The Effect of Randomization to Weight Loss on Total Mortality in Older Overweight and Obese Adults: The ADAPT Study

Shea, M. Kyla; Houston, Denise K.; Nicklas, Barbara J.; Messier, Stephen P.; Davis, Cralen; Miller, Michael E.; Harris, Tamara B.; Kitzman, Dalane W.; Kennedy, Kimberly; Kritchevsky, Stephen B.

doi:10.1093/gerona/glp217

Cited by 96 publications

(74 citation statements)

References 26 publications

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“…These beneficial results became already apparent after 6 months and persisted during the 18 months of the study. Follow-up after 8 years demonstrated no increased mortality [67] . In fact, the groups randomised to diet or diet plus exercise had a 50% lower mortality than the groups, just receiving advice on healthy life-style or exercise.…”

Section: Life-style Intervention: Is It Feasible In the Frail Elderly?mentioning

confidence: 81%

Prevalence, Pathophysiology, Health Consequences and Treatment Options of Obesity in the Elderly: A Guideline

2012

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The prevalence of obesity is rising progressively, even among older age groups. By the year 2030–2035 over 20% of the adult US population and over 25% of the Europeans will be aged 65 years and older. The predicted prevalence of obesity in Americans, 60 years and older was 37% in 2010. The predicted prevalence of obesity in Europe in 2015 varies between 20 and 30% dependent on the model used. This means 20.9 million obese 60+ people in the USA in 2010 and 32 million obese elders in 2015 in the EU. Although cut-off values of BMI, waist circumference and percentages of fat mass have not been defined for the elderly (nor for the elderly of different ethnicity), it is clear from several meta-analyses that mortality and morbidity associated with overweight and obesity only increases at a BMI above 30 kg/m<sup>2</sup>. Thus, treatment should only be offered to patients who are obese rather than overweight and who also have functional impairments, metabolic complications or obesity-related diseases, that can benefit from weight loss. The weight loss therapy should aim to minimize muscle and bone loss but also vigilance as regards the development of sarcopenic obesity – a combination of an unhealthy excess of body fat with a detrimental loss of muscle and fat-free mass including bone – is important in the elderly, who are vulnerable to this outcome. Life-style intervention should be the first step and consists of a diet with a 500 kcal (2.1 MJ) energy deficit and an adequate intake of protein of high biological quality together with calcium and vitamin D, behavioural therapy and multi-component exercise. Multi-component exercise includes flexibility training, balance training, aerobic exercise and resistance training. The adherence rate in most studies is around 75%. Knowledge of constraints and modulators of physical inactivity should be of help to engage the elderly in physical activity. The role of pharmacotherapy and bariatric surgery in the elderly is largely unknown as in most studies people aged 65 years and older have been excluded.

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Section: Life-style Intervention: Is It Feasible In the Frail Elderly?mentioning

confidence: 81%

Prevalence, Pathophysiology, Health Consequences and Treatment Options of Obesity in the Elderly: A Guideline

2012

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“…Taken together, these results suggest that despite a lower risk for Type 2 diabetes and possibly cardiovascular disease and the potential absence of improvement in the metabolic profile of MHO subjects after weight loss, lifestyle interventions (weight management and physical activity) should continue to be recommended to reduce total mortality in all obese individuals. 68 Furthermore, several studies have shown that gastric bypass surgery may reduce the risk of mortality in obese subjects. 69,70 However, no data seem to be currently available on the effect of gastric bypass surgery in MHO individuals.…”

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confidence: 99%

Characterizing the profile of obese patients who are metabolically healthy

et al. 2010

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The presence of obesity-related metabolic disturbances varies widely among obese individuals. Accordingly, a unique subset of obese individuals has been described in the medical literature, which seems to be protected or more resistant to the development of metabolic abnormalities associated with obesity. These individuals, now known as 'metabolically healthy but obese' (MHO), despite having excessive body fatness, display a favorable metabolic profile characterized by high levels of insulin sensitivity, no hypertension as well as a favorable lipid, inflammation, hormonal, liver enzyme and immune profile. However, recent studies have indicated that this healthier metabolic profile may not translate into a lower risk for mortality. Mechanisms that could explain the favorable metabolic profile of MHO individuals are poorly understood. However, preliminary evidence suggests that differences in visceral fat accumulation, birth weight, adipose cell size and gene expression-encoding markers of adipose cell differentiation may favor the development of the MHO phenotype. Despite the uncertainty regarding the exact degree of protection related to the MHO status, identification of underlying factors and mechanisms associated with this phenotype will eventually be invaluable in helping us understand factors that predispose, delay or protect obese individuals from metabolic disturbances. Collectively, a greater understanding of the MHO individual has important implications for therapeutic decision making, the characterization of subjects in research protocols and medical education. Keywords: metabolically healthy but obese; insulin sensitivity; body composition; metabolic risk factors; cardiovascular diseases Introduction Obesity has been increasing at a rapid rate over the past decades and has now reached epidemic proportions. Recent data suggest that 65% of US adult are overweight (body mass index425 kg m À2) and 30% are obese (body mass index430 kg m À2).1 Obesity is associated with numerous metabolic complications such as Type 2 diabetes, dyslipidemia, hypertension, cardiovascular diseases and several forms of cancer. 2 The risk of developing obesity-related complications is proportional to the degree of obesity, and more specifically to android fat accumulation. 3 However, the presence of these obesity-related metabolic disturbances varies widely among obese individuals. 4,5 Accordingly, a unique subset of obese individuals has been described in the medical literature that seems to be protected or more resistant to the development of metabolic abnormalities associated with obesity. 6-12 These individuals, now known as 'metabolically healthy but obese' (MHO), despite having excessive body fatness, display favorable metabolic profiles characterized by high levels of insulin sensitivity, no hypertension, as well as favorable lipid, inflammation, hormonal, liver enzyme and immune profiles 7,9,[13][14][15] ( Figure 1). This phenomenon has also been observed in adolescents. 16 Despite a clinical awareness of the MHO individu...

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“…Weight loss of 5% and more (equivalent to 4.9 kg of mean initial body weight of the total study group) was exceeded by at least 1.6 kg in the HC group and by 1.9 kg in the HP group, reflecting a decreasing risk in both groups. Moreover, it has been shown that weight loss of around 5 kg, as achieved by 66.2% of subjects, is associated with a reduction in allcause mortality [31].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of High Carbohydrate versus High Protein Meal Replacements on Weight Reduction - A Randomized Controlled Trial

Möller¹,

Willers²,

Hahn³

2015

J Obes Weight Loss Ther

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The Effect of Randomization to Weight Loss on Total Mortality in Older Overweight and Obese Adults: The ADAPT Study

Cited by 96 publications

References 26 publications

Prevalence, Pathophysiology, Health Consequences and Treatment Options of Obesity in the Elderly: A Guideline

Prevalence, Pathophysiology, Health Consequences and Treatment Options of Obesity in the Elderly: A Guideline

Characterizing the profile of obese patients who are metabolically healthy

Efficacy of High Carbohydrate versus High Protein Meal Replacements on Weight Reduction - A Randomized Controlled Trial

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