Weight Loss, Exercise, or Both and Physical Function in Obese Older Adults

Abstract

BACKGROUND Obesity exacerbates the age-related decline in physical function and causes frailty in older adults; however, the appropriate treatment for obese older adults is controversial. METHODS In this 1-year, randomized, controlled trial, we evaluated the independent and combined effects of weight loss and exercise in 107 adults who were 65 years of age or older and obese. Participants were randomly assigned to a control group, a weightmanagement (diet) group, an exercise group, or a weight-management-plus-exercise (diet–exercise) group. The primary outcome was the change in score on the modified Physical Performance Test. Secondary outcomes included other measures of frailty, body composition, bone mineral density, specific physical functions, and quality of life. RESULTS A total of 93 participants (87%) completed the study. In the intention-to-treat analysis, the score on the Physical Performance Test, in which higher scores indicate better physical status, increased more in the diet–exercise group than in the diet group or the exercise group (increases from baseline of 21% vs. 12% and 15%, respectively); the scores in all three of those groups increased more than the scores in the control group (in which the score increased by 1%) (P<0.001 for the between-group differences). Moreover, the peak oxygen consumption improved more in the diet–exercise group than in the diet group or the exercise group (increases of 17% vs. 10% and 8%, respectively; P<0.001); the score on the Functional Status Questionnaire, in which higher scores indicate better physical function, increased more in the diet–exercise group than in the diet group (increase of 10% vs. 4%, P<0.001). Body weight decreased by 10% in the diet group and by 9% in the diet–exercise group, but did not decrease in the exercise group or the control group (P<0.001). Lean body mass and bone mineral density at the hip decreased less in the diet–exercise group than in the diet group (reductions of 3% and 1%, respectively, in the diet–exercise group vs. reductions of 5% and 3%, respectively, in the diet group; P<0.05 for both comparisons). Strength, balance, and gait improved consistently in the diet–exercise group (P<0.05 for all comparisons). Adverse events included a small number of exercise-associated musculoskeletal injuries. CONCLUSIONS These findings suggest that a combination of weight loss and exercise provides greater improvement in physical function than either intervention alone.

Obesity in the elderly: an emerging health issue

“…The authors suggest that treatment strategies for obese older subjects should focus more on maintaining body weight and improving physical function, but avoiding weight loss. This conclusion, although reasonable, should take into account the statements of the consensus panel of the American Society for the Nutrition and the Obesity Society 4 and the recent data published by Villareal et al 11 supporting the positive effect of moderate weight loss in the elderly. Caution concerning weight loss in the elderly is supported by the so called Obesity Paradox, where obesity in older people is beneficial or neutral rather than harmful.…”

Obesity and fracture in men and women: An epidemiologic perspective

“…(85) Some randomized controlled trials of weight loss in the elderly have been proven effective and have demonstrated improvements in quality of life, cardiovascular health indicators, and physical function. (89) Recently Villareal and colleagues (90) reported that weight loss among obese older adults achieved through a regimen that included physical activity was accompanied by very small losses of lean mass (3%) and bone density (1%). These losses were much smaller than in the dietonly weight loss regimen and were accompanied by gains in strength, balance, and gait.…”

“…These losses were much smaller than in the dietonly weight loss regimen and were accompanied by gains in strength, balance, and gait. (90) The question remains whether such gains in physical function would ameliorate fall risk to the extent that they compensate for BMD loss in the fracture-risk calculus. We hypothesize that if weight loss can be achieved while maintaining or increasing lean mass and bone strength, the benefits to elderly participants would accrue in multiple domains of health and function, including fracture prevention.…”

Challenges with the Medicare Obesity Benefit: Practical Concerns & Proposed Solutions

“…Nearly half of the studies cited in the determination examined populations predominantly < 65 years of age. [13][14][15][16][17][18] Only three studies were pertinent to older adults: a weight-loss systematic review; 19 the ADAPT study; 20 and a study by Villareal,21 all aimed at encouraging functional improvement following weight loss. Studies conducted in primary care settings using IBT were limited, 22 as were those using function as the sole outcome measure.…”

“…25,26 This is partly due to the effect of weight-loss induced declines in bone density and in muscle mass and quality (sarcopenia). 21 An estimated 25 % of total weight lost in older adults undergoing weight-loss interventions constitutes fat-free (muscle) mass. 27 While it is difficult to define muscle loss, 28 mitigating the impact of weight lossinduced muscle decline can prevent unintended consequences.…”