Weight Loss and Physical Activity for Disease Prevention in Obese Older Adults: an Important Role for Lifestyle Management
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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.
KeywordsObese 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.WHO 10 facts on obesity. World Health Organization 2013. http://www.who.int/features/factfiles/obesity/en/. Accessed 25 Apr 2014.
- 2.CDC Overweight and obesity facts. Centers for Disease Control and Prevention. 2014. http://www.cdc.gov/obesity/data/adult.html. Accessed 21 April 2014.
- 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
- 5.AMA News Room. AMA Adopts new policies on second day of voting at annual meeting. Obesity as a disease. American Medical Association 2013. http://www.ama-assn.org/ama/pub/news/news/2013/2013-06-18-new-ama-policies-annual-meeting.page. Accessed 21 Apr 2014
- 6.WHO Global strategy on diet, physical activity and health. Obesity and Overweight Facts. World Health Organization. 2003. http://www.who.int/dietphysicalactivity/media/en/gsfs_obesity.pdf. Accessed April 21, 2014.
- 7.TOS Obesity, bias and stigmatization. The Obesity Society 2014. http://www.obesity.org/resources-for/obesity-bias-and-stigmatization.htm. Accessed May 5, 2014.
- 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.AHA FACTS with a very heavy heart. Obesity and cardiovascular disease (CVD). American Heart Association 2013. http://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_305059.pdf. Accessed 21 Apr 2014.
- 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
- 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
- 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
- 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
- 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
- 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
- 49.AHA. Treating obesity as a disease. American Heart Association. 2014. https://www.heart.org/HEARTORG/GettingHealthy/WeightManagement/Obesity/Treating-Obesity-as-a-Disease_UCM_459557_Article.jsp. Accessed April 21, 2014.
- 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
- 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
- 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
- 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
- 72.National Council on Aging. Center for aging. Enhance fitness. http://www.ncoa.org/improve-health/center-for-healthy-aging/enhance-fi.html. Accessed April 25, 2014.
- 73.Healthy Aging Regional Collaborative. http://www.healthyagingsf.org/. Accessed April 25, 2014.
- 74.MOVE! Weight Management Program. http://www.move.va.gov/. Accessed April 25, 2014.
- 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
- 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