Effectiveness of a Weight-Loss Intervention in Preventing Frailty and Functional Decline in Community-Dwelling Obese Older People. A Randomized Controlled Trial

Abstract

Background: Obesity is a risk factor for frailty and muscle weakness, so weight loss in obese older adults may prevent frailty and functional decline. Objective: To assess the safety and efficacy of a multimodal weight-loss intervention in improving functional performance and reducing frailty risk in obese older adults. Design: Randomized controlled trial with 2 parallel arms. Setting and participants: Community-dwelling obese adults aged 65-75 years with body mass index (BMI) 30-39 kg/m2. Intervention: 6-month multimodal intervention based on diet and a physical activity program. Control group: Usual care. Main and secondary outcome measures: Frailty (Fried criteria) rate and functional performance at 6, 12, and 24 months of follow-up, respectively. Intermediate outcome measures: Weight loss, body composition changes, and metabolic and inflammatory biomarker changes. Results: N=305. The study intervention increased gait speed at 12 and 24 months of follow-up, but had no significant effect on frailty prevention. It was effective in reducing weight, BMI, fat mass, interleukin 6, and insulin resistance and improving self-reported quality of life. Conclusions: The study intervention was not demonstrated to be effective in preventing frailty in obese people aged 65-75 years at 24 months of follow-up. However, it allowed weight loss and a reduction in inflammatory and insulin resistance markers, which could have a long-term effect on frailty that requires further research.

Outcomes addressed in randomized controlled lifestyle intervention trials in community‐dwelling older people with (sarcopenic) obesity—An evidence map

“…19 months for at least some study outcomes. 45,57,63,64,70,76,81 of life (n = 13, 24.1%), psychological (n = 10, 18.5%), risk for adverse health event and medical conditions (n = 5, 9.3%), medications (n = 3, 5.6%), pain (n = 4, 7.4%), and sleep (n = 2, 3.7%).…”

“…Of 57,721 unique records, 109 articles of 54 studies were included in the evidence map as they provided information on outcomes assessed (Figure 1 and Table S4). 34–87 The unique accession numbers from all database searches are available upon request.…”

“…No study in individuals with SO lasted longer than 26 weeks. Seven studies, all in individuals of the obesity phenotype, included a post‐intervention follow‐up period ranging from 5 to 19 months for at least some study outcomes 45,57,63,64,70,76,81 . The study's participants' age ranged from 65.3 to 77.4 years across studies, with only four RCTs reporting a mean age of 75 years and older.…”

Effect of overweight/obesity and metabolic syndrome on frailty in middle‐aged and older Japanese adults

“…Serra‐Prat et al. examined the effectiveness of a weight‐loss intervention in preventing frailty in community‐dwelling adults with obesity aged 65–75 years in a randomized control trial 37 ; the intervention allowed a reduction in inflammatory and insulin resistance markers with weight loss but was not demonstrated to be effective in preventing frailty owing to a short follow‐up period (24 months). Therefore, an extended period might be required to examine the effect of diabetes interventions on frailty prevention.…”

“…Accordingly, improving blood glucose levels with weight loss was considered effective in preventing frailty. Serra-Prat et al examined the effectiveness of a weightloss intervention in preventing frailty in community-dwelling adults with obesity aged 65-75 years in a randomized control trial37 ; the intervention allowed a reduction in inflammatory and insulin resistance markers with weight loss but was not demonstrated to be effective in preventing frailty owing to a short follow-up periodF I G U R E 3 Forest plot of subgroup analyses for the risk factors associated with frailty. (A), Male and (B) female.…”