Behavior Tx Helps Older Patients Shed Pounds

Published: Aug 1, 2013 | Updated: Aug 2, 2013

By Cole Petrochko, Staff Writer, MedPage Today

Reviewed by F. Perry Wilson, MD, MSCE; Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Action Points

·         Note that this secondary analysis of a randomized trial revealed that older subjects lost more weight and sustained weight loss better than younger participants when using counseling or an Internet-based tool.

·         Be aware that without measures of body composition, there exists the possibility that weight loss could be distinct from fat-loss.

Older adults enrolled in a weight loss intervention had greater short-term and 3-year weight loss than their younger counterparts, researchers found.

Overweight and obese adults older than 60 lost more weight with the aid of an Internet-based intervention (P=0.024) and personal counseling (P=0.002) shortly after the start of the intervention and after 3 years' follow-up than did younger participants, according to Laura Svetkey, MD, of Duke University Medical Center, and colleagues.

However, older patients did not lose significant amounts of weight when assigned to a self-directed control intervention (P=0.36), they wrote online in the journal Obesity.

The authors noted that 71% of adults older than 60 are overweight or obese, but that obesity-related cardiovascular disease risks and physical limitations -- including hypertension, diabetes, metabolic syndrome, and difficulty walking -- could be improved through weight loss.

Prior research has indicated that behavioral weight loss interventions are associated with significant weight loss, but the age-based effectiveness of these interventions has not been properly evaluated, particularly when delivered through a technological route.

The authors analyzed the effects of age on weight loss and maintenance of a weight loss regimen in 1,032 overweight and obese adult patients with hypertension and/or dyslipidemia who participated in the WLM (Weight Loss Maintenance) trial.

Participants were randomized to a 30-month intervention of behavioral weight loss, monthly personal counseling, or unlimited access over the study period to an Internet-based behavioral intervention following a 6-month behavioral weight loss intervention.

The study sample included patients as young as 25 and as old as 83, and who were taking medication for hypertension or dyslipidemia. They were categorized by age group, which included 50 and younger, 51-60, and 60+.

The researchers gathered data on weight, diet, and estimates of weekly time spent engaged in moderate to vigorous physical activity, as well as demographic data, medication use, perceived current and ideal weight, weight loss history, perceived stress, and depression.

Study outcomes included weight lost during the pre-randomization intervention and after 36 months of intervention.

At baseline, older participants' weight "tended to be slightly lower" and "a smaller proportion of older participants were obese," at 73% of those over 60 versus 81% of those 50 or younger.

In the first phase of the study, older adults lost significantly more weight than younger participants, with 66% of older patients losing 4 kg or more versus 51% of participants ages 50 or younger. The authors also noted that "the amount of phase I weight loss also tended to increase with age, with mean weight loss of 8.54, 8.64, and 9.12% in those 50 or younger, 51 to 60, and older than 60, respectively."

After the second phase of the study, older participants kept weight off better than younger participants, with a mean weight regain of 6.54% among those 50 and younger, 5.47% among those 51 to 60, and 5.05% in those older than 60 (P=0.011 for trend). Mean weight change between the groups was highest among those older than 60, versus the youngest and middle age groups (-4.24 kg versus -2.86 and -3.64).

These trends were not significant in those who were in the control maintenance group.

"In the absence of any maintenance intervention, more weight regain occurred, indicating that further intervention is needed after initial weight loss," they concluded, adding that future research should determine optimal interventions for patients in the older age group.

The study was limited by a lack of understanding of biological and behavioral mechanisms, no measure of body composition, and lack of smaller-sized age categories.

The study was supported by grants from the National Heart, Lung, and Blood Institute.

The authors declared they had no conflicts of interest.

Primary source: Obesity
Source reference: Svetkey LP, et al "Greater weight loss with increasing age in the weight loss maintenance trial" Obesity 2013; DOI: 10.1002/oby.20506.

http://www.medpagetoday.com/PrimaryCare/Obesity/40790