Research Institute - Obese Study

NASM Research Update Effectiveness of Weight Loss Interventions for Obese Older Adults

Holly C. Felix and Delia S. West. American Journal of Health Promotion. 2013 Jan-Feb;27(3):191-9.

Introduction • Obesity rates continue to climb in the older adult population • The health consequences of obesity for older adults are significant – Increase chronic disease risk – Cognitive and functional decline

• Unfortunately few weight-loss intervention programs specifically target older adults

Purpose â&#x20AC;˘ The purpose of this literature review is to: 1. Examine evidence and effectiveness of weight loss interventions for obese older adults 2. Dispel myths concerning weight loss interventions 3. Guide health promotion practice for obese older adults

Overview • Inclusion criteria: – Random controlled trials targeting obese (BMI > 30) older adults (mean age > 60) that examine behavioral and pharmaceutical weight loss strategies with 1-year follow-up – Studies with quasi-experimental designs examining surgical weight loss strategies for obese older adults

• Database search: – PubMed was searched for articles published through July 2010 using a combination of key terms relating to obesity, older adults, and weight loss – Only English-language studies included – Abstracts screened for relevancy – 10 Random Control Trials met inclusion criteria COPYRIGHT 2012, NATIONAL ACADEMY OF SPORTS MEDICINE

Results • Strategies identified to achieve weight loss for older adults include: – Behavioral lifestyle changes – Increased physical activity – Reduced calorie intake

– Weight loss surgery – Weight loss medication

Behavioral / Lifestyle Change • Positives – 8 out of 10 identified Random Control Trials (RTC) produced significant weight loss among older adults – Older adults may be more responsive to these types of weight loss interventions versus younger adults – Physical activity was shown to improve ease of weight maintenance and physical function

• Negatives – Four of the trials identified some discomfort from participants (e.g., gastrointestinal distress, musculoskeletal problems) – Two studies identified reduced bone mineral density in conjunction with weight loss COPYRIGHT 2012, NATIONAL ACADEMY OF SPORTS MEDICINE

Weight Loss Surgery • Positives – Moderate evidence to support the inclusion of weight loss surgery as a safe method to obtain weight loss – No surgery-related deaths

• Negatives – A few studies indicated older adults have significantly longer hospital stays and complications (e.g., bleeding, infection) than younger adults – Complications were attributed primarily to preexisting conditions

Weight Loss Medications • Positives – Trials show orlistat (only FDA approved weight loss medication) to be moderately effective in producing weight loss for various age groups – Few serious adverse events reported

• Negatives – Lack of evidence to support use for older adults; no RTC’s identified – More research needed to determine safety Note: Unconvincing evidence was found to support over-the-counter weight loss supplements; authors discourage use

Conclusions • Obesity rates are increasing in elderly population • Obesity intervention programs targeting older adults are not widely studied – Treatment efforts focus on children and younger adults

• Behavioral and lifestyle change appears to the safest weight loss method versus surgery or medication • More emphasis on weight loss programs in locations with high rates of elderly (e.g. senior centers) is needed

Implications for the Fitness Professional • Fitness professionals can implement behavioral/lifestyle weight loss programs for obese older adults • Fitness professionals should strive to minimize client discomforts such as musculoskeletal aches and pains or gastrointestinal distress – Offer corrective exercise programs to correct muscle imbalances and faulty movement patterns – Always err on the side of caution and slowly progress a client’s exercise program – Offer sound nutritional advice while staying within scope of practice COPYRIGHT 2012, NATIONAL ACADEMY OF SPORTS MEDICINE

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