Long-term maintenance of weight loss after lifestyle intervention in frail, obese older adults

Abstract

Objectives-To determine if long-term weight loss with associated improvement in physical and metabolic health can be maintained after lifestyle intervention in frail, obese older adults.Design-Thirty-month follow-up pilot study of a 1-year lifestyle intervention trial. Setting-CommunityParticipants-Sixteen frail, obese (body mass index = 36±2 kg/m 2 ) older (71±1 yr) adults Measurements-Body weight and composition, physical function, markers of the metabolic syndrome, glucose and insulin response to an oral glucose tolerance test, bone mineral density (BMD), liver and renal function tests, and food diaries.Results-At 30-month follow-up, weight (101.5±3.8 vs. 94.5 ± 3.9 kg) and BMI (36.0 ±1.7 vs. 33.5±1.7 kg/m 2 ) remained significantly below baseline (all p<0.05). No significant change in fatfree mass (56.7±2.1 vs. 56.9 ±2.2 kg) or appendicular lean mass (24.1±1.0 vs. 24.1±1.1kg, all p>0.05) occurred between 12 months (end of trial) and 30 months. Improvements in the physical performance test (PPT 27±0.7 vs. 30.2±0.6), insulin sensitivity (4.1±0.8 vs. 3.0±0.6), and insulin area under the curve (12484±2042 vs. 9270±1139 min·mg/dl) remained at 30 months compared to baseline (all p<0.05). Waist circumference (116±3 vs. 109±3 cm) and systolic blood pressure (134±6 vs. 123±5 mm HG) remained decreased at 30 months compared to baseline (all p<0.05). Whole body and lumbar spine BMD did not change; however, total hip BMD progressively decreased at 30 months compared to baseline (0.985±.026 vs. 0.941±.024 g/cm 2 ; p<0.05). There were no adverse effects on liver or renal function. Food frequency questionnaire data showed lower overall caloric intake (−619±157 kcal/day) at 30 months compared to baseline (p<0.05). Conclusion-These findings suggest that long-term maintenance of clinically important weight loss is possible in frail, obese older adults. Weight maintenance appears to be achieved through continued caloric restriction. Larger, long-term studies are needed to follow up on these findings and investigate mechanisms and behaviors underlying maintenance of weight loss and physical function.

Effect of an 18-month physical activity and weight loss intervention on body composition in overweight and obese older adults

“…Overall, WL success reported in this trial is encouraging; with 84% of participants in the PA 1 WL group weighing less at 18 months than at baseline and sustaining an average WL of 7.7%. Long-term WL maintenance of this magnitude is in general agreement with the pilot study findings in frail, obese, older adults reported by Waters et al (16) and notably, is clinically meaningful (19). Nevertheless, we observed considerable variability about this average WL estimate (SD 5 6.8%), with 30% of participants in the PA 1 WL group experiencing weight regain of at least 2 kg during the 12-month "weight maintenance" period.…”

Group trajectory analysis helps to identify older cancer survivors who benefit from distance‐based lifestyle interventions

“…24,26 Virtually no trials have included a postintervention follow-up of 1 year or longer, which has been suggested as the optimal length of time for the evaluation of maintenance of behavioral change. 24,25 Direct comparisons of our results and the results of other trials of PA for cancer survivors are difficult because few trials have been of long-term duration or have examined long-term maintenance of PA. 23 Consistent with our findings, 2 long-term trials in breast and prostate cancer survivors reported maintenance of PA by a proportion of the intervention group. 27,28 In a study of breast cancer survivors (n 5 44) assigned to a 1-year intervention of resistance and impact training, 56% continued to exercise during the 1year follow-up; however, 43% of those who continued to exercise did so at a reduced effort.…”

“…Although rare, similar findings have been reported among older frail adults after a lifestyle intervention. 23 Furthermore, the trajectory patterns of the W/L-INT group during the second year of the observation period demonstrated that a large portion of the group (groups 2 and 3; 91.1% of the sample) increased PA upon receiving the intervention despite a 1-year waiting period.…”

Effect of Aerobic or Resistance Exercise, or Both, on Bone Mineral Density and Bone Metabolism in Obese Older Adults While Dieting: A Randomized Controlled Trial

“…An important limitation to improve the physical and metabolic function of older adults with obesity with weight loss therapy is reduction of BMD, which could increase the risk of fractures. (2,7,8,20) In fact, it has been reported that after long-term weight loss, bone loss continues despite some degree of weight regain (21,22) arguing against the notion that the loss of BMD with weight loss is a physiologic response to loss of total body mass. With weight regain, there is fat regain, but this is not accompanied by bone regain.…”

“…With weight regain, there is fat regain, but this is not accompanied by bone regain. (21,22) This bone loss on top of ongoing age-related bone loss may result in osteoporosis, especially among those who have lower BMD at the start of weight loss. In addition, although obesity is associated with increased BMD, it is associated with increased risk for frailty, (17,23) an independent risk factor for falls and fractures.…”