZARD RATIO 463 00:15:40,080 --> 00:15:41,720 FOR OUR PRIMARY OUTCOME WOULD BE 464 00:15:41,720 --> 00:15:44,680 DIFFERENT THAN ILI MIGHT HAVE A 465 00:15:44,680 --> 00:15:47,280 LOWER INCIDENCE OF PROBLEMS THAN 466 00:15:47,280 --> 00:15:49,720 DSE. 467 00:15:49,720 --> 00:15:53,200 HOWEVER, THE CUMULATIVE 468 00:15:53,200 --> 00:15:55,640 INCIDENCE FOR FATAL AND 469 00:15:55,640 --> 00:15:58,560 NON-FATAL MI AND STROKES OR 470 00:15:58,560 --> 00:15:59,680 HOSPITALIZED ANGINA WHICH WAS 471 00:15:59,680 --> 00:16:01,760 OUR PRIMARY OUTCOME SHOW NO 472 00:16:01,760 --> 00:16:03,520 DIFFERENCES AS SEEN HERE. 473 00:16:03,520 --> 00:16:05,040 I CAN'T IMAGINE TWO MORE 474 00:16:05,040 --> 00:16:06,240 PARALLEL LINES, MORE SIMILAR 475 00:16:06,240 --> 00:16:10,280 LINES FOR D DSE AND ILI OVER TE 476 00:16:10,280 --> 00:16:11,400 10 YEARS. 477 00:16:11,400 --> 00:16:13,600 THE SAME WAS TRUE FOR ALL OF THE 478 00:16:13,600 --> 00:16:18,320 SECONDARY CVD COMPOSITE 479 00:16:18,320 --> 00:16:20,080 OUTCOMES. 480 00:16:20,080 --> 00:16:22,600 TO SUM, THIS WAS A SURPRISING OR 481 00:16:22,600 --> 00:16:24,560 DISAPPOINTING FINDING. 482 00:16:24,560 --> 00:16:25,680 LEADING TO SEVERAL DIFFERENT 483 00:16:25,680 --> 00:16:28,520 EXPLANATIONS FOR THESE RESULTS. 484 00:16:28,520 --> 00:16:31,040 PROBABLY THE CENTRAL MOST 485 00:16:31,040 --> 00:16:32,040 APPROPRIATE INTERPRETATION IS 486 00:16:32,040 --> 00:16:34,760 THAT WEIGHT LOSS DOES NOT AFFECT 487 00:16:34,760 --> 00:16:36,840 CVD RISK IN OVERWEIGHT ADULTS 488 00:16:36,840 --> 00:16:40,720 WITH DIABETES. 489 00:16:40,720 --> 00:16:41,800 HOWEVER, OTHERS HAVE SOUGHT 490 00:16:41,800 --> 00:16:43,440 OTHER EXPLANATIONS. 491 00:16:43,440 --> 00:16:45,120 FOR EXAMPLE, SOMEONE SAID THE 492 00:16:45,120 --> 00:16:46,840 SAMPLE WAS TOO SICK. 493 00:16:46,840 --> 00:16:49,480 THEY HAD CVD. 494 00:16:49,480 --> 00:16:52,760 OTHERS HAVE SAID THE SAMPLE WAS 495 00:16:52,760 --> 00:16:53,720 TOO HEALTHY BECAUSE THEY HAD TO 496 00:16:53,720 --> 00:16:55,280 PASS A TREADMILL TEST. 497 00:16:55,280 --> 00:16:57,440 OTHERS HAVE SAID WELL, THERE WAS 498 00:16:57,440 --> 00:16:58,320 BETTER RISK FACTOR MANAGEMENT 499 00:16:58,320 --> 00:17:00,960 OVER TIME, AND THAT MAY HAVE 500 00:17:00,960 --> 00:17:02,480 OBSCURED THE EFFECTIVE HE WAS 501 00:17:02,480 --> 00:17:04,800 LOSS. 502 00:17:04,800 --> 00:17:05,680 WEIGHT 503 00:17:05,680 --> 00:17:05,880 LOSS. 504 00:17:05,880 --> 00:17:06,680 ANOTHER POSSIBILITY IS THAT THE 505 00:17:06,680 --> 00:17:07,960 WEIGHT LOSSES WERE NOT LARGE 506 00:17:07,960 --> 00:17:09,840 ENOUGH, OR THAT THOSE WHO DID 507 00:17:09,840 --> 00:17:11,800 NOT LOSE WEIGHT MAY HAVE BLUNTED 508 00:17:11,800 --> 00:17:15,320 ANY POSITIVE EFFECTS OF WEIGHT 509 00:17:15,320 --> 00:17:16,160 LOSS. 510 00:17:16,160 --> 00:17:17,000 SOME HAVE QUESTIONED WHETHER THE 511 00:17:17,000 --> 00:17:21,800 WEIGHT LOSS IS ES ACHIEVED BY I 512 00:17:21,800 --> 00:17:22,880 CAN BE SUFFICIENT. 513 00:17:22,880 --> 00:17:25,160 THEY POINT TO THE FACT THAT FROM 514 00:17:25,160 --> 00:17:26,560 BARIATRIC SURGERY WHERE WEIGHT 515 00:17:26,560 --> 00:17:27,720 LOSSES ARE MUCH BIGGER, THEY 516 00:17:27,720 --> 00:17:29,040 HAVE BEEN ABLE TO SHOW THAT 517 00:17:29,040 --> 00:17:33,320 THERE WERE DECREASES IN THE CVD 518 00:17:33,320 --> 00:17:34,280 INCIDENCE. 519 00:17:34,280 --> 00:17:36,240 SO IN LOOK AHEAD, WE CANNOT TEST 520 00:17:36,240 --> 00:17:39,680 ANY OF THESE HYPOTHESES OR THESE 521 00:17:39,680 --> 00:17:40,760 POSSIBILITY EXPLANATIONS. 522 00:17:40,760 --> 00:17:43,400 BUT WE CAN LOOK AT POST HOCK 523 00:17:43,400 --> 00:17:48,360 DATA ANALYSIS THAT MIGHT GIVE US 524 00:17:48,360 --> 00:17:49,280 SOME GLIMPSE OF WHAT MIGHT HAVE 525 00:17:49,280 --> 00:17:50,480 BEEN HAPPENING IN OUR TRIAL. 526 00:17:50,480 --> 00:17:52,240 BUT KEEP IN MIND WE CAN'T 527 00:17:52,240 --> 00:17:56,040 RANDOMIZE PEOPLE TO EITHER HAVE 528 00:17:56,040 --> 00:17:58,040 A LARGER WEIGHT LOSS OR NOT AS 529 00:17:58,040 --> 00:17:58,560 LARGE A WEIGHT LOSS. 530 00:17:58,560 --> 00:18:00,640 SO LET'S LOOK AT EACH OF THESE 531 00:18:00,640 --> 00:18:01,240 PROPOSED EXPLANATIONS FOR A 532 00:18:01,240 --> 00:18:01,880 MINUTE. 533 00:18:01,880 --> 00:18:03,120 ONE THAT I'M GOING TO FOCUS ON 534 00:18:03,120 --> 00:18:04,520 WAS THAT THE SAMPLE MIGHT HAVE 535 00:18:04,520 --> 00:18:08,320 BEEN TOO SICK. 536 00:18:08,320 --> 00:18:12,440 NOW IN TERMS OF THIS HYPOTHESIS, 537 00:18:12,440 --> 00:18:13,560 IT'S VERY INTERESTING TO DIVIDE 538 00:18:13,560 --> 00:18:15,760 THE GROUPS INTO THOSE WITH A CVD 539 00:18:15,760 --> 00:18:19,600 HISTORY AND THOSE WITHOUT AT 540 00:18:19,600 --> 00:18:21,800 BASELINE. 541 00:18:21,800 --> 00:18:22,760 SO IF YOU LOOK AT THE GROUP 542 00:18:22,760 --> 00:18:28,760 WITHOUT A CVD HISTORY, IT 543 00:18:28,760 --> 00:18:29,760 INCLUDES -- THIS IS THE GROUP 544 00:18:29,760 --> 00:18:31,200 WITHOUT A CVD HISTORY. 545 00:18:31,200 --> 00:18:36,760 AND THAT INCLUDED 86% OF OUR 546 00:18:36,760 --> 00:18:41,120 SAMPLE HAD NO CVD HISTORY. 547 00:18:41,120 --> 00:18:42,320 AND YOU CAN SEE THERE THAT THERE 548 00:18:42,320 --> 00:18:46,280 WAS A SLIGHTLY BUT 549 00:18:46,280 --> 00:18:47,800 NON-SIGNIFICANTLY LOWER RISK OF 550 00:18:47,800 --> 00:18:50,200 THE PRIMARY OUTCOME IN ILI THAN 551 00:18:50,200 --> 00:18:53,320 IN DSE IN THOSE WITH NO 552 00:18:53,320 --> 00:18:57,160 CARDIOVASCULAR DISEASE HISTORY. 553 00:18:57,160 --> 00:18:59,760 ODDS RATIO OF .86. 554 00:18:59,760 --> 00:19:01,360 BUT IT WAS A NON-SIGNIFICANT 555 00:19:01,360 --> 00:19:05,560 EFFECT. 556 00:19:05,560 --> 00:19:08,320 OVER HERE IN THE CVD HISTORY 557 00:19:08,320 --> 00:19:09,280 GROUP, THERE WAS ALSO A 558 00:19:09,280 --> 00:19:11,160 NON-SIGNIFICANT EFFECT WITH S 559 00:19:11,160 --> 00:19:13,240 IN THE OPPOSITE DIRECTION. 560 00:19:13,240 --> 00:19:15,520 1.13 HAS A RATIO. 561 00:19:15,520 --> 00:19:17,720 LEADING TO A NON-SIGNIFICANT 562 00:19:17,720 --> 00:19:21,440 INTERACTION BUT VERY CLOSE TO 563 00:19:21,440 --> 00:19:26,000 SIGNIFICANT. 564 00:19:26,000 --> 00:19:27,200 YOU CAN ALSO SEE THE EXPECTATION 565 00:19:27,200 --> 00:19:29,320 THAT PEOPLE WITH CVD HISTORY 566 00:19:29,320 --> 00:19:31,480 WOULD HAVE GREATER RISK OF HEART 567 00:19:31,480 --> 00:19:33,560 DISEASE OUTCOMES -- EXCUSE ME -- 568 00:19:33,560 --> 00:19:34,640 THAT THOSE WITH THE HISTORY 569 00:19:34,640 --> 00:19:35,760 WOULD HAVE A GREATER RISK THAN 570 00:19:35,760 --> 00:19:37,280 THOSE WITHOUT A HISTORY AND SURE 571 00:19:37,280 --> 00:19:38,400 ENOUGH, WE FOUND THAT. 572 00:19:38,400 --> 00:19:39,920 BUT IT DOES SUGGEST TO US THAT 573 00:19:39,920 --> 00:19:43,200 IF WE HAVE DONE OUR INTERVENTION 574 00:19:43,200 --> 00:19:46,120 WITH PEOPLE WHO DID NOT HAVE CVD 575 00:19:46,120 --> 00:19:48,120 AT THE BEGINNING, WE MIGHT HAVE 576 00:19:48,120 --> 00:19:52,720 ACHIEVED A DIFFERENT EFFECT. 577 00:19:52,720 --> 00:19:54,000 NOW MORE RECENTLY, THERE'S BEEN 578 00:19:54,000 --> 00:19:57,200 ANOTHER STUDY OF OURS, A POST 579 00:19:57,200 --> 00:19:58,720 HOC EXPLANATION, THAT ALSO 580 00:19:58,720 --> 00:19:59,960 SUGGESTS A SIGNIFICANT BENEFIT 581 00:19:59,960 --> 00:20:03,880 ON CVD INCIDENCE IN THOSE WHO 582 00:20:03,880 --> 00:20:04,960 ARE HEALTHIEST. 583 00:20:04,960 --> 00:20:07,040 HERE INSTEAD OF USING CVD 584 00:20:07,040 --> 00:20:08,920 HISTORY, WE USED THE DEFICIT 585 00:20:08,920 --> 00:20:09,560 ACCUMULATION MODEL TO LOOK AT 586 00:20:09,560 --> 00:20:11,680 THE TOTAL NUMBER OF HEALTH 587 00:20:11,680 --> 00:20:13,760 DEFICITS A PERSON HAD AT 588 00:20:13,760 --> 00:20:14,640 BASELINE. 589 00:20:14,640 --> 00:20:19,000 WE DIVIDED PEOPLE INTO THREE 590 00:20:19,000 --> 00:20:20,960 DIFFERENT TERTILES ACCORDING TO 591 00:20:20,960 --> 00:20:22,160 PROBLEMS THEY HAD AT BASELINE. 592 00:20:22,160 --> 00:20:24,360 WE USED THE MIDDLE TERTILE AS 593 00:20:24,360 --> 00:20:24,960 OUR REFERENCE GROUP. 594 00:20:24,960 --> 00:20:27,960 AND AS YOU CAN SEE HERE, THOSE 595 00:20:27,960 --> 00:20:32,280 PEOPLE IN THE LOWEST SOMEBODY 596 00:20:32,280 --> 00:20:33,680 TERTILE WITH THE FEWEST PROBLEMS 597 00:20:33,680 --> 00:20:36,440 AT BASELINE ACTUALLY SHOWED A 598 00:20:36,440 --> 00:20:37,080 SIGNIFICANT REDUCTION IN THE 599 00:20:37,080 --> 00:20:41,560 HAZARD RATIO FOR THE PRIMARY CVD 600 00:20:41,560 --> 00:20:45,200 OUTCOME. 601 00:20:45,200 --> 00:20:47,600 IN CONTRAST, THERE WAS A 602 00:20:47,600 --> 00:20:49,040 NON-SIGNIFICANT WORSENING IN 603 00:20:49,040 --> 00:20:52,120 THEIR OUTCOMES, SO AGAIN, I'LL 604 00:20:52,120 --> 00:20:54,080 SUGGEST THAT PERHAPS INTERVENING 605 00:20:54,080 --> 00:20:55,280 EARLIER IS GOING TO BE HELPFUL. 606 00:20:55,280 --> 00:20:56,800 THIS IS A POINT I'LL KEEP MAKING 607 00:20:56,800 --> 00:20:58,680 THROUGHOUT THE TRIAL, THROUGHOUT 608 00:20:58,680 --> 00:21:07,560 MY SLIDES TODAY. 609 00:21:07,560 --> 00:21:11,640 SO ANOTHER PROPOSED EXPLANATION 610 00:21:11,640 --> 00:21:18,720 IS IMPROVING THE RISK FACTOR 611 00:21:18,720 --> 00:21:20,760 MANAGEMENT IMPROVED HEALTH OF 612 00:21:20,760 --> 00:21:22,600 THE CONTROL CONDITION. 613 00:21:22,600 --> 00:21:23,920 ILI IN BLUE, AS YOU CAN SEE 614 00:21:23,920 --> 00:21:25,120 EVERY SLIDE AT EVERY TIME POINT, 615 00:21:25,120 --> 00:21:27,840 THERE IS GREATER USE OF 616 00:21:27,840 --> 00:21:30,040 ANTIHYPERTENSIVES, STATINS, AND 617 00:21:30,040 --> 00:21:31,560 INSULIN IN THE CONTROL GROUP 618 00:21:31,560 --> 00:21:32,800 THAN THERE WAS IN THE 619 00:21:32,800 --> 00:21:36,760 INTERVENTION GROUP. 620 00:21:36,760 --> 00:21:38,040 THIS SLIDE ALSO SHOWS MEDICAL 621 00:21:38,040 --> 00:21:40,800 CARE WAS CHANGING DRAMATICALLY 622 00:21:40,800 --> 00:21:42,640 OVER THE COURSE OF THE STUDY, 623 00:21:42,640 --> 00:21:45,840 LIKELY REDUCING CVD EVENTS AND 624 00:21:45,840 --> 00:21:47,880 STATISTICAL POWER AND ALSO 625 00:21:47,880 --> 00:21:48,440 AFFECTING RESULTS. 626 00:21:48,440 --> 00:21:50,240 YOU CAN SEE ANTIHYPERTENSIVE USE 627 00:21:50,240 --> 00:21:51,880 GOING UP, STATINS GOING UP A 628 00:21:51,880 --> 00:21:57,080 LOT, INSULIN USE GOING UP A LOT. 629 00:21:57,080 --> 00:21:59,960 THE HIGHER USE OF STATINS IN DSE 630 00:21:59,960 --> 00:22:03,000 LED TO LOWER LEVELS OF LDL IN 631 00:22:03,000 --> 00:22:08,160 DSE THAN IN ILI, AS SHOWN HERE. 632 00:22:08,160 --> 00:22:10,000 SO PERHAPS ONE EXPLANATION FOR 633 00:22:10,000 --> 00:22:11,600 OUR RESULTS IS THAT WE HAD TWO 634 00:22:11,600 --> 00:22:14,000 DIFFERENT MECHANISMS OPERATING 635 00:22:14,000 --> 00:22:16,160 FOR THE TWO DIFFERENT ARMS. 636 00:22:16,160 --> 00:22:18,040 IN ILI, PERHAPS IT WAS WEIGHT 637 00:22:18,040 --> 00:22:18,240 LOSS. 638 00:22:18,240 --> 00:22:19,760 IN THE LIFESTYLE INTERVENTION, 639 00:22:19,760 --> 00:22:21,440 IT WAS IMPROVING OUR RISK OF 640 00:22:21,440 --> 00:22:22,160 HEART DISEASE. 641 00:22:22,160 --> 00:22:25,760 BULL IN BUT IN DSE, IT MIGHTN 642 00:22:25,760 --> 00:22:28,160 THE LOWER LDL LEVELS LEADING TO 643 00:22:28,160 --> 00:22:30,920 IMPROVEMENTS. 644 00:22:30,920 --> 00:22:34,960 SO ANOTHER EXPLANATION WE 645 00:22:34,960 --> 00:22:36,120 PROPOSED WAS THAT THE WEIGHT 646 00:22:36,120 --> 00:22:37,600 LOSSES WERE NOT LARGE ENOUGH, OR 647 00:22:37,600 --> 00:22:39,040 THAT THOSE WHO DID NOT LOSE 648 00:22:39,040 --> 00:22:41,760 WEIGHT BLUNTED THE EFFECT OF 649 00:22:41,760 --> 00:22:46,680 WEIGHT LOSS. 650 00:22:46,680 --> 00:22:48,640 TO ADDRESS THIS HYPOTHESIS, WE 651 00:22:48,640 --> 00:22:50,400 CONDUCTED A SECONDARY ANALYSIS 652 00:22:50,400 --> 00:22:51,760 AND WE SHOWED THE RESULTS THAT 653 00:22:51,760 --> 00:22:54,920 I'M GOING TO TALK ABOUT HERE. 654 00:22:54,920 --> 00:22:55,840 USING EITHER THE DIABETES 655 00:22:55,840 --> 00:23:00,080 SUPPORT AND EDUCATION GROUP AS A 656 00:23:00,080 --> 00:23:03,040 WHOLE, ORTHOS IN ILI WHO GAINED 657 00:23:03,040 --> 00:23:05,200 WEIGHT OR REMAINED WEIGHT STABLE 658 00:23:05,200 --> 00:23:06,320 AS I'VE SHOWN HERE. 659 00:23:06,320 --> 00:23:07,600 WE FOUND A SIGNIFICANT REDUCTION 660 00:23:07,600 --> 00:23:09,120 IN THE PRIMARY OUTCOME, BUT ONLY 661 00:23:09,120 --> 00:23:11,240 FOR THOSE INDIVIDUALS WHO LOST 662 00:23:11,240 --> 00:23:14,680 10% OR MORE OF THEIR BODY 663 00:23:14,680 --> 00:23:15,200 WEIGHT. 664 00:23:15,200 --> 00:23:18,600 THE RIGHT-HAND BAR. 665 00:23:18,600 --> 00:23:22,000 THIS GROUP HAD A SIGNIFICANT 666 00:23:22,000 --> 00:23:23,320 REDUCTION IN THEIR RISK OF 667 00:23:23,320 --> 00:23:24,960 PRIMARY OUTCOME RELATIVE TO HERE 668 00:23:24,960 --> 00:23:28,440 THE GAINERS OR THE STABLE. 669 00:23:28,440 --> 00:23:29,560 THIS ANALYSIS IS INTERESTING AND 670 00:23:29,560 --> 00:23:31,240 IT SUGGESTS THAT LARGER WEIGHT 671 00:23:31,240 --> 00:23:35,040 LOSSES MAY HAVE BEEN NEEDED TO 672 00:23:35,040 --> 00:23:36,600 PRODUCE A GREATER EFFECT. 673 00:23:36,600 --> 00:23:39,880 OR THAT WE NEEDED A GREATER 674 00:23:39,880 --> 00:23:41,080 NUMBER OF PARTICIPANTS LOSING 675 00:23:41,080 --> 00:23:41,920 10%. 676 00:23:41,920 --> 00:23:46,240 BUT THIS IS A POST HOC ANALYSIS. 677 00:23:46,240 --> 00:23:47,560 NOT A RANDOMIZED COMPARISON. 678 00:23:47,560 --> 00:23:49,320 SO ALTHOUGH WE INCLUDED 679 00:23:49,320 --> 00:23:50,800 COVARIATES IN OUR ANALYSES, 680 00:23:50,800 --> 00:23:52,480 THOSE INDIVIDUALS WHO LOST MORE 681 00:23:52,480 --> 00:23:54,000 WEIGHT SHOWN IN THE RIGHT BAR 682 00:23:54,000 --> 00:23:56,200 MAY HAVE DIFFERED FROM THOSE WHO 683 00:23:56,200 --> 00:23:57,720 WERE GAINING OR WEIGHT STABLE IN 684 00:23:57,720 --> 00:23:59,160 MANY DIFFERENT WAYS THAT WE 685 00:23:59,160 --> 00:24:00,160 COULDN'T KNOW ABOUT OR DIDN'T 686 00:24:00,160 --> 00:24:00,640 CONTROL FOR. 687 00:24:00,640 --> 00:24:02,960 DUE TO THE LACK OF SIGNIFICANT 688 00:24:02,960 --> 00:24:04,080 DIFFERENCES IN THE PRIMARY 689 00:24:04,080 --> 00:24:06,160 OUTCOME AND OF FUTILITY 690 00:24:06,160 --> 00:24:07,560 ANALYSIS, NIH DECIDED TO STOP 691 00:24:07,560 --> 00:24:10,320 ALL OF THE INTERVENTIONS IN THE 692 00:24:10,320 --> 00:24:10,960 YEAR 2012. 693 00:24:10,960 --> 00:24:13,920 BUT CONTINUED LOOK AHEAD AS AN 694 00:24:13,920 --> 00:24:16,440 OBSERVATIONAL STUDY. 695 00:24:16,440 --> 00:24:17,880 THIS PROVIDED US WITH A 696 00:24:17,880 --> 00:24:18,880 WONDERFUL OPPORTUNITY TO EXAMINE 697 00:24:18,880 --> 00:24:21,080 THE EFFECT OF THE FIRST 10 YEARS 698 00:24:21,080 --> 00:24:23,160 OF INTERVENTION ON OTHER HEALTH 699 00:24:23,160 --> 00:24:25,920 OUTCOMES RELATED TO DIABETES AND 700 00:24:25,920 --> 00:24:26,160 OBESITY. 701 00:24:26,160 --> 00:24:27,400 IT ALSO PROVIDED AN OPPORTUNITY 702 00:24:27,400 --> 00:24:29,040 FOR US TO ADD NEW MEASURES 703 00:24:29,040 --> 00:24:32,320 RELEVANT TO AGING. 704 00:24:32,320 --> 00:24:34,080 THE LOOK AHEAD TRIAL IS STILL 705 00:24:34,080 --> 00:24:34,680 ONGOING. 706 00:24:34,680 --> 00:24:37,280 IT'S NOW FUNDED BY NIA, AND IT'S 707 00:24:37,280 --> 00:24:38,800 BEING DONE ENTIRELY BY PHONE 708 00:24:38,800 --> 00:24:41,200 CONTACT WITH OUR PARTICIPANTS. 709 00:24:41,200 --> 00:24:43,520 BUT I DID WANT TO ADVISE YOU OR 710 00:24:43,520 --> 00:24:49,640 LET YOU KNOW THAT IT IS ONGOING. 711 00:24:49,640 --> 00:24:51,640 NOW ALTHOUGH THE PRIMARY OUTCOME 712 00:24:51,640 --> 00:24:54,160 OF CBD WAS NOT SIGNIFICANT, 713 00:24:54,160 --> 00:24:55,360 INTENSIVE LIFESTYLE INTERVENTION 714 00:24:55,360 --> 00:24:56,760 WAS FOUND TO HAVE MANY POSITIVE 715 00:24:56,760 --> 00:25:00,320 EFFECTS ON MANY OTHER OUTCOMES. 716 00:25:00,320 --> 00:25:04,880 SIEF SELECTED I'VE SELECTS 717 00:25:04,880 --> 00:25:06,760 LIST YEAR AND I'M EVEN GOING TO 718 00:25:06,760 --> 00:25:07,960 PICK A SMALLER NUMBER OF THOSE 719 00:25:07,960 --> 00:25:09,920 TO TALK ABOUT IN THESE NEXT FEW 720 00:25:09,920 --> 00:25:14,520 SLIDES. 721 00:25:14,520 --> 00:25:16,480 SO ONE THING THAT HAS BEEN SHOWN 722 00:25:16,480 --> 00:25:18,680 IS THERE WAS AN ASSOCIATION 723 00:25:18,680 --> 00:25:20,880 BETWEEN BEING IN INTENSIVE 724 00:25:20,880 --> 00:25:21,520 LIFESTYLE INTERVENTION AND THE 725 00:25:21,520 --> 00:25:24,720 POSSIBILITY OF REMISSION OF TYPE 726 00:25:24,720 --> 00:25:25,560 2 DIABETES. 727 00:25:25,560 --> 00:25:27,040 NOW REMISSION WAS DEFINED AS NOT 728 00:25:27,040 --> 00:25:29,440 NEEDING DIABETES MEDICATIONS AND 729 00:25:29,440 --> 00:25:32,200 STILL HAVING NORMAL GLUCOSE OR 730 00:25:32,200 --> 00:25:36,000 GLUCOSE LEVELS IN A NON-DIABETIC 731 00:25:36,000 --> 00:25:36,880 RANGE. 732 00:25:36,880 --> 00:25:38,320 ILI HAD GREATER PREVALENCE OF 733 00:25:38,320 --> 00:25:43,320 REMISSION IN YEARS 1, 2, 3 AND . 734 00:25:43,320 --> 00:25:45,640 THE GREATEST BENEFITS WERE IN 735 00:25:45,640 --> 00:25:48,080 YEAR ONE, AND ALSO THE GREATEST 736 00:25:48,080 --> 00:25:49,800 BENEFITS WERE IN THOSE WHO WERE 737 00:25:49,800 --> 00:25:56,240 HEALTHIEST AT BASELINE. 738 00:25:56,240 --> 00:25:58,960 ANOTHER POSITIVE EFFECT WAS ON 739 00:25:58,960 --> 00:26:02,280 THE INCIDENCE OF NEPHROPATHY. 740 00:26:02,280 --> 00:26:04,800 SO ONE OF THE MICROVASCULAR 741 00:26:04,800 --> 00:26:07,440 COMPLICATIONS OF DIABETES WAS 742 00:26:07,440 --> 00:26:12,440 ALSO MARKETEDLY MARKEDLY R 743 00:26:12,440 --> 00:26:13,000 LIFESTYLE INTERVENTION. 744 00:26:13,000 --> 00:26:14,440 AS SEEN HERE, THE CONTROL GROUP 745 00:26:14,440 --> 00:26:16,480 IN BLUE HAS A MUCH HIGHER RISK 746 00:26:16,480 --> 00:26:20,920 OF DEVELOPING THIS HIGH RISK 747 00:26:20,920 --> 00:26:23,200 CHRONIC KIDNEY DISEASE RELATIVE 748 00:26:23,200 --> 00:26:27,360 TO OUR INTENSIVE LIFESTYLE 749 00:26:27,360 --> 00:26:30,760 INTERVENTION. 750 00:26:30,760 --> 00:26:32,520 I THINK THIS IS ONE OF THE OTHER 751 00:26:32,520 --> 00:26:33,960 INTERESTING FINDINGS OF LOOK 752 00:26:33,960 --> 00:26:34,520 AHEAD. 753 00:26:34,520 --> 00:26:36,160 BECAUSE IT DEALS REALLY WITH 754 00:26:36,160 --> 00:26:37,240 TREATMENT, NOT JUST PREVENTION 755 00:26:37,240 --> 00:26:39,560 OF SOMETHING. 756 00:26:39,560 --> 00:26:40,880 BUT IT DEALS WITH TREATMENT OF 757 00:26:40,880 --> 00:26:42,280 AN ONGOING PROBLEM, IN THIS 758 00:26:42,280 --> 00:26:44,240 CASE, SLEEP APNEA. 759 00:26:44,240 --> 00:26:49,040 IN THIS SUBGROUP OF 264 ADULTS 760 00:26:49,040 --> 00:26:52,040 WITH TYPE 2 DIABETES AND 761 00:26:52,040 --> 00:26:53,240 PREVIOUSLY DIAGNOSED OBSTRUCTIVE 762 00:26:53,240 --> 00:26:55,080 SLEEP APNEA, WE FOUND AN 763 00:26:55,080 --> 00:26:57,520 INTENSIVE LIFESTYLE INTERVENTION 764 00:26:57,520 --> 00:27:03,520 REDUCED THE INCIDENCE OF OSA, 765 00:27:03,520 --> 00:27:06,360 AND IT WAS FAR GREATER REDUCTION 766 00:27:06,360 --> 00:27:07,920 IN THE INTERVENTION GROUP THAN 767 00:27:07,920 --> 00:27:08,760 IN THE CONTROL GROUP. 768 00:27:08,760 --> 00:27:11,200 THIS SLIDE SHOWS YOU THE 769 00:27:11,200 --> 00:27:12,160 INCIDENCE -- THE REDUCTION, 770 00:27:12,160 --> 00:27:18,080 EXCUSE ME, IN OBSTRUCTIVE SLEEP 771 00:27:18,080 --> 00:27:20,240 APNEA IN THESE PATIENTS AT YEAR 772 00:27:20,240 --> 00:27:22,560 FOUR, AND YOU CAN SEE HERE THE 773 00:27:22,560 --> 00:27:23,880 MARKED NUMBER OF PEOPLE WITH 774 00:27:23,880 --> 00:27:27,840 IMPROVED OSA IN ILI VERSUS DSE. 775 00:27:27,840 --> 00:27:29,120 IF YOU ACTUALLY LOOK AT 776 00:27:29,120 --> 00:27:33,160 REMISSION RATES AT FOUR YEARS, 777 00:27:33,160 --> 00:27:34,600 ILI HAD 20.7% OF THEIR 778 00:27:34,600 --> 00:27:37,240 PARTICIPANTS NO LONGER HAD 779 00:27:37,240 --> 00:27:38,640 OBSTRUCTIVE SLEEP APNEA COMPARED 780 00:27:38,640 --> 00:27:44,120 TO ONLY 4% IN THE CONTROL GROUP. 781 00:27:44,120 --> 00:27:46,400 NOW I'D LIKE TO JUST LOOK AT ONE 782 00:27:46,400 --> 00:27:48,280 OF THE PUBLIC HEALTH KIND OF 783 00:27:48,280 --> 00:27:50,680 OUTCOMES, SO I HOPE I'VE COVERED 784 00:27:50,680 --> 00:27:52,040 SOME PREVENTION AND TREATMENT 785 00:27:52,040 --> 00:27:53,000 OUTCOMES, NOW I JUST WANTED TO 786 00:27:53,000 --> 00:27:54,200 LOOK AT ONE PUBLIC HEALTH ONE, 787 00:27:54,200 --> 00:27:56,600 WHICH IS THAT ILI HELPED REDUCE 788 00:27:56,600 --> 00:27:57,000 HEALTHCARE COSTS. 789 00:27:57,000 --> 00:28:00,880 IT WAS A 15% REA DUCKS IN E 790 00:28:00,880 --> 00:28:02,800 NURM BER OF DAYS IN THE 791 00:28:02,800 --> 00:28:03,720 HOSPITAL, 5% REDUCTION IN 792 00:28:03,720 --> 00:28:06,480 MEDICATION COST, LEAVING TO A 793 00:28:06,480 --> 00:28:07,080 SAVINGS OF $5,280 PER PERSON 794 00:28:07,080 --> 00:28:10,520 OVER THE 10 YEARS. 795 00:28:10,520 --> 00:28:13,600 HOWEVER, THE COST OF OFFERING 796 00:28:13,600 --> 00:28:16,040 ILI EXCEEDED THAT OF THE COST OF 797 00:28:16,040 --> 00:28:16,880 DSE. 798 00:28:16,880 --> 00:28:21,240 SO ILI COST $1,500 PER 799 00:28:21,240 --> 00:28:24,640 PARTICIPANT PER YEAR VERSUS ONLY 800 00:28:24,640 --> 00:28:26,040 $122 PER PARTICIPANT PER YEAR 801 00:28:26,040 --> 00:28:28,040 FOR DSE WHEN AVERAGED OVER THE 802 00:28:28,040 --> 00:28:29,640 10 YEARS. 803 00:28:29,640 --> 00:28:31,880 IN TERMS OF COST-EFFECTIVENESS, 804 00:28:31,880 --> 00:28:34,280 OUR OUTCOME IS REALLY DEPENDENT 805 00:28:34,280 --> 00:28:36,720 ON WHICH MEASURE OF HEALTH 806 00:28:36,720 --> 00:28:38,480 UTILITIES WE UTILIZED. 807 00:28:38,480 --> 00:28:39,920 NOW I DON'T WANT YOU TO HAVE THE 808 00:28:39,920 --> 00:28:41,520 IDEA THAT EVERYTHING WAS 809 00:28:41,520 --> 00:28:43,720 POSITIVE FROM ILI, ALTHOUGH I 810 00:28:43,720 --> 00:28:45,360 WOULD ARGUE THAT MOST OF THEM 811 00:28:45,360 --> 00:28:47,000 WERE, BUT THERE WERE SOME 812 00:28:47,000 --> 00:28:48,880 NEGATIVE EFFECTS OF ILI ON 813 00:28:48,880 --> 00:28:49,920 HEALTH, PARTICULARLY IN TERMS OF 814 00:28:49,920 --> 00:28:52,480 LOSS OF LEAN BODY MASS, AND AN 815 00:28:52,480 --> 00:28:58,200 INCREASED RISK OF FRACTURES. 816 00:28:58,200 --> 00:29:00,240 WE COMPLETED DEXA MEASURES ON A 817 00:29:00,240 --> 00:29:02,760 SUBSET OF PARTICIPANTS AT 818 00:29:02,760 --> 00:29:04,480 BASELINE YEARS 1, 4, 8 AND AT 819 00:29:04,480 --> 00:29:07,720 THE END OF THE TRIAL. 820 00:29:07,720 --> 00:29:08,640 AS PARTICIPANTS LOST WEIGHT AT 821 00:29:08,640 --> 00:29:10,360 YEAR ONE, THEY HAD MARKED 822 00:29:10,360 --> 00:29:12,760 IMPROVEMENTS IN BOTH THEIR FAT 823 00:29:12,760 --> 00:29:14,960 MASS AND THEIR LEAN MASS. 824 00:29:14,960 --> 00:29:16,720 HERE, BY THE WAY, THE DSE GROUP 825 00:29:16,720 --> 00:29:18,280 IS SHOWN IN THE SOLID LINE AND 826 00:29:18,280 --> 00:29:21,000 THE ILI IN THE DOTTED LINE. 827 00:29:21,000 --> 00:29:23,640 BUT AS ILI GRADUALLY REGAINED 828 00:29:23,640 --> 00:29:25,960 WEIGHT BETWEEN YEARS 1 AND 4 OR 829 00:29:25,960 --> 00:29:28,880 YEARS 1 AND 8 EVEN, YOU CAN SEE 830 00:29:28,880 --> 00:29:30,320 THAT THEIR FAT MASS INCREASED 831 00:29:30,320 --> 00:29:31,960 BUT THEIR LEAN MASS DID NOT 832 00:29:31,960 --> 00:29:34,360 INCREASE. 833 00:29:34,360 --> 00:29:35,800 WE'RE NOT SURE WHAT THE HEALTH 834 00:29:35,800 --> 00:29:38,960 CONSEQUENCES OF THIS WILL BE, 835 00:29:38,960 --> 00:29:39,880 BUT ONE POSSIBILITY IS THAT IT 836 00:29:39,880 --> 00:29:41,680 WOULD INCREASE THE RISK OF 837 00:29:41,680 --> 00:29:43,760 FRACTURES IN ILI RELATIVE TO 838 00:29:43,760 --> 00:29:46,200 DSE. 839 00:29:46,200 --> 00:29:48,080 THERE WERE NO DIFFERENCES IN THE 840 00:29:48,080 --> 00:29:51,760 INCIDENCE OF TOTAL FRACTURES. 841 00:29:51,760 --> 00:29:53,320 HOWEVER, AS SHOWN HERE, THERE 842 00:29:53,320 --> 00:29:55,280 WERE DIFFERENCES IN THE 843 00:29:55,280 --> 00:29:57,400 CUMULATIVE INCIDENCE OF FRAILTY 844 00:29:57,400 --> 00:29:58,360 FRACTURES, WHICH ARE FRACTURES 845 00:29:58,360 --> 00:30:01,520 OF THE HIP, PELVIS, UPPER ARM OR 846 00:30:01,520 --> 00:30:01,800 SHOULDER. 847 00:30:01,800 --> 00:30:03,120 THESE WERE GREATER IN FEMALES 848 00:30:03,120 --> 00:30:05,680 THAN IN MALES, AND WITHIN EACH 849 00:30:05,680 --> 00:30:07,800 GENDER WERE GREATER IN THE 850 00:30:07,800 --> 00:30:08,560 INTERVENTION GROUP THAN IN THE 851 00:30:08,560 --> 00:30:10,520 CONTROL GROUP. 852 00:30:10,520 --> 00:30:14,680 SO THIS IS A CONCERN TO US 853 00:30:14,680 --> 00:30:15,560 BECAUSE OBVIOUSLY YOU DO NOT 854 00:30:15,560 --> 00:30:18,400 WANT TO HAVE PEOPLE HAVING 855 00:30:18,400 --> 00:30:19,080 FRAILTY FRACTURES, AND THIS MAY 856 00:30:19,080 --> 00:30:21,640 HAVE BEEN RELATED TO THEIR LOSS 857 00:30:21,640 --> 00:30:23,160 OF LEAN MASS. 858 00:30:23,160 --> 00:30:24,640 NOW, I ALSO WANT TO EMPHASIZE 859 00:30:24,640 --> 00:30:26,320 THE FACT THAT THERE WERE NO 860 00:30:26,320 --> 00:30:27,880 SIGNIFICANT EFFECTS OF ILI ON 861 00:30:27,880 --> 00:30:29,640 HEALTH FOR SEVERAL VERY KEY 862 00:30:29,640 --> 00:30:30,280 HEALTH PROBLEMS. 863 00:30:30,280 --> 00:30:31,720 I'VE ALREADY POINTED OUT THAT 864 00:30:31,720 --> 00:30:33,680 FOR OUR PRIMARY OUT COME OF CVD, 865 00:30:33,680 --> 00:30:35,120 THERE WERE NO EFFECTS. 866 00:30:35,120 --> 00:30:36,320 I ALSO WANT TO TELL YOU THAT 867 00:30:36,320 --> 00:30:38,520 THERE WERE NO EFFECTS FOR 868 00:30:38,520 --> 00:30:41,960 CANCER, COGNITIVE FUNCTION, OR 869 00:30:41,960 --> 00:30:42,560 COGNITIVE IMPAIRMENT DEMENTIA. 870 00:30:42,560 --> 00:30:45,080 I'LL SHOW YOU SOME EXAMPLES OF 871 00:30:45,080 --> 00:30:48,880 THIS ON THE NEXT SLIDES. 872 00:30:48,880 --> 00:30:50,320 THIS SLIDE LOOKS AT THE RISK OF 873 00:30:50,320 --> 00:30:52,080 CANCER, AND YOU CAN SEE HERE 874 00:30:52,080 --> 00:30:54,280 NONE OF THE P VALUES ARE 875 00:30:54,280 --> 00:30:55,560 SIGNIFICANT. 876 00:30:55,560 --> 00:30:56,800 NO DIFFERENCES STATISTICALLY 877 00:30:56,800 --> 00:30:58,760 SIGNIFICANT DIFFERENCES BETWEEN 878 00:30:58,760 --> 00:31:02,040 DSE AND ILI FOR CANCER RISK. 879 00:31:02,040 --> 00:31:04,600 THERE'S A TREND FOR A POSITIVE 880 00:31:04,600 --> 00:31:06,640 EFFECT IN OBESITY-RELATED 881 00:31:06,640 --> 00:31:08,760 CANCERS BUT IT'S JUST A P OF 882 00:31:08,760 --> 00:31:09,160 .10. 883 00:31:09,160 --> 00:31:13,000 NO DIFFERENCES AGAIN IN CANCER 884 00:31:13,000 --> 00:31:15,080 MORTALITY. 885 00:31:15,080 --> 00:31:17,920 WE ALSO HAD NO EFFECTS ON 886 00:31:17,920 --> 00:31:20,760 COGNITIVE FUNCTION, BUT WE DID 887 00:31:20,760 --> 00:31:25,680 HAVE POSITIVE EFFECTS ON BRAIN 888 00:31:25,680 --> 00:31:27,640 STRUCTURE WITH POSITIVE BENEFITS 889 00:31:27,640 --> 00:31:31,720 IN ILI VERSUS DSE. 890 00:31:31,720 --> 00:31:33,320 HOWEVER WE HAVE NOT FOUND ANY 891 00:31:33,320 --> 00:31:35,320 EFFECTS THUS FAR ON COGNITIVE 892 00:31:35,320 --> 00:31:35,720 IMPAIRMENT. 893 00:31:35,720 --> 00:31:38,600 MILD COGNITIVE IMPAIRMENT OR 894 00:31:38,600 --> 00:31:39,280 DEMENTIA. 895 00:31:39,280 --> 00:31:40,560 THIS MAY BE BECAUSE OUR RATES OF 896 00:31:40,560 --> 00:31:42,120 BOTH OF THESE PROBLEMS HAS BEEN 897 00:31:42,120 --> 00:31:45,960 SO LOW THUS FAR. 898 00:31:45,960 --> 00:31:50,640 SO OUR ADJUDICATED MCI WAS ONLY 899 00:31:50,640 --> 00:31:54,480 6.4% IN BOTH ILI AND DSE AND 900 00:31:54,480 --> 00:31:57,320 ADJUDICATED DEMENTIA WAS ONLY 901 00:31:57,320 --> 00:31:58,280 1.8% IN BOTH. 902 00:31:58,280 --> 00:31:59,280 SO THAT'S ONE OF THE REASONS 903 00:31:59,280 --> 00:32:01,680 WE'LL BE ABLE TO CONTINUE WITH 904 00:32:01,680 --> 00:32:03,440 FUNDING TO LOOK AT THESE 905 00:32:03,440 --> 00:32:04,680 COGNITIVE IMPAIRMENTS OVER TIME. 906 00:32:04,680 --> 00:32:06,640 AGAIN THOUGH THERE WERE 907 00:32:06,640 --> 00:32:09,040 SIGNIFICANT INTERACTIONS BETWEEN 908 00:32:09,040 --> 00:32:12,120 BASELINE BMI AND CVD HISTORY. 909 00:32:12,120 --> 00:32:14,240 NOW MOST RECENTLY, WE HAVE ADDED 910 00:32:14,240 --> 00:32:16,760 ANOTHER NON-SIGNIFICANT EFFECT 911 00:32:16,760 --> 00:32:17,960 OF ILI ON HEALTH. 912 00:32:17,960 --> 00:32:21,760 IT'S IN TERMS OF OVERALL 913 00:32:21,760 --> 00:32:25,240 MORTALITY. 914 00:32:25,240 --> 00:32:27,040 WITH ADJUDICATED MORTALITY AND 915 00:32:27,040 --> 00:32:28,440 ITS CAUSES OVER THE ENTIRE 916 00:32:28,440 --> 00:32:29,880 STUDY, AND WE'VE JUST PUBLISHED 917 00:32:29,880 --> 00:32:32,600 THESE RESULTS IN A VERY RECENT 918 00:32:32,600 --> 00:32:33,800 ISSUE OF DIABETES CARE. 919 00:32:33,800 --> 00:32:37,440 THIS SLIDE SHOWS THE TOTAL 920 00:32:37,440 --> 00:32:40,520 MORTALITY OVER THE ENTIRE STUDY. 921 00:32:40,520 --> 00:32:41,800 DURING THE INTERVENTION, THE 922 00:32:41,800 --> 00:32:43,560 TRANSITION, AND THE POST 923 00:32:43,560 --> 00:32:45,640 INTERVENTION PHASES. 924 00:32:45,640 --> 00:32:48,720 OVER THIS ENTIRE PERIOD, THE 925 00:32:48,720 --> 00:32:51,320 HAZARD RATIO WAS .92. 926 00:32:51,320 --> 00:32:55,720 SO THERE WAS AN 8% REDUCTION IN 927 00:32:55,720 --> 00:32:57,960 ALL CAUSE MORTALITY FOR ILI 928 00:32:57,960 --> 00:32:59,520 VERSUS DSE, BUT THIS WAS NOT 929 00:32:59,520 --> 00:33:02,480 SIGNIFICANT, A P OF .16. 930 00:33:02,480 --> 00:33:06,040 SO ILI NEITHER IMPROVED NOR 931 00:33:06,040 --> 00:33:07,400 WORSENED ALL CAUSE MORTALITY 932 00:33:07,400 --> 00:33:15,480 RELATIVE TO DSE. 933 00:33:15,480 --> 00:33:19,000 HERE I'VE SHOWN YOU THE THE 934 00:33:19,000 --> 00:33:20,640 ADJUDICATED PRIMARY CAUSES OF 935 00:33:20,640 --> 00:33:21,320 DEATH. 936 00:33:21,320 --> 00:33:22,280 THERE WERE NO DIFFERENCES IN 937 00:33:22,280 --> 00:33:25,800 CANCER RISK, CVD OR OTHER. 938 00:33:25,800 --> 00:33:26,440 HOWEVER, ONE OF THE THINGS I 939 00:33:26,440 --> 00:33:28,400 THINK THAT'S INTERESTING IN THIS 940 00:33:28,400 --> 00:33:32,480 SLIDE IS THAT CANCER AND OTHER 941 00:33:32,480 --> 00:33:35,800 ARE HIGHER ADJUDICATED PRIMARY 942 00:33:35,800 --> 00:33:40,840 CAUSES OF DEATH IN THIS 943 00:33:40,840 --> 00:33:41,360 POPULATION. 944 00:33:41,360 --> 00:33:44,080 AGAIN, WE'VE CONDUCTED A POST 945 00:33:44,080 --> 00:33:46,960 HOC ANALYSIS COMPARING ALL CAUSE 946 00:33:46,960 --> 00:33:48,920 MORTALITY IN ILI ACCORDING TO 947 00:33:48,920 --> 00:33:51,320 THE MAGNITUDE OF THEIR WEIGHT 948 00:33:51,320 --> 00:33:52,960 LOSSES, COMPARED TO DSE AS A 949 00:33:52,960 --> 00:33:55,240 WHOLE. 950 00:33:55,240 --> 00:33:56,360 WE SHOW THAT THOSE INDIVIDUALS 951 00:33:56,360 --> 00:33:57,760 WHO HAD THE BIGGEST WEIGHT 952 00:33:57,760 --> 00:34:00,200 LOSSES AT ONE YEAR, SO THAT'S A 953 00:34:00,200 --> 00:34:03,920 WEIGHT LOSS OF 10% OR MORE, HAD 954 00:34:03,920 --> 00:34:07,440 LESS MORTALITY OVER THE 955 00:34:07,440 --> 00:34:08,840 SUBSEQUENT PERIOD OF THE STUDY. 956 00:34:08,840 --> 00:34:12,680 SO BETWEEN YEARS TWO AND THE END 957 00:34:12,680 --> 00:34:16,480 OF THE TRIAL IN ILI VERSUS DSE. 958 00:34:16,480 --> 00:34:18,000 IN CONTRAST, THOSE INDIVIDUALS 959 00:34:18,000 --> 00:34:20,640 WHO HAD THE LEAST WEIGHT LOSS OR 960 00:34:20,640 --> 00:34:23,360 ACTUALLY GAINED HAD ALMOST 961 00:34:23,360 --> 00:34:26,000 SIGNIFICANT WORSENING IN THEIR 962 00:34:26,000 --> 00:34:30,040 MORTALITY BUT NOT QUITE 963 00:34:30,040 --> 00:34:30,440 SIGNIFICANT, .088. 964 00:34:30,440 --> 00:34:34,320 SO AGAIN, THIS IS A POST HOC 965 00:34:34,320 --> 00:34:35,760 ANALYSIS, BUT IT'S VERY 966 00:34:35,760 --> 00:34:36,720 INTERESTING BECAUSE IT GOES 967 00:34:36,720 --> 00:34:38,680 ALONG WITH SOME OF OUR OTHER 968 00:34:38,680 --> 00:34:39,880 POST HOC ANALYSES, SUGGESTING 969 00:34:39,880 --> 00:34:41,320 THAT THOSE INDIVIDUALS WHO LOST 970 00:34:41,320 --> 00:34:45,800 THE MOST WEIGHT IN ILI, 10% OR 971 00:34:45,800 --> 00:34:47,760 MORE, DID SHOW BENEFICIAL 972 00:34:47,760 --> 00:34:50,400 EFFECTS RELATIVE TO DSE AS A 973 00:34:50,400 --> 00:34:51,280 WHOLE. 974 00:34:51,280 --> 00:34:53,240 AND THAT THOSE INDIVIDUALS WHO 975 00:34:53,240 --> 00:34:54,240 GAINED WEIGHT MAY HAVE HAD A 976 00:34:54,240 --> 00:35:03,520 SLIGHT WORSENING IN THEIR RISK. 977 00:35:03,520 --> 00:35:05,480 NOW FINALLY, IN ANOTHER RECENT 978 00:35:05,480 --> 00:35:06,920 MANUSCRIPT THAT WE PUBLISHED IN 979 00:35:06,920 --> 00:35:09,000 DIABETES CARE, WE EXAMINED WHAT 980 00:35:09,000 --> 00:35:09,960 HAPPENED WITH WEIGHT OVER THE 981 00:35:09,960 --> 00:35:12,920 FULL COURSE OF LOOK AHEAD. 982 00:35:12,920 --> 00:35:14,680 SO NOW LOOKING AT WEIGHT CHANGES 983 00:35:14,680 --> 00:35:17,960 PARTICULARLY DURING THE POST 984 00:35:17,960 --> 00:35:18,720 INTERVENTION PERIOD. 985 00:35:18,720 --> 00:35:20,880 AS YOU CAN SEE HERE, BOTH ILI 986 00:35:20,880 --> 00:35:24,200 AND DSE LOST WEIGHT OVER THE 987 00:35:24,200 --> 00:35:27,720 LAST SIX TO 10 YEARS OF THE 988 00:35:27,720 --> 00:35:32,720 STUDY. 989 00:35:32,720 --> 00:35:34,800 WE USE TRAJECTORY ANALYSES TO 990 00:35:34,800 --> 00:35:36,120 DETERMINE IF THERE WERE 991 00:35:36,120 --> 00:35:36,760 DIFFERENT PATTERNS OF WEIGHT 992 00:35:36,760 --> 00:35:40,040 CHANGES AFTER THE END OF 993 00:35:40,040 --> 00:35:40,960 INTERVENTION. 994 00:35:40,960 --> 00:35:42,120 THIS ANALYSIS IDENTIFIED FOUR 995 00:35:42,120 --> 00:35:45,080 DIFFERENT TRAJECTORIES. 996 00:35:45,080 --> 00:35:46,960 GAINERS, A STABLE GROUP, A 997 00:35:46,960 --> 00:35:48,680 STEADY LOSS GROUP, AND A STEEP 998 00:35:48,680 --> 00:35:51,640 LOSS GROUP. 999 00:35:51,640 --> 00:35:53,280 THE STEEP LOSS GROUP INCLUDED 1000 00:35:53,280 --> 00:35:57,240 ONLY 10% OF THE PARTICIPANTS. 1001 00:35:57,240 --> 00:35:59,000 BUT I WANT TO POINT OUT HOW 1002 00:35:59,000 --> 00:36:00,320 STEEP THEIR WEIGHT LOSSES WERE. 1003 00:36:00,320 --> 00:36:03,040 ON AVERAGE, THESE INDIVIDUALS 1004 00:36:03,040 --> 00:36:06,200 LOST ALMOST 20% OF THEIR BODY 1005 00:36:06,200 --> 00:36:08,520 WEIGHT OVER THE EIGHT YEARS FROM 1006 00:36:08,520 --> 00:36:10,240 YEAR EIGHT TO 16. 1007 00:36:10,240 --> 00:36:11,360 THAT'S FAR GREATER THAN WE 1008 00:36:11,360 --> 00:36:13,120 ACHIEVED WITH OUR ILI PROGRAM 1009 00:36:13,120 --> 00:36:14,240 DURING THE ORIGINAL 1010 00:36:14,240 --> 00:36:16,480 INTERVENTION. 1011 00:36:16,480 --> 00:36:18,440 WE ALSO FOUND THAT THESE STEEP 1012 00:36:18,440 --> 00:36:19,800 LOSER, THESE 10% OF THE GROUP, 1013 00:36:19,800 --> 00:36:23,280 HAD AN INCREASED RISK OF 1014 00:36:23,280 --> 00:36:23,560 MORTALITY. 1015 00:36:23,560 --> 00:36:25,800 30% OF THESE INDIVIDUALS PASSED 1016 00:36:25,800 --> 00:36:27,760 AWAY, VERSUS 10 TO 19% IN OUR 1017 00:36:27,760 --> 00:36:31,600 OTHER THREE GROUPS. 1018 00:36:31,600 --> 00:36:34,120 THEY WERE ALSO OLDER, SICKER, 1019 00:36:34,120 --> 00:36:36,880 AND THEY REPORTED LESS USE OF 1020 00:36:36,880 --> 00:36:39,240 HEALTHY WEIGHT LOSS STRATEGIES. 1021 00:36:39,240 --> 00:36:43,160 SO THESE DATA SUGGEST TO US THAT 1022 00:36:43,160 --> 00:36:45,200 PERHAPS THEIR WEIGHT LOSSES WERE 1023 00:36:45,200 --> 00:36:46,600 UNINTENTIONAL, NOT INTENTIONAL. 1024 00:36:46,600 --> 00:36:48,560 AGAIN, SUGGESTING THAT 1025 00:36:48,560 --> 00:36:49,400 UNINTENTIONAL WEIGHT LOSS MAY 1026 00:36:49,400 --> 00:36:52,160 HAVE A NEGATIVE EFFECT ON 1027 00:36:52,160 --> 00:36:53,800 HEALTH, EVEN IF INTENTIONAL 1028 00:36:53,800 --> 00:37:00,480 WEIGHT LOSS IS HELPFUL. 1029 00:37:00,480 --> 00:37:04,080 SO IN CONCLUSION, ILI HAD NO 1030 00:37:04,080 --> 00:37:08,480 EFFECT ON SEVERAL IMPORTANT 1031 00:37:08,480 --> 00:37:09,920 THINGS, INCLUDING THE PRIMARY 1032 00:37:09,920 --> 00:37:11,440 OUT COME OF CVD. 1033 00:37:11,440 --> 00:37:13,320 IT ALSO HAD NO EFFECT ON CANCER, 1034 00:37:13,320 --> 00:37:16,800 COGNITION OR MORTALITY. 1035 00:37:16,800 --> 00:37:18,800 HOWEVER, ILI HAS HAD A POSITIVE 1036 00:37:18,800 --> 00:37:21,280 EFFECT ON MANY HEALTH ISSUES, 1037 00:37:21,280 --> 00:37:23,680 INCLUDING DIABETES REMISSION, 1038 00:37:23,680 --> 00:37:26,840 CHRONIC KIDNEY DISEASE, SLEEP 1039 00:37:26,840 --> 00:37:28,200 APNEA, AND OTHERS THAT I DIDN'T 1040 00:37:28,200 --> 00:37:30,040 EVEN DISCUSS. 1041 00:37:30,040 --> 00:37:32,360 THESE POSITIVE EFFECTS WERE 1042 00:37:32,360 --> 00:37:36,160 OFTEN GREATEST AT YEAR ONE AND 1043 00:37:36,160 --> 00:37:36,840 DIMINISHED OVER TIME. 1044 00:37:36,840 --> 00:37:39,480 THERE WAS HETEROGENEITY IN THE 1045 00:37:39,480 --> 00:37:43,400 RESPONSE TO ILI RELATIVE TO DSE. 1046 00:37:43,400 --> 00:37:45,040 ILI HAD A POSITIVE IMPACT IN 1047 00:37:45,040 --> 00:37:46,480 THOSE WHO WERE HEALTHIEST AT 1048 00:37:46,480 --> 00:37:47,240 BASELINE. 1049 00:37:47,240 --> 00:37:48,760 AND IN THOSE WHO LOST GREATER 1050 00:37:48,760 --> 00:37:53,480 THAN 10% OF THEIR BODY WEIGHT AT 1051 00:37:53,480 --> 00:37:58,200 ONE YEAR. 1052 00:37:58,200 --> 00:38:00,160 SO NOW I WANT TO RETURN TO MY 1053 00:38:00,160 --> 00:38:01,600 ORIGINAL QUESTION, SHOULD OLDER 1054 00:38:01,600 --> 00:38:03,560 ADULTS WITH DIABETES AND OBESITY 1055 00:38:03,560 --> 00:38:06,040 BE ENCOURAGED TO LOSE WEIGHT? 1056 00:38:06,040 --> 00:38:06,960 MY ANSWER, AND I WANT TO POINT 1057 00:38:06,960 --> 00:38:08,800 OUT THAT THIS IS MY ANSWER, NOT 1058 00:38:08,800 --> 00:38:10,320 EVERYONE WILL AGREE, IS YES, I 1059 00:38:10,320 --> 00:38:12,520 THINK THEY SHOULD BE ENCOURAGED. 1060 00:38:12,520 --> 00:38:13,520 BECAUSE GIVEN THE MANY 1061 00:38:13,520 --> 00:38:15,520 OUTCOMES OF WEIGHT LOSS IN THESE 1062 00:38:15,520 --> 00:38:17,480 OLDER INDIVIDUALS, I BELIEVE 1063 00:38:17,480 --> 00:38:18,320 CONTINUING TO RECOMMEND WEIGHT 1064 00:38:18,320 --> 00:38:21,320 LOSS IS APPROPRIATE. 1065 00:38:21,320 --> 00:38:22,760 HOWEVER, I THINK WE NEED TO BE 1066 00:38:22,760 --> 00:38:24,560 RECOMMENDING INTENTIONAL WEIGHT 1067 00:38:24,560 --> 00:38:28,400 LOSS AT APPROPRIATE RATES, AND 1068 00:38:28,400 --> 00:38:29,600 THAT OLDER, SICKER PATIENTS WHO 1069 00:38:29,600 --> 00:38:32,440 ARE LOSING WEIGHT TOO RAPIDLY, 1070 00:38:32,440 --> 00:38:39,120 SHOULD RAISE OUR CONCERNS. 1071 00:38:39,120 --> 00:38:40,320 NOW FOR MORE INFORMATION ABOUT 1072 00:38:40,320 --> 00:38:42,640 THESE STUDIES OR FOR MORE 1073 00:38:42,640 --> 00:38:44,400 INFORMATION ABOUT OUR TRIAL LOOK 1074 00:38:44,400 --> 00:38:46,360 AHEAD, I WOULD ENCOURAGE YOU TO 1075 00:38:46,360 --> 00:38:48,160 LOOK AT THIS RECENT ARTICLE I'VE 1076 00:38:48,160 --> 00:38:51,280 PUBLISHED IN OWE OBESITY, WHIH 1077 00:38:51,280 --> 00:38:52,360 REALLY SUMMARIZED MANY OF THE 1078 00:38:52,360 --> 00:38:53,920 FINDINGS FROM THE LOOK AHEAD 1079 00:38:53,920 --> 00:38:54,760 RANDOMIZED TRIAL AND INCLUDES 1080 00:38:54,760 --> 00:38:56,120 ALL THE DATA I WAS TALKING ABOUT 1081 00:38:56,120 --> 00:38:57,120 TODAY AND ALL THE REFERENCES FOR 1082 00:38:57,120 --> 00:38:59,720 WHAT I WAS TALKING ABOUT TODAY. 1083 00:38:59,720 --> 00:39:05,200 THERE'S ALSO THE 1084 00:39:05,200 --> 00:39:05,840 WWW.LOOKAHEADTRIAL.ORG WEBSITE 1085 00:39:05,840 --> 00:39:07,160 WHICH INCLUDES THE PROTOCOL FOR 1086 00:39:07,160 --> 00:39:08,160 THE DIFFERENT PHASES OF LOOK 1087 00:39:08,160 --> 00:39:10,760 AHEAD AND THE FULL BIBLIOGRAPHY. 1088 00:39:10,760 --> 00:39:12,080 AND FINALLY, WE'VE BEEN PUTTING 1089 00:39:12,080 --> 00:39:15,480 ALL OF OUR DATA GRADUALLY ON THE 1090 00:39:15,480 --> 00:39:17,880 NIDDK WEBSITE ON THE REPOSITORY, 1091 00:39:17,880 --> 00:39:19,520 AND WE'VE BEEN SENDING BLOOD 1092 00:39:19,520 --> 00:39:22,720 SAMPLES TO THE NIDDK REPOSITORY. 1093 00:39:22,720 --> 00:39:24,800 SO THOSE WILL ALL BE AVAILABLE 1094 00:39:24,800 --> 00:39:26,840 TO INVESTIGATORS WITHIN LOOK 1095 00:39:26,840 --> 00:39:29,040 AHEAD OR OUTSIDE OF LOOK AHEAD, 1096 00:39:29,040 --> 00:39:30,520 WHO WANT TO PROPOSE NEW USES OF 1097 00:39:30,520 --> 00:39:33,000 OUR DATA, NEW PROJECTS, OR NEW 1098 00:39:33,000 --> 00:39:34,120 USES OF OUR SAMPLES. 1099 00:39:34,120 --> 00:39:39,040 SO FOR EXAMPLE, WE HAD A GWAS OF 1100 00:39:39,040 --> 00:39:39,360 PARTICIPANTS. 1101 00:39:39,360 --> 00:39:41,240 I DID NOT GO INTO ANY OF THE 1102 00:39:41,240 --> 00:39:43,080 GENETIC ANALYSES IN MY FINDINGS 1103 00:39:43,080 --> 00:39:44,200 TODAY, BUT THEY ARE ALL 1104 00:39:44,200 --> 00:39:46,360 AVAILABLE IF YOU WANT TO GO TO 1105 00:39:46,360 --> 00:39:47,040 THIS REPOSITORY. 1106 00:39:47,040 --> 00:39:48,800 SO I JUST WANT TO END BY 1107 00:39:48,800 --> 00:39:49,880 THANKING YOU ALL AND 1108 00:39:49,880 --> 00:39:51,080 PARTICULARLY THANKING THE OFFICE 1109 00:39:51,080 --> 00:39:53,360 OF DISEASE PREVENTION FOR 1110 00:39:53,360 --> 00:39:54,800 SUGGESTED ME AS A SPEAKER TODAY. 1111 00:39:54,800 --> 00:39:57,880 THANK YOU. 1112 00:39:57,880 --> 00:40:00,600 >> THANK YOU, DR. WING, VERY 1113 00:40:00,600 --> 00:40:03,440 MUCH FOR A FASCINATING 1114 00:40:03,440 --> 00:40:03,760 PRESENTATION. 1115 00:40:03,760 --> 00:40:05,200 LOTS OF QUESTIONS TO CONSIDER. 1116 00:40:05,200 --> 00:40:09,440 AND WE HAVE A LITTLE TIME TO DO 1117 00:40:09,440 --> 00:40:10,000 THAT. 1118 00:40:10,000 --> 00:40:14,040 SO LET ME START. 1119 00:40:14,040 --> 00:40:15,600 WHY WOULD OBSERVATIONAL STUDIES 1120 00:40:15,600 --> 00:40:18,560 SHOW HIGHER MORTALITY AND WEIGHT 1121 00:40:18,560 --> 00:40:21,280 LOSS WHERE A TRIAL LIKE LOOK 1122 00:40:21,280 --> 00:40:22,680 AHEAD SHOWED MANY HEALTH 1123 00:40:22,680 --> 00:40:26,920 BENEFITS FROM WEIGHT LOSS? 1124 00:40:26,920 --> 00:40:28,320 >> I BELIEVE THAT'S REALLY 1125 00:40:28,320 --> 00:40:29,840 BECAUSE OF THE PROBLEM OF 1126 00:40:29,840 --> 00:40:31,120 DISTINGUISHING INTENTIONAL 1127 00:40:31,120 --> 00:40:33,880 VERSUS UNINTENTIONAL WEIGHT 1128 00:40:33,880 --> 00:40:34,160 LOSS. 1129 00:40:34,160 --> 00:40:36,160 SO IN AN OBSERVATIONAL STUDY YOU 1130 00:40:36,160 --> 00:40:37,280 HAVE A LOT OF PEOPLE LOSING 1131 00:40:37,280 --> 00:40:38,360 WEIGHT BUT YOU DON'T KNOW WHY OR 1132 00:40:38,360 --> 00:40:38,880 HOW. 1133 00:40:38,880 --> 00:40:40,880 IN A CLINICAL TRIAL, WHAT YOU'VE 1134 00:40:40,880 --> 00:40:42,520 DONE IS TAKE IN HALF THE PEOPLE 1135 00:40:42,520 --> 00:40:45,360 AND RANDOMLY ASSIGN THEM TO 1136 00:40:45,360 --> 00:40:46,240 INTENTIONALLY LOSE WEIGHT. 1137 00:40:46,240 --> 00:40:47,560 YOU'VE TAUGHT THEM HEALTHY 1138 00:40:47,560 --> 00:40:49,200 STRATEGIES TO DO IT, AND YOU'VE 1139 00:40:49,200 --> 00:40:50,640 FOLLOWED THEM OVER TIME. 1140 00:40:50,640 --> 00:40:52,080 SO I BELIEVE THAT THAT'S THE 1141 00:40:52,080 --> 00:40:52,400 DIFFERENCE. 1142 00:40:52,400 --> 00:40:53,880 IT'S IN THE METHODOLOGY AND THE 1143 00:40:53,880 --> 00:40:55,000 DESIGN OF THOSE TWO TYPES OF 1144 00:40:55,000 --> 00:40:57,520 STUDIES. 1145 00:40:57,520 --> 00:40:59,720 >> THANK YOU. 1146 00:40:59,720 --> 00:41:02,000 I SHOULD HAVE SAID THIS AT THE 1147 00:41:02,000 --> 00:41:03,320 BEGINNING OF THE QUESTION AND 1148 00:41:03,320 --> 00:41:05,320 ANSWER PERIOD BUT LET ME DO IT 1149 00:41:05,320 --> 00:41:05,960 NOW. 1150 00:41:05,960 --> 00:41:08,560 THE CODE FOR CONTINUING MEDICAL 1151 00:41:08,560 --> 00:41:12,320 EDUCATION CREDITS IS 37947. 1152 00:41:12,320 --> 00:41:13,280 SO THOSE OF YOU WHO ARE 1153 00:41:13,280 --> 00:41:16,800 INTERESTED IN THAT, 37947. 1154 00:41:16,800 --> 00:41:19,840 NOW, RETURNING TO QUESTIONS. 1155 00:41:19,840 --> 00:41:20,960 SOME PEOPLE HAVE SUGGESTED THAT 1156 00:41:20,960 --> 00:41:24,440 WE DON'T NEED TO DO THESE LARGE, 1157 00:41:24,440 --> 00:41:25,880 EXPENSIVE CLINICAL TRIALS 1158 00:41:25,880 --> 00:41:28,640 ANYMORE, THAT WE CAN INSTEAD USE 1159 00:41:28,640 --> 00:41:30,680 SOPHISTICATED CAUSAL MODELING 1160 00:41:30,680 --> 00:41:32,440 TECHNIQUES WITH FAR LESS 1161 00:41:32,440 --> 00:41:33,760 EXPENSIVE OBSERVATIONAL DATA TO 1162 00:41:33,760 --> 00:41:34,960 ANSWER THESE QUESTIONS. 1163 00:41:34,960 --> 00:41:39,360 WHAT'S YOUR VIEW? 1164 00:41:39,360 --> 00:41:40,360 >> I'VE HEARD THAT OFTEN TALKED 1165 00:41:40,360 --> 00:41:42,040 ABOUT WITH EMR DATA, SO FOR 1166 00:41:42,040 --> 00:41:42,960 EXAMPLE, TAKING A GROUP OF 1167 00:41:42,960 --> 00:41:44,080 PEOPLE AND THEN FOLLOWING THEM 1168 00:41:44,080 --> 00:41:45,680 THROUGH EMR DATA, BUT I WOULD 1169 00:41:45,680 --> 00:41:46,360 REALLY QUESTION THAT. 1170 00:41:46,360 --> 00:41:47,360 FIRST OF ALL, I WOULD QUESTION 1171 00:41:47,360 --> 00:41:48,680 HOW YOU'RE EVER GOING TO 1172 00:41:48,680 --> 00:41:50,000 DISTINGUISH THOSE PEOPLE WHO ARE 1173 00:41:50,000 --> 00:41:52,480 LOSING WEIGHT INTENTIONALLY AND 1174 00:41:52,480 --> 00:41:55,040 USING HEALTHY STRATEGIES, VERSUS 1175 00:41:55,040 --> 00:41:57,880 THOSE PEOPLE WHO ARE LOSING 1176 00:41:57,880 --> 00:41:59,320 WEIGHT UNINTENTIONALLY BECAUSE 1177 00:41:59,320 --> 00:42:00,080 THEY'RE ALREADY ILL. 1178 00:42:00,080 --> 00:42:02,080 SO YOU CAN TRY TO DO THAT BY 1179 00:42:02,080 --> 00:42:03,360 SAYING OKAY, LET'S LEAVE OUT 1180 00:42:03,360 --> 00:42:06,520 ANYBODY WHO'S A SMOKER, LET'S 1181 00:42:06,520 --> 00:42:07,720 LEAVE OUT ANYBODY WHO HAS CANCER 1182 00:42:07,720 --> 00:42:08,840 IN THE FIRST TWO OR THREE YEARS 1183 00:42:08,840 --> 00:42:10,280 AND LOOK AT THEIR MORTALITY 1184 00:42:10,280 --> 00:42:10,800 SUBSEQUENT. 1185 00:42:10,800 --> 00:42:12,960 THAT'S WHAT THEY'VE DONE IN 1186 00:42:12,960 --> 00:42:13,960 OBSERVATIONAL STUDIES BEFORE. 1187 00:42:13,960 --> 00:42:16,960 BUT I THINK THOSE ARE ALL STILL 1188 00:42:16,960 --> 00:42:20,120 OPEN TO CRITICISM BECAUSE THEY 1189 00:42:20,120 --> 00:42:22,520 REALLY CAN'T DISTINGUISH THE 1190 00:42:22,520 --> 00:42:24,600 TWO, INTENTIONAL VERSUS 1191 00:42:24,600 --> 00:42:25,120 UNINTENTIONAL WEIGHT LOSS. 1192 00:42:25,120 --> 00:42:26,200 >> OKAY. 1193 00:42:26,200 --> 00:42:30,560 LOOK AHEAD DID A GREAT JOB IN 1194 00:42:30,560 --> 00:42:31,280 RECRUITING MINORITY 1195 00:42:31,280 --> 00:42:32,320 PARTICIPANTS. 1196 00:42:32,320 --> 00:42:35,120 37% IN THE EARLY 2,000s IS 1197 00:42:35,120 --> 00:42:36,240 MUCH BETTER THAN A LOT OF OTHER 1198 00:42:36,240 --> 00:42:37,480 STUDIES THAT WERE UNDERWAY AT 1199 00:42:37,480 --> 00:42:37,880 THE SAME TIME. 1200 00:42:37,880 --> 00:42:41,360 HOW DID YOU MANAGE THAT? 1201 00:42:41,360 --> 00:42:42,840 >> THAT WAS A LOT OF WORK BUT IT 1202 00:42:42,840 --> 00:42:43,320 WAS GREAT. 1203 00:42:43,320 --> 00:42:44,200 WE ACHIEVED IT. 1204 00:42:44,200 --> 00:42:45,760 FIRST OF ALL, OUR SITES WERE 1205 00:42:45,760 --> 00:42:47,360 SELECTED TO BE ALL OVER THE 1206 00:42:47,360 --> 00:42:49,920 UNITED STATES. 1207 00:42:49,920 --> 00:42:53,400 SO WE HAD A SITE IN TEXAS THAT 1208 00:42:53,400 --> 00:42:55,400 WAS RECRUITING, WE HAD A SITE IN 1209 00:42:55,400 --> 00:42:56,400 BALTIMORE THAT WAS ABLE TO 1210 00:42:56,400 --> 00:42:57,440 RECRUIT A LOT OF AFRICAN 1211 00:42:57,440 --> 00:42:58,000 AMERICANS. 1212 00:42:58,000 --> 00:43:02,280 WE HAD A SITE IN L.A. THAT WAS 1213 00:43:02,280 --> 00:43:04,040 ABLE TO RECUTE A LOT OF 1214 00:43:04,040 --> 00:43:05,880 HISPANICS AND ACTUALLY TRANSLATE 1215 00:43:05,880 --> 00:43:07,440 A LOT OF THE MATERIAL INTO 1216 00:43:07,440 --> 00:43:09,600 SPANISH FOR THESE PARTICIPANTS. 1217 00:43:09,600 --> 00:43:12,560 AND NEW YORK HAD A SITE. 1218 00:43:12,560 --> 00:43:14,200 SO BY PUTTING SITES IN DIFFERENT 1219 00:43:14,200 --> 00:43:15,120 CENTERS AROUND THE COUNTRY, WE 1220 00:43:15,120 --> 00:43:17,360 WERE ABLE TO RECRUIT DIFFERENT 1221 00:43:17,360 --> 00:43:18,960 MINORITY GROUPS PLUS IN 1222 00:43:18,960 --> 00:43:20,120 ADDITION, THAT WAS A REAL GOAL 1223 00:43:20,120 --> 00:43:22,960 IN THE STUDY. 1224 00:43:22,960 --> 00:43:24,160 SO EVERYBODY WAS ENCOURAGED TO 1225 00:43:24,160 --> 00:43:25,600 TRY VERY HARD TO RECRUIT THOSE 1226 00:43:25,600 --> 00:43:26,040 MINORITY GROUPS. 1227 00:43:26,040 --> 00:43:26,920 >> IT CLEARLY WORKED. 1228 00:43:26,920 --> 00:43:28,640 >> I SHOULD HAVE ALSO MENTIONED 1229 00:43:28,640 --> 00:43:31,400 THAT WE ALSO HAD SITES WITH THE 1230 00:43:31,400 --> 00:43:33,360 INDIAN TRIBES, AND THAT THE 1231 00:43:33,360 --> 00:43:35,840 INDIAN HEALTH SERVICE ALSO 1232 00:43:35,840 --> 00:43:36,760 HELPED FUND THE STUDY. 1233 00:43:36,760 --> 00:43:39,480 >> GREAT. 1234 00:43:39,480 --> 00:43:41,440 LOOK AHEAD HAD A TARGET OF 1235 00:43:41,440 --> 00:43:42,240 175 MINUTES OF PHYSICAL 1236 00:43:42,240 --> 00:43:42,480 ACTIVITY. 1237 00:43:42,480 --> 00:43:45,280 WHAT KIND OF PHYSICAL ACTIVITY 1238 00:43:45,280 --> 00:43:48,440 QUALIFIED OR COUNTED TOWARDS 1239 00:43:48,440 --> 00:43:49,960 THAT 175 MINUTES? 1240 00:43:49,960 --> 00:43:52,280 >> I SHOULD POINT OUT, IT'S 1241 00:43:52,280 --> 00:43:52,800 175 MINUTES PER WEEK. 1242 00:43:52,800 --> 00:43:53,360 >> OKAY. 1243 00:43:53,360 --> 00:43:55,240 >> SO IT'S ABOUT 35 MINUTES EACH 1244 00:43:55,240 --> 00:43:58,800 DAY, YOU KNOW, FIVE DAYS A WEEK. 1245 00:43:58,800 --> 00:43:59,960 AND WHAT REALLY COUNTS IS 1246 00:43:59,960 --> 00:44:02,120 SOMETHING EQUIVALENT TO BRISK 1247 00:44:02,120 --> 00:44:02,440 WALKING. 1248 00:44:02,440 --> 00:44:04,200 AND THAT'S WHAT MOST OF OUR 1249 00:44:04,200 --> 00:44:04,600 PARTICIPANTS DID. 1250 00:44:04,600 --> 00:44:06,840 KEEP IN MIND OUR PARTICIPANTS 1251 00:44:06,840 --> 00:44:07,840 WERE 60 YEARS OLD WHEN THEY 1252 00:44:07,840 --> 00:44:09,880 STARTED THE STUDY, SO NOW ON 1253 00:44:09,880 --> 00:44:12,320 AVERAGE, THEY'RE IN THEIR 80s. 1254 00:44:12,320 --> 00:44:13,960 SO BRISK WALKING IS AN 1255 00:44:13,960 --> 00:44:15,920 APPROPRIATE TYPE OF EXERCISE AS 1256 00:44:15,920 --> 00:44:16,800 PEOPLE ARE AGING. 1257 00:44:16,800 --> 00:44:18,120 THEY DON'T NEED ANY EQUIPMENT, 1258 00:44:18,120 --> 00:44:21,840 THEY DON'T NEED ANY SPECIAL 1259 00:44:21,840 --> 00:44:23,600 PROGRAMS OR ANYTHING TO DO BRISK 1260 00:44:23,600 --> 00:44:23,920 WALKING. 1261 00:44:23,920 --> 00:44:25,240 SO THAT'S WHAT WE TYPICALLY 1262 00:44:25,240 --> 00:44:26,440 ENCOURAGE, THAT'S WHAT WE 1263 00:44:26,440 --> 00:44:28,320 ENCOURAGE IN DPP AND THAT'S WHAT 1264 00:44:28,320 --> 00:44:31,480 WE ENCOURAGED IN LOOK AHEAD TOO. 1265 00:44:31,480 --> 00:44:33,160 >> YOU MENTIONED THAT A 1266 00:44:33,160 --> 00:44:33,920 PARTICIPANT'S PHYSICIAN COULD 1267 00:44:33,920 --> 00:44:36,520 CHANGE THEIR MEDICATIONS DURING 1268 00:44:36,520 --> 00:44:37,000 THE TRIAL. 1269 00:44:37,000 --> 00:44:40,880 DID THAT APPLY TO METFORMIN AND 1270 00:44:40,880 --> 00:44:42,080 IN DPP? 1271 00:44:42,080 --> 00:44:45,840 I REALIZE THAT'S NOT LOOK AHEAD, 1272 00:44:45,840 --> 00:44:46,920 THAT WAS DPP. 1273 00:44:46,920 --> 00:44:49,640 WAS THAT POSSIBLE THERE OR -- 1274 00:44:49,640 --> 00:44:50,720 AND MORE GENERALLY IN LOOK 1275 00:44:50,720 --> 00:44:52,400 AHEAD, HOW DID CHANGES IN 1276 00:44:52,400 --> 00:44:53,800 MEDICATIONS, HOW WERE THOSE 1277 00:44:53,800 --> 00:44:55,680 MONITORED AND DEALT WITH IN THE 1278 00:44:55,680 --> 00:44:56,560 ANALYSIS? 1279 00:44:56,560 --> 00:44:58,280 >> I WANT TO ANSWER THE LOOK 1280 00:44:58,280 --> 00:44:59,360 AHEAD ONE BECAUSE I CAN'T QUITE 1281 00:44:59,360 --> 00:45:01,360 REMEMBER ALL THE DETAILS OF THE 1282 00:45:01,360 --> 00:45:03,120 DPP STUDY, BUT IN LOOK AHEAD, I 1283 00:45:03,120 --> 00:45:03,880 CAN TELL YOU WHAT HAPPENED. 1284 00:45:03,880 --> 00:45:06,280 IN LOOK AHEAD, WE HAD A VERY 1285 00:45:06,280 --> 00:45:09,120 STANDARD ALGORITHM FOR 1286 00:45:09,120 --> 00:45:11,320 MODIFICATIONS IN THEIR DIABETES 1287 00:45:11,320 --> 00:45:12,160 MEDICATION DURING THE FIRST 1288 00:45:12,160 --> 00:45:15,440 PERIOD OF INTENSIVE LIFESTYLE 1289 00:45:15,440 --> 00:45:15,800 INTERVENTION. 1290 00:45:15,800 --> 00:45:16,440 SO FOR EXAMPLE, IF YOU HAVE A 1291 00:45:16,440 --> 00:45:17,440 PERSON ON INSULIN AND THEY'RE 1292 00:45:17,440 --> 00:45:18,960 GOING TO START TO LOSE WEIGHT 1293 00:45:18,960 --> 00:45:20,920 RAPIDLY OR HOPEFULLY NOT TOO 1294 00:45:20,920 --> 00:45:24,000 RAPIDLY BUT APPROPRIATELY, BHU 1295 00:45:24,000 --> 00:45:26,960 THEY ARE GOING TO BUT 1296 00:45:26,960 --> 00:45:29,920 THEY ARE GOING TO LOSE WEIGHT 1297 00:45:29,920 --> 00:45:30,560 QUICKLY AT THE BEGINNING, YOU 1298 00:45:30,560 --> 00:45:33,760 DON'T WANT THEM TO STAY ON TOO 1299 00:45:33,760 --> 00:45:35,600 LONG -- WE HAD A VERY SPECIFIC 1300 00:45:35,600 --> 00:45:37,560 ALGORITHM AS TO HOW MUCH THEY 1301 00:45:37,560 --> 00:45:38,880 SHOULD CUT BACK THEIR INSULIN. 1302 00:45:38,880 --> 00:45:40,520 WE MONITORED THEIR BLOOD SUGAR 1303 00:45:40,520 --> 00:45:41,720 AND ADJUSTED THEIR MEDICATIONS. 1304 00:45:41,720 --> 00:45:43,400 SO THAT WAS THE ONLY PART OF THE 1305 00:45:43,400 --> 00:45:45,880 TRIAL WHERE WE AS A TRIAL WERE 1306 00:45:45,880 --> 00:45:49,160 DOING ANYTHING WITH MEDICATIONS. 1307 00:45:49,160 --> 00:45:50,680 THROUGHOUT THE REST OF THE 1308 00:45:50,680 --> 00:45:52,000 TRIAL, WE FELT THAT IT WAS MORE 1309 00:45:52,000 --> 00:45:54,760 APPROPRIATE FOR THE 1310 00:45:54,760 --> 00:45:55,480 PARTICIPANTS' OWN PHYSICIAN TO 1311 00:45:55,480 --> 00:45:57,280 BE MAKING ALL OTHER ADJUSTMENTS 1312 00:45:57,280 --> 00:45:59,760 IN THEIR MEDICATIONS. 1313 00:45:59,760 --> 00:46:01,880 SO THAT INCLUDED THEIR 1314 00:46:01,880 --> 00:46:03,160 ANTIHYPERTENSIVES, THEIR 1315 00:46:03,160 --> 00:46:06,200 STATINS, OR INSULIN OR ANY OTHER 1316 00:46:06,200 --> 00:46:07,760 MEDICATIONS FOR DIABETES OVER 1317 00:46:07,760 --> 00:46:08,200 TIME. 1318 00:46:08,200 --> 00:46:10,360 THAT WAS DONE IN PART FOR COST 1319 00:46:10,360 --> 00:46:11,160 REASONS BECAUSE IT WOULD HAVE 1320 00:46:11,160 --> 00:46:13,000 BEEN VERY EXPENSIVE IF WE HAD 1321 00:46:13,000 --> 00:46:14,560 TAKEN ON ALL THE MEDICAL 1322 00:46:14,560 --> 00:46:16,080 MANAGEMENT OF 5,000 INDIVIDUALS. 1323 00:46:16,080 --> 00:46:17,600 PLUS WE FELT THAT THAT WAS MORE 1324 00:46:17,600 --> 00:46:19,120 THE WAY THAT IT SHOULD BE DONE 1325 00:46:19,120 --> 00:46:21,240 IN A CLINICAL TRIAL SUCH AS 1326 00:46:21,240 --> 00:46:21,800 THIS. 1327 00:46:21,800 --> 00:46:23,520 NOW THAT'S A QUESTION THAT CAN 1328 00:46:23,520 --> 00:46:25,160 COME BACK AND HAUNT US A LITTLE 1329 00:46:25,160 --> 00:46:26,360 BIT NOW AND IS SOMETHING THAT WE 1330 00:46:26,360 --> 00:46:29,320 CAN CERTAINLY DISCUSS IF YOU 1331 00:46:29,320 --> 00:46:33,320 WOULD LIKE. 1332 00:46:33,320 --> 00:46:36,120 >> WHAT WERE THE BENEFITS OF THE 1333 00:46:36,120 --> 00:46:37,120 INTERVENTION IN DIFFERENT RACIAL 1334 00:46:37,120 --> 00:46:37,400 GROUPS? 1335 00:46:37,400 --> 00:46:40,040 I'M TRYING TO REMEMBER -- YOU 1336 00:46:40,040 --> 00:46:42,760 HAD GOOD REPRESENTATION OF 1337 00:46:42,760 --> 00:46:44,560 MINORITY GROUPS BUT I DON'T 1338 00:46:44,560 --> 00:46:46,960 RECALL RESULTS IN YOUR 1339 00:46:46,960 --> 00:46:48,040 PRESENTATION BY RACE OR 1340 00:46:48,040 --> 00:46:49,000 ETHNICITY. 1341 00:46:49,000 --> 00:46:50,800 >> I DIDN'T ACTUALLY PRESENT IT 1342 00:46:50,800 --> 00:46:53,880 BECAUSE MOST OF OUR RESULTS DID 1343 00:46:53,880 --> 00:46:56,960 NOT DIFFER BY RACE/ETHNICITY. 1344 00:46:56,960 --> 00:46:58,480 A FEW OF THEM DID BUT MOST OF 1345 00:46:58,480 --> 00:46:59,360 OUR RESULTS DID NOT. 1346 00:46:59,360 --> 00:47:00,680 SO I HAVE NOT COVERED THOSE. 1347 00:47:00,680 --> 00:47:02,080 BUT THEY ARE COVERED, I THINK, 1348 00:47:02,080 --> 00:47:04,160 TO SOME EXTENT MORE IN MY REVIEW 1349 00:47:04,160 --> 00:47:05,800 PAPER AND CERTAINLY BY GOING 1350 00:47:05,800 --> 00:47:07,760 BACK AND CHECKING EACH OF THOSE 1351 00:47:07,760 --> 00:47:09,200 REFERENCES DEPENDING ON WHICH 1352 00:47:09,200 --> 00:47:10,400 OUT COME YOU'RE MOST INTERESTED 1353 00:47:10,400 --> 00:47:10,560 IN. 1354 00:47:10,560 --> 00:47:12,360 >> I THINK IT'S ACTUALLY A VERY 1355 00:47:12,360 --> 00:47:15,000 GOOD OUTCOME THAT YOU FOUND FEW 1356 00:47:15,000 --> 00:47:18,400 IF ANY DIFFERENCES AMONG RACIAL 1357 00:47:18,400 --> 00:47:21,120 OR ETHNIC GROUPS, WHICH MEANS 1358 00:47:21,120 --> 00:47:23,000 IT'S QUITE GENERALIZED, IT WORKS 1359 00:47:23,000 --> 00:47:23,320 FOR EVERYONE. 1360 00:47:23,320 --> 00:47:25,200 >> WE FOUND SLIGHT DIFFERENCES 1361 00:47:25,200 --> 00:47:26,720 IN WEIGHT LOSS INITIALLY AS IS 1362 00:47:26,720 --> 00:47:27,280 OFTEN FOUND WITH AFRICAN 1363 00:47:27,280 --> 00:47:28,920 AMERICANS LOSING LESS WEIGHT 1364 00:47:28,920 --> 00:47:30,640 THAN CAUCASIANS, WHITES, BUT 1365 00:47:30,640 --> 00:47:34,720 OVER TIME, EVERYBODY CAME 1366 00:47:34,720 --> 00:47:35,160 TOGETHER. 1367 00:47:35,160 --> 00:47:36,480 SO THAT OVER TIME, YOU DON'T SEE 1368 00:47:36,480 --> 00:47:37,880 BIG DIFFERENCES IN THE WEIGHT 1369 00:47:37,880 --> 00:47:40,280 LOSS OUTCOMES. 1370 00:47:40,280 --> 00:47:41,400 SO I THINK THAT WAS ONE. 1371 00:47:41,400 --> 00:47:43,920 INTERESTING FINDINGS. 1372 00:47:43,920 --> 00:47:49,920 >> HAS ANYONE PROPOSED THE 1373 00:47:49,920 --> 00:47:51,120 REBOUND OBSERVED IN WEIGHT GAIN 1374 00:47:51,120 --> 00:47:53,960 OR WEIGHT LOSS AND PHYSICAL 1375 00:47:53,960 --> 00:47:55,440 ACTIVITY EXERT NEGATIVE EFFECTS 1376 00:47:55,440 --> 00:47:57,200 FOR THE PRIMARY OUTCOMES OF THE 1377 00:47:57,200 --> 00:47:57,400 STUDY? 1378 00:47:57,400 --> 00:47:58,640 >> I CERTAINLY AGREE WITH THAT, 1379 00:47:58,640 --> 00:47:59,640 THAT CERTAINLY COULD BE PART OF 1380 00:47:59,640 --> 00:48:02,480 WHAT IS HAPPENING. 1381 00:48:02,480 --> 00:48:03,360 I'VE SHOWN YOU WHAT HAPPENED 1382 00:48:03,360 --> 00:48:05,240 WITH OUR WEIGHT LOSSES AND OUR 1383 00:48:05,240 --> 00:48:05,880 FITNESS. 1384 00:48:05,880 --> 00:48:07,960 WE GOT OUR BEST EFFECTS AT YEAR 1385 00:48:07,960 --> 00:48:12,640 ONE, WITH GRADUALLY DIMINISHING 1386 00:48:12,640 --> 00:48:14,040 EFFECTS AND TOWARDS THE END OF 1387 00:48:14,040 --> 00:48:15,800 THE STUDY, BOTH GROUPS WERE 1388 00:48:15,800 --> 00:48:16,480 LOSING WEIGHT. 1389 00:48:16,480 --> 00:48:17,560 SO ALL OF THOSE DIFFERENCES MAY 1390 00:48:17,560 --> 00:48:19,120 HAVE AFFECTED OUR OUTCOMES BUT 1391 00:48:19,120 --> 00:48:21,280 WE HAVE NOT DONE ANALYSES 1392 00:48:21,280 --> 00:48:23,520 LOOKING AT SPECIFICALLY WEIGHT 1393 00:48:23,520 --> 00:48:25,000 LOSS OR REGAINED OR SPECIFIC 1394 00:48:25,000 --> 00:48:27,520 PERIODS OF TIME. 1395 00:48:27,520 --> 00:48:29,960 LOTS OF DATA FOR ANYBODY THAT 1396 00:48:29,960 --> 00:48:31,080 WAS LIKE TO ANALYZE IT. 1397 00:48:31,080 --> 00:48:32,440 >> THAT'S A GOOD SEGUE TO THE 1398 00:48:32,440 --> 00:48:33,000 NEXT QUESTION. 1399 00:48:33,000 --> 00:48:36,960 YOU INDICATED THAT LOOK AHEAD IS 1400 00:48:36,960 --> 00:48:38,120 CONTINUING, EVEN 22 YEARS AFTER 1401 00:48:38,120 --> 00:48:38,800 IT BEGAN. 1402 00:48:38,800 --> 00:48:47,920 WHAT'S THE FUTURE OF THE STUDY? 1403 00:48:47,920 --> 00:48:49,520 >> IT'S NOW ENTIRELY BEING DONE 1404 00:48:49,520 --> 00:48:51,120 BY PHONE CALLS FROM THE 1405 00:48:51,120 --> 00:48:51,800 COORDINATING CENTERS. 1406 00:48:51,800 --> 00:48:53,160 SO WE ORIGINALLY HAD 16 SITES 1407 00:48:53,160 --> 00:48:54,640 BUT AT THIS POINT IN TIME, WE 1408 00:48:54,640 --> 00:48:56,080 CONVERTED TO JUST THE 1409 00:48:56,080 --> 00:48:57,280 COORDINATING CENTER CALLING ALL 1410 00:48:57,280 --> 00:49:03,600 OUR PARTICIPANTS. 1411 00:49:03,600 --> 00:49:05,240 AND WE WENT FROM ORIGINALLY 1412 00:49:05,240 --> 00:49:07,080 HAVING YEARLY VISITS WITH EACH 1413 00:49:07,080 --> 00:49:09,760 PATIENT TO DURING THE 1414 00:49:09,760 --> 00:49:10,640 OBSERVATIONAL PERIOD EVERY OTHER 1415 00:49:10,640 --> 00:49:13,360 YEAR VISITS WITH THE PATIENTS TO 1416 00:49:13,360 --> 00:49:15,560 NOW DOING IT ENTIRELY BY PHONE. 1417 00:49:15,560 --> 00:49:16,560 THAT'S PARTIALLY BECAUSE NOW 1418 00:49:16,560 --> 00:49:17,720 THAT THESE PATIENTS HAVE AGED, 1419 00:49:17,720 --> 00:49:18,880 IT'S MUCH, MUCH MORE DIFFICULT 1420 00:49:18,880 --> 00:49:20,480 TO GET THEM INTO THE CLINIC, 1421 00:49:20,480 --> 00:49:21,560 IT'S MUCH MORE DANGEROUS FOR 1422 00:49:21,560 --> 00:49:24,080 THEM TO TRY TO ARRIVE TO THE 1423 00:49:24,080 --> 00:49:25,640 CLINIC, FOR US TO GET THEM ON AN 1424 00:49:25,640 --> 00:49:26,680 EXAM TABLE, ET CETERA, ET 1425 00:49:26,680 --> 00:49:27,280 CETERA, ET CETERA. 1426 00:49:27,280 --> 00:49:29,240 SO FOR MANY REASON, WE MOVED THE 1427 00:49:29,240 --> 00:49:30,200 WHOLE STUDY TO BE A PHONE 1428 00:49:30,200 --> 00:49:31,320 CONTACT STUDY. 1429 00:49:31,320 --> 00:49:35,680 WE WILL BE FOLLOWING SOME OF THE 1430 00:49:35,680 --> 00:49:37,800 KEY OUTCOMES OF AGING, SO FOR 1431 00:49:37,800 --> 00:49:38,760 EXAMPLE, COGNITIVE FUNCTION WILL 1432 00:49:38,760 --> 00:49:40,840 BE ONE OF THE VERY IMPORTANT 1433 00:49:40,840 --> 00:49:42,600 OUTCOMES WITH ADJUDICATION AGAIN 1434 00:49:42,600 --> 00:49:44,440 OF DEMENTIA AND MILD COGNITIVE 1435 00:49:44,440 --> 00:49:45,240 IMPAIRMENT. 1436 00:49:45,240 --> 00:49:46,720 WE'RE ALSO FOLLOWING OTHER 1437 00:49:46,720 --> 00:49:49,480 PROBLEMS THAT ARE RELATED TO 1438 00:49:49,480 --> 00:49:50,120 OLDER INDIVIDUALS. 1439 00:49:50,120 --> 00:49:52,440 SO FOR EXAMPLE, DEPRESSION, 1440 00:49:52,440 --> 00:49:55,840 QUALITY OF LIFE, SLEEP PROBLEMS. 1441 00:49:55,840 --> 00:49:57,480 THERE'S A WHOLE BIG ANCILLARY 1442 00:49:57,480 --> 00:50:01,240 STUDY ON SLEEP THAT'S BEING 1443 00:50:01,240 --> 00:50:02,560 CONDUCTED. 1444 00:50:02,560 --> 00:50:07,560 AND THEN WE'RE ALSO WORKING WITH 1445 00:50:07,560 --> 00:50:09,600 DR. PETER HUCKFELT AT UNIVERSITY 1446 00:50:09,600 --> 00:50:10,760 OF MINNESOTA WHO IS ACCESSING 1447 00:50:10,760 --> 00:50:13,920 THE MEDICARE DATABASES AND WILL 1448 00:50:13,920 --> 00:50:15,520 BE ABLE TO LOOK AT HEALTH COSTS 1449 00:50:15,520 --> 00:50:18,440 AND HEALTH SAVINGS OVER THE 1450 00:50:18,440 --> 00:50:21,280 COURSE OF LOOK AHEAD, USING THE 1451 00:50:21,280 --> 00:50:22,800 MEDICARE DATABASES. 1452 00:50:22,800 --> 00:50:24,280 >> SOUNDS LIKE THERE'S LOTS OF 1453 00:50:24,280 --> 00:50:26,760 OPPORTUNITY FOR NEW WORK. 1454 00:50:26,760 --> 00:50:31,160 WITH THE TRANSITION TO THIS 1455 00:50:31,160 --> 00:50:32,920 TELEPHONE OPERATION, IT RAISES 1456 00:50:32,920 --> 00:50:34,360 QUESTIONS ABOUT RELYING ON SELF 1457 00:50:34,360 --> 00:50:35,640 REPORT DATAVERSE US DATA 1458 00:50:35,640 --> 00:50:36,960 DIRECTLY COLLECTED ON BEHALF OF 1459 00:50:36,960 --> 00:50:39,480 THE STUDY. 1460 00:50:39,480 --> 00:50:41,000 THAT WOULD APPLY TO SOME 1461 00:50:41,000 --> 00:50:44,080 VARIABLES, PERHAPS, LIKE WEIGHT 1462 00:50:44,080 --> 00:50:45,280 OR HEIGHT. 1463 00:50:45,280 --> 00:50:46,920 IT MIGHT NOT APPLY TO SOME OTHER 1464 00:50:46,920 --> 00:50:50,520 VARIABLES, I'M NOT SURE HOW YOU 1465 00:50:50,520 --> 00:50:52,040 MEASURE COGNITIVE FUNCTIONING 1466 00:50:52,040 --> 00:50:53,280 OVER THE PHONE, BUT PERHAPS YOU 1467 00:50:53,280 --> 00:50:55,280 COULD ENLIGHTEN US. 1468 00:50:55,280 --> 00:50:56,040 >> SURE. 1469 00:50:56,040 --> 00:50:59,320 THERE ARE VERY GOOD STANDARDIZED 1470 00:50:59,320 --> 00:51:00,600 WAYS TO MEASURE COGNITIVE 1471 00:51:00,600 --> 00:51:01,520 FUNCTION OVER THE PHONE SO YOU 1472 00:51:01,520 --> 00:51:03,240 CAN ADMINISTER MANY OF THESE 1473 00:51:03,240 --> 00:51:05,840 COGNITIVE FUNCTION TESTS WITH 1474 00:51:05,840 --> 00:51:06,880 VALIDATED MEASURES OVER THE 1475 00:51:06,880 --> 00:51:08,360 PHONE WITH OLDER INDIVIDUALS. 1476 00:51:08,360 --> 00:51:11,640 IT'S BEING DONE IN OTHER TRIALS 1477 00:51:11,640 --> 00:51:13,400 AT THE MOMENT, WE'LL BE ADOPTING 1478 00:51:13,400 --> 00:51:14,280 THE SAME PROCEDURES IN OUR 1479 00:51:14,280 --> 00:51:14,920 TRIAL. 1480 00:51:14,920 --> 00:51:16,120 NOW MEASURING WEIGHT IS MORE 1481 00:51:16,120 --> 00:51:16,600 DIFFICULT. 1482 00:51:16,600 --> 00:51:18,520 SO AT THE MOMENT, WE ARE NOT 1483 00:51:18,520 --> 00:51:20,640 DOING ANYTHING TO MAKE CERTAIN 1484 00:51:20,640 --> 00:51:22,840 THAT OUR RESULTS ARE RELIABLE 1485 00:51:22,840 --> 00:51:24,040 FOR WEIGHT OR VALID FOR WEIGHT. 1486 00:51:24,040 --> 00:51:25,840 WE ARE USING SELF-REPORT. 1487 00:51:25,840 --> 00:51:26,960 HOWEVER, THAT'S BEEN AN AREA 1488 00:51:26,960 --> 00:51:28,080 WHERE MANY OF US HAVE TALKED 1489 00:51:28,080 --> 00:51:31,240 ABOUT DOING AN ANCILLARY STUDY, 1490 00:51:31,240 --> 00:51:33,240 WHERE WE COULD EITHER PROVIDE 1491 00:51:33,240 --> 00:51:35,200 SCALES WITH REMOTE CAPABILITIES 1492 00:51:35,200 --> 00:51:39,360 SO THAT THEY COULD DWSH WHEN THE 1493 00:51:39,360 --> 00:51:40,560 PERSON GOT ON THE SCALE, WE 1494 00:51:40,560 --> 00:51:41,880 COULD SEE THEIR WEIGHT, OR AT 1495 00:51:41,880 --> 00:51:43,080 LEAST HAVING PEOPLE TAKE 1496 00:51:43,080 --> 00:51:45,040 PICTURES OF THEMSELVES AS 1497 00:51:45,040 --> 00:51:45,720 THEY'RE WEIGHING THEIRSELVES. 1498 00:51:45,720 --> 00:51:47,200 >> I WOULD VOTE FOR THE 1499 00:51:47,200 --> 00:51:48,000 BLUETOOTH TECHNOLOGY. 1500 00:51:48,000 --> 00:51:48,440 >> YES. 1501 00:51:48,440 --> 00:51:50,920 IT'S BETTER IF WE CAN AFFORD IT. 1502 00:51:50,920 --> 00:51:52,520 >> YEAH, YEAH, AND YOU MIGHT BE 1503 00:51:52,520 --> 00:51:55,920 ABLE TO DO THAT IN A SUBSET. 1504 00:51:55,920 --> 00:51:56,800 >> EXACTLY. 1505 00:51:56,800 --> 00:51:59,200 WHAT WE'RE HOPING. 1506 00:51:59,200 --> 00:52:00,280 THE STUDY IS STILL ONGOING SO 1507 00:52:00,280 --> 00:52:01,280 THERE'S LOTS OF OPPORTUNITIES 1508 00:52:01,280 --> 00:52:02,640 FOR PEOPLE TO GET INVOLVED IN 1509 00:52:02,640 --> 00:52:03,680 THE STUDY. 1510 00:52:03,680 --> 00:52:04,760 EITHER AS I SAID LOOKING AT SOME 1511 00:52:04,760 --> 00:52:06,320 OF OUR DATA, LOOKING AT SOME OF 1512 00:52:06,320 --> 00:52:07,840 OUR BLOOD WORK OR PROPOSING 1513 00:52:07,840 --> 00:52:10,320 ANCILLARY STUDIES. 1514 00:52:10,320 --> 00:52:12,120 SO WE'RE VERY OPEN TO ANCILLARY 1515 00:52:12,120 --> 00:52:14,040 STUDIES GOING ON AT THIS TIME. 1516 00:52:14,040 --> 00:52:15,560 >> I WOULD THINK THAT ONE OF THE 1517 00:52:15,560 --> 00:52:17,760 BIGGEST FRUSTRATIONS FOR YOU AND 1518 00:52:17,760 --> 00:52:20,720 THE OTHER INVESTIGATORS WAS THE 1519 00:52:20,720 --> 00:52:21,600 REBOUND AFTER THE FIRST YEAR. 1520 00:52:21,600 --> 00:52:23,080 YOU HAD SUCH A GREAT EFFECT IN 1521 00:52:23,080 --> 00:52:27,280 THE FIRST YEAR, AND THEN THE 1522 00:52:27,280 --> 00:52:28,280 EFFECT AT LEAST FOR WEIGHT OR 1523 00:52:28,280 --> 00:52:29,680 PHYSICAL ACTIVITY DECLINED NOT 1524 00:52:29,680 --> 00:52:31,040 QUITE BACK TO BASELINE LEVELS 1525 00:52:31,040 --> 00:52:37,200 BUT CERTAINLY BACK IN THAT 1526 00:52:37,200 --> 00:52:38,240 DIRECTION. 1527 00:52:38,240 --> 00:52:39,800 WHAT CAN WE DO IN FUTURE STUDIES 1528 00:52:39,800 --> 00:52:41,120 TO TRY TO PREVENT THAT REA 1529 00:52:41,120 --> 00:52:43,160 BOUND? 1530 00:52:43,160 --> 00:52:43,520 REBOUND? 1531 00:52:43,520 --> 00:52:44,720 WOULDN'T IT BE FUND TO SEE WHAT 1532 00:52:44,720 --> 00:52:45,920 THE EFFECT OF THIS INTERVENTION 1533 00:52:45,920 --> 00:52:46,760 WAS, IF YOU CAN HOLD THAT? 1534 00:52:46,760 --> 00:52:48,640 >> I TOTALLY AGREE WITH YOU. 1535 00:52:48,640 --> 00:52:49,760 I HAVE BEEN WORKING ON THAT 1536 00:52:49,760 --> 00:52:50,840 PROBLEM FOR YEARS AND YEARS AND 1537 00:52:50,840 --> 00:52:51,240 YEARS. 1538 00:52:51,240 --> 00:52:54,800 WAY BEYOND THE 22 YEARS INVOLVED 1539 00:52:54,800 --> 00:52:56,760 IN LOOK AHEAD. 1540 00:52:56,760 --> 00:52:58,160 WE DON'T KNOW WHAT WE CAN DO. 1541 00:52:58,160 --> 00:53:01,240 SO SOME PEOPLE HAVE SUGGESTED 1542 00:53:01,240 --> 00:53:03,200 THAT IF WE EDIT A MEDICATION, IT 1543 00:53:03,200 --> 00:53:03,840 MIGHT HELP. 1544 00:53:03,840 --> 00:53:04,600 THERE'S DIFFERENT APPROACHES 1545 00:53:04,600 --> 00:53:10,280 THAT WE COULD POSSIBLY USE. 1546 00:53:10,280 --> 00:53:12,080 WE COULD HAVE TRIED MORE 1547 00:53:12,080 --> 00:53:13,600 AGGRESSIVE APPROACHES TO WEIGHT 1548 00:53:13,600 --> 00:53:14,800 LOSS OR HAVING PEOPLE HAVE 1549 00:53:14,800 --> 00:53:16,000 DIFFERENT APPROACHES. 1550 00:53:16,000 --> 00:53:18,080 SO OURS WAS A CALORIE-BASED 1551 00:53:18,080 --> 00:53:18,600 DIET. 1552 00:53:18,600 --> 00:53:19,600 MAYBE OVER TIME WE COULD HAVE 1553 00:53:19,600 --> 00:53:21,520 GONE TO A CARBOHYDRATE 1554 00:53:21,520 --> 00:53:22,800 RESTRICTED DIET, YOU KNOW, 1555 00:53:22,800 --> 00:53:24,560 CHANGING THE TYPE OF DIET MIGHT 1556 00:53:24,560 --> 00:53:25,320 HELP WITH VARIETY. 1557 00:53:25,320 --> 00:53:26,400 BUT I THINK ALL OF THOSE ARE 1558 00:53:26,400 --> 00:53:28,400 STILL GOING TO SHOW THIS WHAT I 1559 00:53:28,400 --> 00:53:29,920 LIKE TO CALL A CHECKMARK TYPE OF 1560 00:53:29,920 --> 00:53:31,440 PATTERN WHERE YOU GET YOUR BEST 1561 00:53:31,440 --> 00:53:33,640 RESULTS INITIALLY, AND THEN THEY 1562 00:53:33,640 --> 00:53:35,600 GRADUALLY REGAIN WEIGHT OVER 1563 00:53:35,600 --> 00:53:35,800 TIME. 1564 00:53:35,800 --> 00:53:38,800 SO THAT'S A CHECKMARK THAT 1565 00:53:38,800 --> 00:53:40,880 UNFORTUNATELY HAS CHARACTERIZED 1566 00:53:40,880 --> 00:53:42,480 EVERY BEHAVIORAL WEIGHT LOSS 1567 00:53:42,480 --> 00:53:44,040 STUDY THAT I KNOW OF, AND ONLY A 1568 00:53:44,040 --> 00:53:45,560 FEW OF THE DRUG STUDIES HAVE NOT 1569 00:53:45,560 --> 00:53:48,280 HAD THAT CHECKMARK PART TOO. 1570 00:53:48,280 --> 00:53:52,560 >> IT'S A CHALLENGE. 1571 00:53:52,560 --> 00:53:53,920 SO THIS STUDY AND OTHERS HAVE 1572 00:53:53,920 --> 00:53:55,640 SHOWN US THAT LIFESTYLE CHANGES 1573 00:53:55,640 --> 00:54:01,440 CAN HAVE HUGE POSITIVE EFFECTS. 1574 00:54:01,440 --> 00:54:02,880 HOW -- NOT JUST ON HEALTH BUT ON 1575 00:54:02,880 --> 00:54:05,520 COST OF HEALTHCARE. 1576 00:54:05,520 --> 00:54:09,120 HOW DO WE EDUCATE SOCIETY ABOUT 1577 00:54:09,120 --> 00:54:11,080 THAT WHEN PEOPLE ARE CONSTANTLY 1578 00:54:11,080 --> 00:54:14,840 BOMBARDED WITH CONTRARY MESSAGES 1579 00:54:14,840 --> 00:54:17,240 OVER SOCIAL AND OTHER MEDIA? 1580 00:54:17,240 --> 00:54:19,200 >> THAT'S VERY INTERESTING 1581 00:54:19,200 --> 00:54:21,920 QUESTION, I THINK IT'S A REALLY 1582 00:54:21,920 --> 00:54:22,800 PROVOCATIVE ONE, PARTICULARLY AT 1583 00:54:22,800 --> 00:54:23,600 THIS MOMENT BECAUSE THERE'S A 1584 00:54:23,600 --> 00:54:29,160 LOT OF EMPHASIS RIGHT NOW ON NOT 1585 00:54:29,160 --> 00:54:30,000 EMPHASIZING WEIGHT LOSS, THAT WE 1586 00:54:30,000 --> 00:54:31,560 SHOULD NOT BE FOCUSING ON 1587 00:54:31,560 --> 00:54:33,200 WEIGHT, WE SHOULD BE FOCUSING 1588 00:54:33,200 --> 00:54:35,200 ONLY ON HEALTH OUTCOMES. 1589 00:54:35,200 --> 00:54:38,000 HOWEVER, IF YOU TALK TO MOST 1590 00:54:38,000 --> 00:54:39,440 PATIENTS, THEY REALLY DO WANT TO 1591 00:54:39,440 --> 00:54:41,280 LOSE WEIGHT, NOT ONLY SHOW 1592 00:54:41,280 --> 00:54:41,960 IMPROVEMENTS IN THEIR DIABETES 1593 00:54:41,960 --> 00:54:44,960 OR THEIR HEART DISEASE. 1594 00:54:44,960 --> 00:54:46,280 THEY WANT TO ALSO SHOW IT ON THE 1595 00:54:46,280 --> 00:54:47,480 SCALE OR IN THEIR CLOTHES. 1596 00:54:47,480 --> 00:54:49,440 SO WE'RE IN A LITTLE BIT OF A 1597 00:54:49,440 --> 00:54:51,480 CONUNDRUM OF HOW WE DO THIS, HOW 1598 00:54:51,480 --> 00:54:55,680 WE EMPHASIZE BOTH WEIGHT LOSS 1599 00:54:55,680 --> 00:54:56,880 AND HEALTH ALL AT THE SAME TIME. 1600 00:54:56,880 --> 00:54:58,280 AND I THINK MANY OF US ARE 1601 00:54:58,280 --> 00:54:59,480 PUTTING OUR HEADS TOGETHER AND 1602 00:54:59,480 --> 00:55:01,440 THINKING ABOUT HOW DO WE BEST DO 1603 00:55:01,440 --> 00:55:04,640 THAT FOR OUR PATIENTS. 1604 00:55:04,640 --> 00:55:07,200 >> AS A CLOSING QUESTION, I 1605 00:55:07,200 --> 00:55:08,480 WOULD ASK, WHAT ADVICE YOU WOULD 1606 00:55:08,480 --> 00:55:12,080 GIVE TO A YOUNG INVESTIGATOR, A 1607 00:55:12,080 --> 00:55:13,920 POSTDOC, A GRADUATE STUDENT 1608 00:55:13,920 --> 00:55:15,040 WHO'S THINKING ABOUT A YEAR 1609 00:55:15,040 --> 00:55:19,440 FOCUSED ON HEALTH AND WEIGHT. 1610 00:55:19,440 --> 00:55:20,520 WHAT ARE THE QUESTIONS THAT ARE 1611 00:55:20,520 --> 00:55:22,120 IMPORTANT TO CONSIDER OVER THE 1612 00:55:22,120 --> 00:55:25,240 NEXT FIVE TO TEP 10 YEARS, AND 1613 00:55:25,240 --> 00:55:26,320 YOU DISCOURAGE SOMEONE, WOULD 1614 00:55:26,320 --> 00:55:28,120 YOU ENCOURAGE THEM? 1615 00:55:28,120 --> 00:55:28,760 WHAT ADVICE WOULD YOU OFFER? 1616 00:55:28,760 --> 00:55:30,040 >> I THINK THAT'S A GREAT 1617 00:55:30,040 --> 00:55:30,520 QUESTION. 1618 00:55:30,520 --> 00:55:32,240 I WOULD STRONGLY ENCOURAGE THEM, 1619 00:55:32,240 --> 00:55:34,120 BECAUSE I THINK THIS IS STILL A 1620 00:55:34,120 --> 00:55:35,400 BURNING PROBLEM IN OUR COUNTRY. 1621 00:55:35,400 --> 00:55:37,800 I MEAN, IT'S SO PROMINENT, IT'S 1622 00:55:37,800 --> 00:55:40,320 SO MUCH ON EVERYBODY'S MIND. 1623 00:55:40,320 --> 00:55:41,720 AND WE STILL DON'T KNOW WHAT TO 1624 00:55:41,720 --> 00:55:42,000 DO. 1625 00:55:42,000 --> 00:55:43,520 I THINK AS YOU POINTED OUT THAT 1626 00:55:43,520 --> 00:55:45,680 FACT THAT THERE IS SO MUCH 1627 00:55:45,680 --> 00:55:46,600 REGAIN IS A PROBLEM. 1628 00:55:46,600 --> 00:55:47,800 AND IT'S ONE THAT WE HAVE TO 1629 00:55:47,800 --> 00:55:49,280 WORK ON AND TRY TO SOLVE. 1630 00:55:49,280 --> 00:55:51,400 BUT AS OF YET, I DON'T BELIEVE 1631 00:55:51,400 --> 00:55:52,240 WE'VE CRACKED THAT. 1632 00:55:52,240 --> 00:55:55,640 I WOULD ALSO ARGUE THAT THERE'S 1633 00:55:55,640 --> 00:55:56,960 SO MANY QUESTIONS THAT COULD 1634 00:55:56,960 --> 00:55:59,040 STILL BE TACKLED. 1635 00:55:59,040 --> 00:56:00,800 LIKE WHY IS WEIGHT LOSS SO 1636 00:56:00,800 --> 00:56:01,920 EFFECTIVE FOR SOME PEOPLE, WHY 1637 00:56:01,920 --> 00:56:03,440 ARE SOME PEOPLE ABLE TO COME 1638 00:56:03,440 --> 00:56:04,800 INTO THE SAME PROGRAM AND LOSE 1639 00:56:04,800 --> 00:56:08,600 WEIGHT AND OTHERS CANNOT? 1640 00:56:08,600 --> 00:56:10,680 WE KNOW THAT ON DAY ONE, SOME 1641 00:56:10,680 --> 00:56:12,160 PEOPLE -- IF I TALK TO A GROUP 1642 00:56:12,160 --> 00:56:13,560 OF PATIENTS ABOUT TO START A 1643 00:56:13,560 --> 00:56:14,640 PROGRAM, I CAN TELL THEM AHEAD 1644 00:56:14,640 --> 00:56:16,400 THAT SOME OF YOU ARE GOING TO DO 1645 00:56:16,400 --> 00:56:18,240 GREAT, SOME OF YOU ARE GOING TO 1646 00:56:18,240 --> 00:56:19,800 DO TERRIBLY, BUT I CAN'T FOR THE 1647 00:56:19,800 --> 00:56:22,040 LIFE OF ME TELL YOU WHO'S WHO. 1648 00:56:22,040 --> 00:56:23,440 NOTHING WE HAVE BEEN ABLE TO 1649 00:56:23,440 --> 00:56:26,480 FIGURE OUT IN TERMS OF 1650 00:56:26,480 --> 00:56:27,320 BEHAVIORAL, PSYCHOLOGICAL, 1651 00:56:27,320 --> 00:56:29,280 GENETIC PREDICTORS REALLY HAS 1652 00:56:29,280 --> 00:56:31,680 TOLD US THE ANSWER TO THAT. 1653 00:56:31,680 --> 00:56:33,200 THERE'S GOT TO BE SOME WAY TO 1654 00:56:33,200 --> 00:56:35,760 FIGURE OUT AHEAD WHO IS GOING TO 1655 00:56:35,760 --> 00:56:36,640 LOSE WEIGHT ON THIS PARTICULAR 1656 00:56:36,640 --> 00:56:38,120 PROGRAM AND WHO IS NOT. 1657 00:56:38,120 --> 00:56:40,280 AND THEN BE ABLE TO TELL 1658 00:56:40,280 --> 00:56:40,840 PARTICIPANTS THAT. 1659 00:56:40,840 --> 00:56:42,720 THIS WOULD BE A GOOD PROGRAM FOR 1660 00:56:42,720 --> 00:56:44,000 YOU OR NOT A GOOD PROGRAM FOR 1661 00:56:44,000 --> 00:56:44,560 YOU. 1662 00:56:44,560 --> 00:56:45,960 WE CAN'T DO THAT. 1663 00:56:45,960 --> 00:56:47,480 YEARS AND YEARS AGO, WHEN I WAS 1664 00:56:47,480 --> 00:56:49,800 FIRST STARTING MY OWN CAREER IN 1665 00:56:49,800 --> 00:56:53,800 RESEARCH ON OBESITY, A GENTLEMAN 1666 00:56:53,800 --> 00:56:56,840 CAME UP TO ME WHO SAID TO ME -- 1667 00:56:56,840 --> 00:56:58,720 HE WAS STUDYING DRUGS AND HE 1668 00:56:58,720 --> 00:57:03,160 SAID TO ME, RENA, WE KNOW WE'RE 1669 00:57:03,160 --> 00:57:04,840 ON THE CUSP OF GETTING DRUGS. 1670 00:57:04,840 --> 00:57:06,120 WE JUST WANT TO YOU DO THE 1671 00:57:06,120 --> 00:57:06,560 PHENOTYPES. 1672 00:57:06,560 --> 00:57:07,320 BECAUSE IF YOU TELL US WHO 1673 00:57:07,320 --> 00:57:08,520 YOU'VE GOT, WE'LL BE ABLE TO 1674 00:57:08,520 --> 00:57:09,520 GIVE YOU A DRUG THAT MATCHES 1675 00:57:09,520 --> 00:57:10,360 THAT PERSON. 1676 00:57:10,360 --> 00:57:12,480 SO IF YOU HAVE A PERSON WHO'S 1677 00:57:12,480 --> 00:57:13,280 GOT OVEREATING PROBLEMS, WE'LL 1678 00:57:13,280 --> 00:57:14,880 GIVE YOU THAT DRUG AND IF 1679 00:57:14,880 --> 00:57:16,720 THEY'VE GOT A LOW METABOLIC 1680 00:57:16,720 --> 00:57:17,520 RATE, WE'LL GIVE YOU ANOTHER 1681 00:57:17,520 --> 00:57:18,160 DRUG. 1682 00:57:18,160 --> 00:57:22,800 WELL, I'M STILL WAITING FOR THE 1683 00:57:22,800 --> 00:57:24,400 DRUG AND FOR THOSE ANSWERS. 1684 00:57:24,400 --> 00:57:25,200 HAVEN'T HAD THEM YET. 1685 00:57:25,200 --> 00:57:26,320 SO MEANWHILE, I WOULD ENCOURAGE 1686 00:57:26,320 --> 00:57:27,640 ANYBODY WHO WANTS TO KEEP 1687 00:57:27,640 --> 00:57:29,000 WORKING ON THIS PROBLEM AND 1688 00:57:29,000 --> 00:57:31,400 WORKING ON BOTH MEDICATIONS, 1689 00:57:31,400 --> 00:57:34,280 DRUGS, SURGERY, AND BEHAVIORAL 1690 00:57:34,280 --> 00:57:34,840 APPROACHES TO IT. 1691 00:57:34,840 --> 00:57:35,560 >> GREAT. 1692 00:57:35,560 --> 00:57:40,400 I THINK THAT'S TERRIFIC ADVICE, 1693 00:57:40,400 --> 00:57:41,920 AND I WANT TO THANK YOU VERY 1694 00:57:41,920 --> 00:57:42,800 MUCH FOR A TERRIFIC 1695 00:57:42,800 --> 00:57:43,920 PRESENTATION, FOR A GREAT 1696 00:57:43,920 --> 00:57:45,880 CONVERSATION HERE AT THE END 1697 00:57:45,880 --> 00:57:46,640 DEALING WITH MANY OF THE 1698 00:57:46,640 --> 00:57:48,560 QUESTIONS THAT CAME IN FROM OUR 1699 00:57:48,560 --> 00:57:49,880 AUDIENCE. 1700 00:57:49,880 --> 00:57:51,280 AND I WANT TO THANK 1701 00:57:51,280 --> 00:57:52,360 EVERYBODY FOR JOINING IN TODAY'S 1702 00:57:52,360 --> 00:57:53,880 GORDON LECTURE, AND PARTICULARLY 1703 00:57:53,880 --> 00:57:54,000 DR. RENA WING. 1704 00:57:54,000 --> 00:00:00,000 THANK YOU.