In Reply: Dr Wing and colleagues raise a concern about the weight loss therapy provided for the conventional group, arguing that an intensive program such as the current Look AHEAD program1 may have been more appropriate. When designing this study in 2000, we aimed to deliver standard good practice as would be provided by a multidisciplinary team within our community. Our conventional program adopted the lifestyle principles of the US Diabetes Prevention Program2 and indeed provided weight loss similar to that described in a meta-analysis of the literature on lifestyle and behavioral interventions for weight loss.3 We did not plan for either a highly intensive experimental weight loss program or a potentially problematic intensive hypoglycemic program. Either or both of these quite different nonsurgical arms could have been used.
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