Weight Loss Interventions in Older Adults with Obesity: A Systematic Review of Randomized Controlled Trials Since 2005

Abstract

Objectives: To identify geriatric obesity interventions that can guide clinical recommendations.

Design: Systematic review using Medline (PubMed), Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, EMBASE (Ovid), and PsycINFO (Proquest) from January 1, 2005, to October 12, 2015, to identify English-language randomized controlled trials.

Participants: Individuals aged 60 and older (mean age ≥65) and classified as having obesity (body mass index ≥30 kg/m² ).

Interventions: Behavioral weight loss interventions not involving pharmacological or procedural therapies lasting 6 months or longer.

Measurements: Two investigators performed the systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria and achieved a high concordance rate (97.3%) in summarizing the primary outcomes. The three primary outcomes were weight loss, physical performance, and quality of life.

Results: Of 5,741 citations, 19 were included. (Six studies were unique, and the remaining 13 were based on the same study population.) Duration ranged from 6 to 18 months (n = 405 participants, age range 66.7-71.1). Weight loss in the intervention groups ranged from 0.5 to 10.7 kg (0.1-9.3%). Five studies had a resistance exercise program accompanying a dietary component. Greater weight loss was observed in groups with a dietary component than those with exercise alone. Exercise alone led to better physical function but no significant weight loss. Combined dietary and exercise components led to the greatest improvement in physical performance measures and quality of life and mitigated reductions in muscle and bone mass observed in diet-only study arms. Heterogeneous outcomes were observed, which limited the ability to synthesize the data quantitatively.

Conclusions: The evidence supporting geriatric obesity interventions to improve physical function and quality of life is of low to moderate quality. Well-designed trials are needed in this population.

Keywords: interventions; obesity; systematic review; weight loss.

Figure 1

Flow diagram of study selection process for systematic review. ^aEight existing systematic reviews on the topic of behavioral weight loss in obese older adults before the review process were identified, and their bibliographies accounted for 145 articles (accounted for in the flow diagram as “additional records identified through other sources”). Duplicates from these 145 articles (n=14) were accounted for in box “Full-text articles excluded.”