Improved Function With Enhanced Protein Intake per Meal: A Pilot Study of Weight Reduction in Frail, Obese Older Adults

Abstract

Background:Obesity is a significant cause of functional limitations in older adults; yet, concerns that weight reduction could diminish muscle along with fat mass have impeded progress toward an intervention. Meal-based enhancement of protein intake could protect function and/or lean mass but has not been studied during geriatric obesity reduction.Methods:In this 6-month randomized controlled trial, 67 obese (body mass index ≥30kg/m2) older (≥60 years) adults with a Short Physical Performance Battery score of 4–10 were randomly assigned to a traditional (Control) weight loss regimen or one with higher protein intake (>30g) at each meal (Protein). All participants were prescribed a hypo-caloric diet, and weighed and provided dietary guidance weekly. Physical function (Short Physical Performance Battery) and lean mass (BOD POD), along with secondary measures, were assessed at 0, 3, and 6 months.Results:At the 6-month endpoint, there was significant (p < .001) weight loss in both the Control (−7.5±6.2kg) and Protein (−8.7±7.4kg) groups. Both groups also improved function but the increase in the Protein (+2.4±1.7 units; p < .001) was greater than in the Control (+0.9±1.7 units; p < .01) group (p = .02).Conclusion:Obese, functionally limited older adults undergoing a 6-month weight loss intervention with a meal-based enhancement of protein quantity and quality lost similar amounts of weight but had greater functional improvements relative to the Control group. If confirmed, this dietary approach could have important implications for improving the functional status of this vulnerable population (ClinicalTrials.gov identifier: NCT01715753).

Quality of Life and Mental Health in Older Adults with Obesity and Frailty: Associations with a Weight Loss Intervention

“…None of the participants endorsed suicidal thoughts or behaviors during the study. As reported previously, there was significant weight loss (mean = −8.4 kg) and physiologically-important improvements in SPPB scores at the 6-month end point for both groups, with a significantly greater improvement in the SPPB score for the Protein group (+2.4 points) relative to Control group (+0.9 point) (22). …”

“…The results by group have already been reported for primary outcomes of interest, namely, changes in physical function and lean body mass (22). Given minimal group differences for QOL and mental health variables, the absence of a protein-specific hypothesis, and in order to increase power, the two groups were combined for the current analyses.…”

Treatment of obesity in older persons—A systematic review

“…Many other studies utilized a balanced hypocaloric diet with normal foods, obtaining a 500 to 750 kCal energy deficit per day. This yielded weight losses of between 5% and 10% over 6 to 18 months . The addition of exercise to a hypocaloric diet did not yield significantly greater weight losses than a hypocaloric diet alone .…”

“…Studies comparing diet plus exercise, diet alone, and exercise alone revealed improved self‐reported or objective physical function in the diet plus exercise groups, followed by exercise, diet then control. A single study comparing weight loss with diet and exercise with differing protein intakes revealed improved physical function in the higher protein intake (1.2 g/kg/d versus 0.8 g/kg/d) group …”

Challenges in the Management of Geriatric Obesity in High Risk Populations

“…However, for the obese, frail, older adult, physical activity must be performed “as tolerated” and is unlikely to provide this protection; the best approach for managing obesity in these individuals remains to be elucidated. New evidence indicating the anabolic advantage of enhancing protein intakes (with or without resistance training) as a means of preserving lean muscle mass and improving physical function during weight reduction may hold promise for this population [ 28 , 29 ].…”