Look AHEAD was a randomized clinical trial designed to examine the long-term health effects of weight loss in overweight and obese individuals with type 2 diabetes. The primary result was that the incidence of cardiovascular events over a median follow up of 9.6 years was not reduced in the intensive lifestyle group relative to the control group. This finding is discussed, with emphasis on its implications for design of clinical trials and clinical treatment of obese people with type 2 diabetes.

Obesity remains a global epidemic. The prevalence of obesity in US adults was 42.4% in 2017-2018 (1) and it continues to rise. Obesityrelated diseases such as cardiovascular disease and type 2 diabetes mellitus (T2DM) are leading causes of preventable deaths. Despite the existence of effective lifestyle interventions, the disease burden and epidemic of obesity continue to worsen. The recent literature on dietary interventions for weight loss has indicated a conceptual shift from what we eat to when we eat. Observational studies have shown that habitual breakfast skipping is associated with obesity, cardiometabolic diseases, T2DM, and increased cardiovascular and all-cause mortality (2-5), whereas habitual breakfast consumption is associated with lower risk of obesity and weight gain over time (6-8). However, randomized controlled trials with a short follow-up duration