Current Diabetes Reports

, 14:539 | Cite as

Weight Loss and Physical Activity for Disease Prevention in Obese Older Adults: an Important Role for Lifestyle Management

  • Willy Marcos ValenciaEmail author
  • Mark Stoutenberg
  • Hermes Florez
Lifestyle Management to Reduce Diabetes/Cardiovascular Risk (EM Venditti, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Lifestyle Management to Reduce Diabetes/Cardiovascular Risk


Weight loss in older adults has been a controversial topic for more than a decade. An obesity paradox has been previously described and the issue of weight status on health outcomes remains a highly debated topic. However, there is little doubt that physical activity (PA) has a myriad of benefits in older adults, especially in obese individuals who are inactive and have a poor cardiometabolic profile. In this review, we offer a critical view to clarify misunderstandings regarding the obesity paradox, particularly as it relates to obese older adults. We also review the evidence on PA and lifestyle interventions for the improvement of cardiorespiratory fitness, which can prevent disease and provide benefits to obese older adults, independent of weight changes.


Obese older adult Physical activity Intentional weight loss Diabetes Obesity paradox Cardiorespiratory fitness Lifestyle interventions Disease prevention 



We would like to thank Dr. Maria van Zuilen for her review of this manuscript. The work contributed by Dr. Mark Stoutenberg was supported by Grant Number 1KL2TR000461 from the Miami Clinical and Translational Science Institute, the National Center for Advancing Translational Sciences, and the National Institute on Minority Health and Health Disparities. Its contents are solely the responsibility of the author and do not necessarily represent the official views of the NIH.

We would like to thank the Health Foundation of South Florida and its Healthy Aging Regional Collaborative, which supported the grant that allowed us to implement the Enhance Fitness exercise program at Miami VAHS.

We would also like to thank the Department of Human and Health Services, which supported our grant NIH grant 1R18AE000049-01, “Peer-lead and Telehealth Activated Care (PACT) in Diabetes Prevention and Management.”

We would like to thank the support of the Geriatric Research, Education and Clinical Center at Miami VAHS.

Compliance with Ethics Guidelines

Conflict of Interest

Willy Marcos Valencia, Mark Stoutenberg, and Hermes Florez declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    WHO 10 facts on obesity. World Health Organization 2013. Accessed 25 Apr 2014.
  2. 2.
    CDC Overweight and obesity facts. Centers for Disease Control and Prevention. 2014. Accessed 21 April 2014.
  3. 3.•
    TOS Obesity Writing Group, Allison DB, Downey M, Atkinson RL, et al. Obesity as a disease: a white paper on evidence and arguments commissioned by the council of The Obesity Society. Obesity. 2008;16:1161–77. This article, ahead of its time, allows the reader not only to better understand the definition and implications of defining obesity and disease, but also to incorporate language and concepts that will be extremely useful when discussing with patients about the definition of obesity as a disease.PubMedCrossRefGoogle Scholar
  4. 4.
    AACE Position Statement, Mechanick JI, Garber AJ, Handelsman Y, Garvey WT. American association of clinical endocrinologists’ position statement on obesity and obesity medicine. Endocr Pract. 2012;18:642–8.PubMedCrossRefGoogle Scholar
  5. 5.
    AMA News Room. AMA Adopts new policies on second day of voting at annual meeting. Obesity as a disease. American Medical Association 2013. Accessed 21 Apr 2014
  6. 6.
    WHO Global strategy on diet, physical activity and health. Obesity and Overweight Facts. World Health Organization. 2003. Accessed April 21, 2014.
  7. 7.
    TOS Obesity, bias and stigmatization. The Obesity Society 2014. Accessed May 5, 2014.
  8. 8.
    Loef M, Walach H. Midlife obesity and dementia: meta-analysis and adjusted forecast of dementia prevalence in the United States and China. Obesity. 2013;21:E51–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Darmon P. Intentional weight loss in older adults: useful or wasting disease generating strategy. Curr Opin Clin Nutr Metab Care. 2013;16:284–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS obesity guideline. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and The Obesity Society. Circulation 2013; 00:000–000.Google Scholar
  11. 11.
    AHA FACTS with a very heavy heart. Obesity and cardiovascular disease (CVD). American Heart Association 2013. Accessed 21 Apr 2014.
  12. 12.
    Reed JL, Chaput J-P, Tremblay A, Doucet E. The maintenance of energy balance is compromised after weight loss. Can J Diabetes. 2013;37:121–7.PubMedCrossRefGoogle Scholar
  13. 13.
    DeFronzo RA, Abdul-Ghani MA. Preservation of β-cell function: the key to diabetes prevention. J Clin Endocrinol Metab. 2011;96:2354–66.PubMedCrossRefGoogle Scholar
  14. 14.
    Kirkman S, Briscoe VJ, Clark N, et al. Diabetes in older adults: a consensus report. J Am Geriatr Soc. 2012;60:2342–56.CrossRefGoogle Scholar
  15. 15.
    Alpert MA, Omran J, Mehra A, Ardhanari S. Impact of obesity and weight loss on cardiac performance and morphology in adults. Prog Cardiovasc Dis. 2014;56:391–400.PubMedCrossRefGoogle Scholar
  16. 16.
    Chrostowska M, Szyndler A, Hoffmann M, Narkiewicz K. Impact of obesity on cardiovascular health. Best Pract Res Clin Endocrinol Metab. 2013;27:147–56.PubMedCrossRefGoogle Scholar
  17. 17.
    Bastien M, Poirier P, Lemieux I, Després J-P. Overview of epidemiology and contribution of obesity to cardiovascular disease. Prog Cardiovasc Dis. 2014;56:369–81.PubMedCrossRefGoogle Scholar
  18. 18.
    Kannel WB, Wilson PW, Nam BH, D’Agostino RB. Risk stratification of obesity as a coronary risk factor. Am J Cardiol. 2002;90:687–701.CrossRefGoogle Scholar
  19. 19.
    McClain J, Hsu F, Brown E, et al. Pericardial adipose tissue and coronary artery calcification in the Multi-Ethnic Study of Atherosclerosis (MESA). Obesity. 2013;21:1056–63.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Labounty TM, Gomez MJ, Achenbach S, et al. Eur Heart J Cardiovasc Imaging. 2013;14:456–63.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Wassel CL, Laughlin GA, Araneta MR, et al. Associations of pericardial and intrathoracic fat with coronary calcium presence and progression in a multiethnic study. Obesity. 2013;21:1704–12.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Grabowski DC, Ellis JE. High body mass index does not predict mortality in older people: analysis of the longitudinal study of aging. JA GS. 2001;49:968–79.Google Scholar
  23. 23.
    Gruberg L, Weissman NJ, Waksman R, et al. The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox? J Am Coll Cardiol. 2002;39:578–84.PubMedCrossRefGoogle Scholar
  24. 24.
    Hainer V, Aldhoon-Hainerová I. Obesity paradox does exist. Diabetes Care. 2013;36 Suppl 2:S276–81.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Carnethon MR, De Chavez PJD, Biggs ML, et al. Association of weight status with mortality in adults with incident diabetes. JAMA. 2012;308:581–90.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Florez H, Castillo-Florez S. Beyond the obesity paradox in diabetes. Fitness, fatness and mortality. Editorial. JAMA. 2012;308:619–20.PubMedCrossRefGoogle Scholar
  27. 27.
    Tobias DK, Pan A, Jackson CL, et al. Body-mass index and mortality among adults with incident type 2 diabetes. N Engl J Med. 2014;370:233–44.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.••
    Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories. A systematic review and meta-analysis. JAMA. 2013;309:71–82. This meta-analysis confirms the expected association between obesity and increased risk for all-cause mortality. The data was stronger in older adults, which is the focus of this review.PubMedCrossRefGoogle Scholar
  29. 29.
    De Schutter A, Lavie CJ, Milani RV. The impact of obesity on risk factors and prevalence and prognosis of coronary heart disease—the obesity paradox. Prog Cardiovasc Dis. 2014;56:401–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Lavie CJ, McAuley PA, Church TS, Milani RV, Blair SN. Obesity and cardiovascular diseases: implications regarding fitness, fatness, and severity in the obesity paradox. J Am Coll Cardiol. 2014;63:1345–54.PubMedCrossRefGoogle Scholar
  31. 31.
    Lavie CJ, Alpert MA, Arena R, Mehra MR, Milani RV, Ventura HO. Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure. J Am Coll Cardiol HF. 2013;1:93–102.Google Scholar
  32. 32.
    McAuley PA, Beavers KM. Contribution of cardiorespiratory fitness to the obesity paradox. Prog Cardiovasc Dis. 2014;56:434–40.PubMedCrossRefGoogle Scholar
  33. 33.
    Barry VW, Baruth M, Beets MW, Durstine JL, Liu J. Blair SN. Fitness vs fatness on all-cause mortality: a meta-analysis. Prog Cardiovasc Dis. 2014;56:382–90.PubMedCrossRefGoogle Scholar
  34. 34.
    Banack HR, Kaufman JS. The obesity paradox: understanding the effect of obesity on mortality among individuals with cardiovascular disease. Prev Med. 2014;62:96–102.PubMedCrossRefGoogle Scholar
  35. 35.
    Preston SH, Stokes A. Obesity paradox. Conditioning on disease enhances biases in estimating the mortality risks of obesity. Epidemiol. 2014;25:454–61.CrossRefGoogle Scholar
  36. 36.
    Zheng H, Tumin D, Qian Z. Obesity and mortality risk: new findings from body mass index trajectories. Am J Epidemiol. 2013;178:1591–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Wildman RP, Muntner P, Reynolds K, et al. The obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering. Prevalence and correlates of 2 phenotypes among the US populations (NHANES 1999–2004). Arch Intern Med. 2008;168:1617–24.PubMedCrossRefGoogle Scholar
  38. 38.
    Hamer M, Stamatakis E. Metabolically healthy obesity and risk of all-cause and cardiovascular disease mortality. J Clin Endocrinol Metab. 2012;97:2482–8.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Hinnouho G-M, Czernichow S, Dugravot A, Batty GD, Kivimaki M, Singh-Manoux A. Metabolically healthy obesity and risk of mortality. Does the definition of metabolic health matter? Diabetes Care. 2013;36:2294–300.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.•
    Kramer CK, Zinman B, Retnakaran R. Are metabolically healthy overweight and obesity benign conditions? A systematic review and meta-analysis. Ann Intern Med. 2013;159:758–69. This systematic review offers a great insight to the suggested concept of healthy obesity, with results consistent with the prevalent need to address and manage obesity.PubMedCrossRefGoogle Scholar
  41. 41.
    Stenholm S, Harris TB, Rantanen T, Visser M, Kritchevsky S, Ferrucci L. Sarcopenic obesity—definition, etiology and consequences. Curr Opin Clin Nutr Metab Care. 2008;11:693–700.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Jensen GL, Hsiao PY. Obesity in older adults: relationship to functional limitation. Curr Opin Clin Nutr Metab Care. 2010;13:46–51.PubMedCrossRefGoogle Scholar
  43. 43.•
    Kalyani RR, Corriere M, Ferrucci L. Age-related and disease-related muscle loss: the effect of diabetes, obesity, and other diseases. Lancet Diabetes Endocrinol 2014; Mar 6 [Epub ahead of print]. This review offers a great insight to the pathophysiology of sarcopenic obesity and the metabolic and endocrinologic issues of sarcopenia, age-related or disease-related. Google Scholar
  44. 44.
    Chung J-Y, Kang H-T, Lee D-K, Lee H-R, Lee Y-J. Body composition and its association with cardiometabolic risk factors in the elderly: a focus on sarcopenic obesity. Arch Gerontol Geriatr. 2013;56:270–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Manini TM, Clark BC. Dynapenia and aging: an update. J Gerontol A Biol Sci Med Sci. 2012;67A:28–40.CrossRefPubMedCentralGoogle Scholar
  46. 46.
    Visser M. Symposium 2: exercise and protein nutrition. Obesity, sarcopenia and their functional consequences in old age. Proc Nutr Soc. 2011;70:114–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Espeland MA, Rejeski WJ, West DS, et al. Intensive weight loss intervention in older individuals: results from the action for health in diabetes type 2 diabetes mellitus trial. J Am Geriatr Soc. 2013;61:912–22.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Gaesser GA, Angadi SS, Sawyer BJ. Exercise and diet, independent of weight loss, improve cardiometabolic risk profile in overweight and obese individuals. Phys Sports Med. 2011;39:87–97.CrossRefGoogle Scholar
  49. 49.
    AHA. Treating obesity as a disease. American Heart Association. 2014. Accessed April 21, 2014.
  50. 50.
    Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M. Prediabetes: a high-risk state for diabetes development. Lancet. 2012;379:2279–90.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343–50.PubMedCrossRefGoogle Scholar
  52. 52.
    Knowler WC, Barrett-Connor E, Flowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle interventions or metformin. N Engl J Med. 2002;346:393–403.PubMedCrossRefGoogle Scholar
  53. 53.
    Wing RR, Hamman RF, Bray GA, et al. Achieving weight and activity goals among diabetes prevention program lifestyle participants. Obes Res. 2004;12:1426–34.PubMedCrossRefGoogle Scholar
  54. 54.
    Crandall J, Schade D, Ma Y, et al. The influence of age on the effects of lifestyle modification and metformin in prevention of diabetes. J Gerontol: Med Sci. 2006;61A:1075–81.Google Scholar
  55. 55.
    Davis N, Ma Y, Delahanty LM, et al. Predictors of sustained reduction in energy and fat intake in the Diabetes Prevention Program Outcomes Study intensive lifestyle intervention. J Acad Nutr Diet. 2013;113:1455–64.PubMedCrossRefGoogle Scholar
  56. 56.
    Delahanty LM, Peyrot M, Shrader PJ, et al. Pretreatment, psychological, and behavioral predictors of weight outcomes among lifestyle intervention participants in the Diabetes Prevention Program (DPP). Diabetes Care. 2013;36:34–40.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Kowall B, Rathmann W, Heier M, et al. Impact of weight and weight change on normalization of prediabetes and on persistence of normal glucose tolerance in an older population: the KORA S4/F4 study. Int J Obes. 2012;36:826–33.CrossRefGoogle Scholar
  58. 58.
    Church TS, LaMonte MJ, Barlow CE, Blair SN. Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes. Arch Intern Med. 2005;165:2114–20.PubMedCrossRefGoogle Scholar
  59. 59.
    Jakicic JM, Jaramillo SA, Balasubramanyam A, et al. Effect of a lifestyle intervention on change in cardiorespiratory fitness in adults with type 2 diabetes: results from the Look AHEAD study. Int J Obes. 2009;33:305–16.CrossRefGoogle Scholar
  60. 60.
    Korytkowski MT. Lessons from the look action for health in diabetes study. Indian J Endocrinol Metab. 2013;17 suppl 3:S650–3.PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    Clark AL, Fonarow GC, Horwich TB. Obesity and the obesity paradox in heart failure. Prog Cardiovasc Dis. 2014;56:409–14.PubMedCrossRefGoogle Scholar
  62. 62.
    Atkins JL, Whincup PH, Morris RW, Lennon LT, Papacosta O, Wannamethee SG. Sarcopenic obesity and risk of cardiovascular disease and mortality: a population-based cohort study of older men. J Am Geriatr Soc. 2014;62:253–60.Google Scholar
  63. 63.
    Brown CJ, Flood KL. Mobility limitation in the older patient. A clinical review. JAMA. 2013;310:1168–77.PubMedCrossRefGoogle Scholar
  64. 64.
    Bouchonville MF, Villareal DT. Sarcopenic obesity: how do we treat it? Curr Opin Endocrinol Diabetes Obes. 2013;20:412–9.PubMedCrossRefGoogle Scholar
  65. 65.
    Pahor M, Guralnik JM, Ambrosius WT, et al. Effect of structured physical activity on prevention of major mobility disability in older adults. The LIFE study randomized clinical trial. JAMA. 2014;311:2387–96.Google Scholar
  66. 66.
    Delahanty LM. The Look AHEAD study: implications for clinical practice go beyond the headlines. J Acad Nutr Diet. 2014;114:537–42.PubMedCrossRefGoogle Scholar
  67. 67.
    Florez H, Pan Q, Ackerman RT, et al. Impact of lifestyle intervention and metformin on health-related quality of life: the Diabetes Prevention Program randomized trial. J Gen Intern Med. 2012;27:1594–601.PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    Ali MK, Echouffo-Tcheugui JB, Williamson DF. How effective were lifestyle interventions in real-world settings that were modeled on the Diabetes Prevention Program? Health Aff. 2012;31:67–75.CrossRefGoogle Scholar
  69. 69.
    Harwell TS, Vanderwood KK, Hall TO, Butcher MK, Helgerson SD. The Montana Cardiovascular Disease and Diabetes Prevention Workgroup. Factors associated with achieving a weight loss goal among participants in an adapted Diabetes Prevention Program. Prim Care Diabetes. 2011;5:125–9.PubMedCrossRefGoogle Scholar
  70. 70.
    West DS, Bursac Z, Cornell CE, et al. Lay health educators translate a weight-loss intervention in senior centers: a randomized controlled trial. Am J Prev Med. 2011;41:385–91.PubMedCrossRefGoogle Scholar
  71. 71.
    Johnson JA, McIlroy WE, Papaioannou A, Thabane L, Giangregorio L. Feasibility study of walking for exercise in individuals living in assisted living settings. J Geriatr Phys Ther. 2013;36:175–81.PubMedCrossRefGoogle Scholar
  72. 72.
    National Council on Aging. Center for aging. Enhance fitness. Accessed April 25, 2014.
  73. 73.
    Healthy Aging Regional Collaborative. Accessed April 25, 2014.
  74. 74.
    MOVE! Weight Management Program. Accessed April 25, 2014.
  75. 75.
    Rejeski WJ, Ip EH, Bertoni AG, et al. Lifestyle change and mobility in obese adults with type 2 diabetes. NEJM. 2012;366:1209–17.PubMedCrossRefPubMedCentralGoogle Scholar
  76. 76.
    Villareal DT, Banks M, Siener C, Sinacore DR, Klein S. Physical frailty and body composition in obese elderly men and women. Obes Res. 2004;12:913–20.PubMedCrossRefGoogle Scholar
  77. 77.
    Waters DL, Ward AL, Villareal DT. Weight loss in obese adults 65 years and older: a review of the controversy. Exp Gerontol. 2013;48:1054–61.PubMedCrossRefGoogle Scholar
  78. 78.
    Blüher S, Markert J, Hergert S, et al. Who should we target for diabetes prevention and diabetes risk reduction? Curr Diabetes Rep. 2012;12:147–56.CrossRefGoogle Scholar
  79. 79.
    Basu S, Seligman H, Winkleby M. A metabolic-epidemiological microsimulation model to estimate the changes in energy intake and physical activity necessary to meet the Health People 2020 obesity objective. Am J Public Health. 2014;104:1209–16.PubMedCrossRefPubMedCentralGoogle Scholar
  80. 80.
    Avenell A, Broom J, Brown TJ, et al. A systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technol Assess. 2004;8:1–182.Google Scholar
  81. 81.
    Herman WH, Edelstein SL, Ratner R, et al. Effectiveness and cost-effectiveness of diabetes prevention among adherent participants. Am J Manag Care. 2013;19:194–202.PubMedPubMedCentralGoogle Scholar
  82. 82.
    Krukowski RA, Lensing S, Love S, et al. Training of lay health educators to implement an evidence-based behavioral weight loss intervention in rural senior centers. The Gerontologist. 2012;53:162–71.PubMedCrossRefGoogle Scholar
  83. 83.
    Krukowski RA, Pope RA, Love S, et al. Examination of costs for a lay health educator-delivered translation of the Diabetes Prevention Program in senior centers. Prev Med. 2013;57:400–2.PubMedCrossRefGoogle Scholar
  84. 84.
    Prohaska T, Belansky E, Belza B, et al. Physical activity, public health, and aging: critical issues and research priorities. J Gerontol: Soc Sci. 2006;61:S267–73.CrossRefGoogle Scholar
  85. 85.
    Barnes PM, Schoenborn CA. Physical activity among adults: United States, 2000: advance data from vital and health statistics. CDC Natl Cent Health Stat. 2003;333:15.Google Scholar
  86. 86.
    Wang F, McDonald T, Reffitt B, Edington DW. BMI, physical activity, and health care utilization/costs among medicare retirees. Obes Res. 2005;13:1450–7.PubMedCrossRefGoogle Scholar
  87. 87.
    Biedenweg K, Meischke H, Bohl A, et al. Understanding older adults’ motivators and barriers to participating in organized programs supporting exercise behaviors. J Prim Prev. 2014;35:1–11.PubMedCrossRefGoogle Scholar
  88. 88.
    Michael YL, Nagel CL, Gold R, Hillier TA. Does change in the neighborhood environment prevent obesity in older women? Soc Sci Med. 2014;102:129–37.PubMedCrossRefGoogle Scholar
  89. 89.
    Chrysant SG, Chrysant GS. New insights into the true nature of the obesity paradox and the lower cardiovascular risk. J Am Soc Hypertens. 2013;7:85–94.PubMedCrossRefGoogle Scholar
  90. 90.
    Swift DL, Johannsen NM, Lavie CJ, Earnest CP, Church TS. The role of exercise and physical activity in weight loss and maintenance. Prog Cardiovasc Dis. 2014;56:441–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York (outside the USA) 2014

Authors and Affiliations

  • Willy Marcos Valencia
    • 1
    • 2
    Email author
  • Mark Stoutenberg
    • 2
  • Hermes Florez
    • 1
    • 2
    • 3
  1. 1.Geriatrics Research, Education and Clinical Center (GRECC)Miami VA Healthcare SystemMiamiUSA
  2. 2.Department of Public Health SciencesUniversity of Miami Miller School of MedicineMiamiUSA
  3. 3.Department of Medicine – Division of Geriatric Medicine and EndocrinologyUniversity of Miami Miller School of MedicineMiamiUSA

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