Effective SLOPE: EffectS of Lifestyle interventions in Older PEople with obesity: a systematic review and network meta-analysis protocol

Abstract

IntroductionObesity is highly prevalent in older adults aged 65 years or older. Different lifestyle interventions (diet, exercise, self-management) are available but benefits and harms have not been fully quantified comparing all available health promotion interventions. Special consideration must be given to functional outcomes and possible adverse effects (loss of muscle and bone mass, hypoglycaemia) of weight loss interventions in this age group. The objective of this study is to synthesise the evidence regarding the effects of different types and modalities of lifestyle interventions, or their combinations, on physical function and obesity-related outcomes such as body composition in older adults with obesity.Methods and analysesSix databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Psychinfo and Web of Science) and two trial registries (Clinicaltrials.gov and the WHO International Clinical Trials Registry Platform) will be searched for randomised controlled trials of lifestyle interventions in older adults with obesity. Screening (title/abstract and full-text) and data extraction of references as well as assessment of risk of bias and rating of the certainty of evidence (Grading of Recommendations, Assessment, Development and Evaluation for network meta-analyses) will be performed by two reviewers independently. Frequentist random-effects network meta-analyses will be conducted to determine the pooled effects from each intervention.Ethics and disseminationWe will submit our findings to peer-reviewed journals and present at national and international conferences as well as in scientific medical societies. Patient-targeted dissemination will involve local and national advocate groups.PROSPERO registration numberCRD42019147286.

Outcomes addressed in randomized controlled lifestyle intervention trials in community‐dwelling older people with (sarcopenic) obesity—An evidence map

“…This evidence map has been developed in the frame of the Effective SLOPE project (EffectS of Lifestyle interventions in Older PEople with obesity: a systematic review and network meta‐analysis; PROSPERO: CRD42019147286) 16 . The reporting of this study complies with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) for Scoping Reviews (PRISMA‐ScR) and the extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews (PRISMA‐S) (Tables S1 and S2).…”

“…Reviews and guidelines on obesity treatment in older adults have been published suggesting that lifestyle interventions in older adults are effective in reducing body weight and favoring combined interventions including dietary and exercise components 9,11,13–15 . The optimal content and dose of interventions, are not well established, one reason being the lack of systematic reviews with meta‐analyses enabling to identify optimal treatment strategies 11,16 . Clinical decisions about treatment should be based on outcomes of high‐quality randomized controlled trials 17 .…”

“…9,11,[13][14][15] The optimal content and dose of interventions, are not well established, one reason being the lack of systematic reviews with meta-analyses enabling to identify optimal treatment strategies. 11,16 Clinical decisions about treatment should be based on outcomes of high-quality randomized controlled trials. 17 Therefore, the selection of outcomes is important relative to adequate power, the fit with the target population, and the avoidance of null findings.…”

Family Medicine's Strategies for Geriatric Obesity and Its Complications

“…Since older persons have higher degrees of multimorbidity, frailty, sarcopenia, and nutritional risk, findings from younger people cannot be extrapolated to older people. Furthermore, one must take into account the negative effects of weight-loss therapies, such as decreased bone mineral density and muscle mass (13). Therefore, functional decline, functional restrictions, and the likelihood of unfavourable events like falls and fractures may all be higher in the elderly.…”

“…Furthermore, the influence of perceived and real impediments on implementing lifestyle changes varies among younger and older persons. Despite these problems, current obesity guidelines still do not adequately address the treatment of obesity in older persons (13). Findings of a community-based study showed that the sample's median weight loss was 5% compared to their initial body weight.…”