Objective This 6-month pilot trial compared two strategies for weight loss in older adults with BMI’s ≥ 35 kg/m2 to assess weight loss response, safety, and impact on physical function. Methods We randomized 28 volunteers to a balanced deficit diet (BDD, 500 kcal/d below estimated energy needs) or an intensive low calorie meal replacement diet (ILCD, 960 kcal/day). Behavioral interventions and physical activity prescriptions were similar for both groups. Primary outcomes were change in body weight and adverse event frequency; secondary outcomes included measures of physical function and body composition. Results ILCD average weight change was −19.1±2.2 kg or 15.9±4.6% of initial body weight compared to −9.1±2.7 kg or 7.2±1.9% for BDD. ILCD lost more fat mass (−7.7 kg, 95%CI [−11.9, −3.5]) but had similar loss of lean mass (−1.7 kg, 95%CI [−4.1, 0.6]) compared to BDD. There were no significant differences in change in physical function or adverse event frequency. Conclusions Compared to a traditional balanced deficit diet intervention, older adults with severe obesity treated with intensive medical weight loss had greater weight loss and decreases in fat mass without a higher frequency of adverse events. In the short-term however, this did not translate into greater improvements in physical function.

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Data from an academic medical weight management program suggest that individuals with access to insurance coverage for nonsurgical obesity treatment have lower levels of attrition and similar levels of participation and outcomes as those who pay out of pocket.

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