The consequences of obesity among older adults are significant, yet few obesity interventions target this group. Unfamiliarity with weight loss intervention effectiveness and concerns that weight loss negatively affects older adults may be inhibiting targeting this group. This paper reviews the evidence on intentional weight loss and effective weight loss interventions for obese older adults to help dispel concerns and guide health promotion practice.
Data Source.
PubMed articles.
Study Inclusion and Exclusion Criteria.
Randomized controlled trials examining behavioral and pharmaceutical weight loss strategies with 1-year follow-up targeting obese (body mass index ≥30) older adults (mean age ≥60 years), and studies with quasi-experimental designs examining surgical weight loss strategies targeting older adults were examined.
Data Extraction.
Abstracts were reviewed for study objective relevancy, with relevant articles extracted and reviewed.
Data Synthesis.
Data were inserted into an analysis matrix.
Results.
Evidence indicates behavioral strategies are effective in producing significant (all p < .05) weight loss without significant risk to obese older adults, but effectiveness evidence for surgical and pharmaceutical strategies for obese older adults is lacking, primarily because this group has not been targeted in trials or analyses did not isolate this group.
Conclusion.
These findings support the promotion of intentional weight loss among obese older adults and provide guidance to health promotion practitioners on effective weight loss interventions to use with this group.
FlegalK.Epidemiologic aspects of overweight and obesity in the United States. Physiol Behav.2005;86:599–602.
2.
FlegalKCarrollMOgdenCCurtinL. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303:235–241.
3.
BellJRogersVDietzW. CDC Grand rounds: Childhood obesity in the United States. MMWR Morb Mortal Wkly Rep.2011;60:42–46.
4.
FlegalKCarrollMKuczmarskiRJohnsonC. Overweight and obesity in the United States: Prevalence and trends, 1960–1994. Int J Obes.1998;22:39–47.
5.
VillarealDApovianCKushnerRKleinS. Obesity in older adults: Technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society. Am J Clin Nutr.2005;82:923–934.
6.
GorospeEDaveJ. The risk of dementia with increased body mass. Age Ageing. 2007;36:23–29.
7.
BeydounMBeydounHWangY. Obesity and central obesity as risk factors for incident dementia and its subtypes: A systematic review and meta-analysis. Obes Res.2008;9:204–218.
8.
JenkinsK. Obesity's effects on the onset of functional impairment among older adults. Gerontologist. 2004;44:206–216.
9.
StrumRRingelJAndreyevaT. Increasing obesity rates and disability trends. Health Aff.2004;23:199–205.
10.
ValiyevaERussellLMillerJSaffordM. Lifestyle-related risk factors and risk of future nursing home admission. Arch Intern Med.2006;166:985–990.
11.
Administration on Aging, A Profile of Older Americans, 2005. Washington, DC: US Dept of Health and Human Services; 2005.
12.
KeehanSSiskoATrufferC. Health spending projections through 2017: The baby-boom generation is coming to Medicare. Health Aff.2008;27:w145–w155.
13.
US Preventative Services Task Force. Screening for Obesity in Adults: Recommendations and Rationale. Washington, DC: Agency for Healthcare Research and Quality; 2003.
14.
FelixHWestDBursacZ. Impact of USPSTF practice guidelines on clinician weight loss counseling as reported by obese patients. Prev Med.2008;47:394–397.
15.
HuffmanG. Evaluating and treating unintentional weight loss in the elderly. Am Fam Physician. 2002;65:640–651.
16.
FriedLTangenCWatsonJ. Frailty in older adults: Evidence of a phenotype. J Gerontol A Biol Sci Med Sci.2000;56:M146–M157.
17.
RitchieCLocherJRothD. Unintentional weight loss predicts decline in activities of daily living function and life-space mobility over 4 years among community-dwelling older adults. J Gerontol A Biol Sci Med Sci.2008;63:67–75.
18.
RyanCBryantEEleazerP. Unintentional weight loss in long-term care: Predictor of mortality in the elderly. South Med J.1995;88:721–724.
19.
Dawson-HughesB. Calcium and vitamin D nutritional needs of elderly women. J Nutr.1996;126:1165S–1167S.
20.
ChernoffR. Dietary management for older subjects with obesity. Clin Geriatr Med.2005;21:725–733.
21.
ChernoffR. Geriatric Nutrition: The Health Professional's Handbook. 3rd ed.Boston, Mass: Jones and Bartlett Publishers; 2006.
22.
FelsonDZhangYHannanMAndersonJ. Effects of weight and body mass index on bone mineral density in men and women: The Framingham Study. J Bone Miner Res.1993;8:567–573.
23.
EnsrudKEwingSStoneK. Intentional and unintentional weight loss and increased bone loss and hip fracture risk in older women. J Am Geriatr Soc.2003;51:1740–1747.
24.
ChaoDEspelandMFarmerD. Effect of voluntary weight loss on bone mineral density in older overweight women. J Am Geriatr Soc.2000;48:753–759.
25.
VillarealDShahKBanksM. Effect of weight loss and exercise therapy on bone metabolism and mass in obese older adults: A one-year randomized controlled trial. J Clin Endocrinol Metab.2008;93:2181–2187.
26.
Cruz-JentoftALandiFTopinkovaEMichelJ. Understanding sarcopenia as a geriatric syndrome. Curr Opin Clin Nutr Metab Care. 2010;13:1–7.
27.
BaumgarnterRKoehlerKGallagherD. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998;147:755–763.
NewmanALeeJVisserM. Weight change and the conservation of lean mass in old age: The Health, Aging and Body Composition Study. Am J Clin Nutr.2005;82:872–878.
30.
WeinheimerESandsLCampbellW. A systematic review of the separate and combined effects of energy restriction an exercise on fat free mass in middle-aged and older adults: Implications for sarcopenic obesity. Nutr Rev.2010;68:375–388.
31.
MyrskylaMChangV. Weight change, initial BMI and mortality among middle- and older-aged adults. Epidemiology. 2009;20:840–848.
32.
NewmanAYanezDHarrisT. Weight change in old age and its association with mortality. J Am Geriatr Soc.2001;49:1309–1318.
33.
IngramDMussolinoM. Weight loss from maximum body weight and mortality: The Third National Health and Nutrition Examination Survey Linked Mortality File. Int J Obes.2010;34:1044–1050.
34.
FrenchSFolsomAJefferyRWilliamsonD. Prospective study of intentionality of weight loss and mortality in older women: The Iowa Women's Health Study. Am J Epidemiol. 1999;149:504–514.
35.
WannametheeSShaperGLennonL. Reasons for intentional weight loss, unintentional weight loss, and mortality in older men. Arch Intern Med.2005;165:1035–1040.
36.
SheaMHoustonDNicklasB. The effect of randomization to weight loss on total mortality in older overweight and obese adults: The ADAPT study. J Gerontol A Biol Sci Med Sci.2010;65A:519–525.
37.
McTigueKMHessRZiourasJ. Obesity in older adults: A systematic review of the evidence for diagnosis and treatment. Obesity. 2006;14:1485–1497.
38.
GlasgowELaChancePToobertD. Long term effects and costs of brief behavioural dietary intervention for patients with diabetes delivered from the medical office. Patient Educ Couns.1997;32:175–184.
39.
MenghamLMorrisBPalmerCWhiteA. Is intensive dietetic intervention effective for overweight patients with diabetes mellitus? A randomized controlled trial in a general practice. Pract Diabetes Int.1999;16:5–8.
40.
IrwinMYasuiYUlrichC. Effect of exercise on total and intra-abdominal body fat in postmenopausal women: A randomized controlled trial. JAMA. 2003;289:323–330.
41.
ToobertDGlasgowRRadcliffeJ. Physiologic and related behavioral outcomes from the Women's Lifestyle Heart Trial. Ann Behav Med.2000;22:1–9.
42.
CrandallJSchadeDMaY. The influence of age on the effects of lifestyle modification and metformin in the prevention of diabetes. J Gerontol A Biol Sci Med Sci.2006;26a:1075–1081.
43.
MessierSLoeserRMillerG. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: The Arthritis, Diet, and Activity Promotion Trial. Arthritis Rheum.2004;50:1501–1510.
44.
RejeskiWFochtBMessierS. Obese, older adults with knee osteoarthritis: Weight loss, exercise, and quality of life. Health Psychol. 2002;21:419–426.
45.
MoreyMSnyderDSloaneR. Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: A randomized controlled trial. JAMA. 2009;302:845–846.
46.
WheltonPAppelLEspelandM. Sodium reduction and weight loss in the treatment of hypertension in older persons: A randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). JAMA. 1998;279:839–846.
47.
PicotJJonesJColquittJ. The clinical effectiveness and cost effectiveness of bariatric (weight loss) surgery for obesity: A systematic review and economic evaluation. Health Technol Assess. 2009;13:1–230.
48.
VarelaJWilsonSNguyenN. Outcomes of bariatric surgery in the elderly. Am Surg.2006;72:865–869.
49.
O'KeefeKKemmeterPKemmterK. Bariatric surgery outcomes in patients aged 65 years and older at an American Society for Metabolic and Bariatric Surgery Center of Excellence. Obes Surg.2010;20:1199–1205.
50.
PollackA. Abbott Labs withdraws Meridia from the market. New York Times. October 9, 2010;B3.
51.
de CastroJDiasTChambelP. A randomized double-blind study comparing the efficacy and safety of orlistat versus placebo in obese patients with mild to moderate hypercholesterolemia. Rev Port Cardiol. 2009;28:1361–1374.
52.
RyanCJohnsonWMyersV. Nonsurgical weight loss for extreme obesity in primary care settings: Results of the Louisiana Obese Subjects Study. Arch Intern Med.2010;170:146–154.
53.
KopelmanPGdeGroot HRissanenA. Weight loss, HbA1c reduction, and tolerability of cetilistat in a randomized, placebo-controlled phase 2 trial in obese diabetics: Comparison with orlistat. Obesity. 2010;18:108–115.
54.
MulsEKolanowskiJScheenA. The effects of orlistat on weight and on serum lipids in obese patients with hypercholesterolemia: A randomized, double-blind, placebo-controlled, multicentre study. Int J Obes Relat Metab Disord. 2001;25(11):1713–1721.
55.
DavidsonMHauptmanJDiGirolamoM. Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat: A randomized controlled trial. JAMA. 1999;281:235–242.
56.
SjöströmLRissanenAAndersenT. Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients. Lancet. 1998;352:167–172.
57.
HauptmanJLucasCBoldrinM. Orlistat in the long-term treatment of obesity in primary care settings. Arch Fam Med.2000;9:160–167.
58.
SchwartzSBansalVHaleC. Compliance, behavior change, and weight loss with orlistat in an over-the-counter setting. Obesity. 2008;16:624–629.
59.
BlanckHSerdulaMGillespieC. Use of nonprescription dietary supplements for weight loss is common among Americans. J Am Diet Assoc.2007;107:441–447.
60.
PittlerMErnestE. Dietary supplements for body weight reduction: A systematic review. Am J Clin Nutr.2004;79:529–536.
61.
WithamMAvenellA. Interventions to achieve long-term weight loss in obese older people: A systematic review and meta-analysis. Age Ageing. 2010;39:176–184.
62.
TaaffeDCauleyJDanielsonM. Race and sex effects on the association between muscle strength, soft tissue, and bone mineral density in healthy elders: The Health, Aging, and Body Composition Study. J Bone Miner Res.2001;16:1343–1352.
63.
NHLBI Obesity Education Initiative Expert Panel. Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults: The Evidence Report. Washington, DC: National Institutes of Health; 1998.
64.
ZamboniMMazzaliGZoicoE. Health consequences of obesity in the elderly: A review of four unresolved questions. Int J Obes.2005;299:1011–1029.
65.
van UffelenJBerecki-GisolfJBrownWDodsonA. What is the health body mass index for women in their seventies? Results from the Australian Longitudinal Study on Women's Health. J Gerontol A Biol Sci Med Sci.2010;65:844–850.
66.
OreopoulosAKalantar-ZadehKSharmaAFonarowG. The obesity paradox in the elderly: Potential mechanisms and clinical implications. Clin Geriatr Med.2009;25:643–659.
67.
DarmonPKaiserMBauerJ. Restrictive diets in the elderly: Never say never again?Clin Nutr.2010;29:170–174.
68.
Mayer-DavisED'AntonioASmithS. Pounds off with empowerment (POWER): A clinical trial of weight management strategies for black and white adults with diabetes who live in medically underserved rural communities. Am J Public Health. 2004;94:1736–1742.
69.
PerriMNezuAPattiEMcCannK. Effect of length of treatment on weight loss. J Consult Clin Psychol. 1989;57:450–452.
70.
PattersonRFrankLKristalAWhiteE. A comprehensive examination of health conditions associated with obesity in older adults. Am J Prev Med.2004;27:385–390.
71.
ElkinsJWhitmerRSidneyS. Midlife obesity and long-term risk of nursing home admission. Obesity. 2006;14:1472–1478.
72.
DaviglusMLuiKYanL. Relation of body mass index in young adult and middle age to Medicare expenditures in older age. JAMA. 2004;292:2743–2749.
73.
DalyRDunstanDOwenN. Does high-intensity resistance training maintain bone mass during moderate weight loss in older overweight adults with type 2 diabetes?Osteoporos Int.2005;16:1703–1712.
74.
US Dept of Health and Human Services. The Surgeon General's Vision for a Healthy and Fit Nation. Rockville, Md: US Dept of Health and Human Services; 2010.
75.
WestDBursacZCornellC. Lay health educators translate a weight-loss intervention in senior centers: A randomized controlled trial. Am J Prev Med.2011;41:385–391.
