Advertisement

Current Diabetes Reports

, 19:114 | Cite as

Benefit-to-Risk Balance of Weight Loss Interventions in Older Adults with Obesity

  • Peter R. DiMilia
  • Alexander C. Mittman
  • John A. BatsisEmail author
Obesity (KM Gadde, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Obesity

Abstract

Purpose of Review

Obesity in the older adult is a burgeoning health epidemic that leads to increased morbidity, disability, and institutionalization. This review presents a brief overview of geriatric-specific consequences of obesity by highlighting the risks and benefits of intentional weight loss.

Recent Findings

Intentional weight loss reduces the extent of adiposity-related illnesses, yet the approach in older adults is fraught with challenges. Interventions combining caloric restriction and physical exercise (aerobic and resistance) maximize fat loss and minimize loss of muscle and bone. Interventions are also effective at improving physical function, reducing medication burden, and improving symptomatic osteoarthritis in this population. Approaches can mitigate the risks of isolated caloric restriction on muscle and bone in a safe and effective manner.

Summary

Effective weight loss strategies should be considered in older adults. While there are potential risks, practical clinical approaches can minimize the potential harms while maximizing their benefits.

Keywords

Obesity Older adults Benefits Risks 

Abbreviations

BMD

Bone mineral density

BMI

Body mass index

CMS

Center for Medicare and Medicaid

HR

Hazard ratio

Notes

Funding Information

Dr. Batsis receives funding from the National Institute on Aging of the National Institutes of Health under Award Number K23AG051681 and from the Friends of the Norris Cotton Cancer Center at Dartmouth and National Cancer Institute Cancer Center Support Grant 5P30 CA023108-37 Developmental Funds. Dr. Batsis also receives funding from the Patient Centered Oriented Research Institute. Support was also provided by the Department of Medicine and the Dartmouth Health Promotion and Disease Prevention Research Center supported by Cooperative Agreement Number U48DP005018 from the Centers for Disease Control and Prevention. The Dartmouth Clinical and Translational Science Institute, under award number UL1TR001086 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH), and by the National Institute for Drug Abuse P30DA029926.

Compliance with Ethical Standards

Conflict of Interest

Peter R. DiMilia and Alexander Mittman declare that they have no conflict of interest.

John A. Batsis received honoraria from the Royal College of Physicians of Ireland, Endocrine Society, and Dinse, Knapp, McAndrew LLC, legal firm. In addition, Dr. Batsis has a patent issued on Instrumented Resistance Exercise Device.

Human and Animal Rights and Informed Consent

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

References

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

  1. 1.
    Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005;293:1861–7.CrossRefGoogle Scholar
  2. 2.
    Lubitz J, Cai L, Kramarow E, Lentzner H. Health, life expectancy, and health care spending among the elderly. N Engl J Med. 2003;349:1048–55.CrossRefGoogle Scholar
  3. 3.
    West L, Cole S, Goodkind D, He W. US Census Bureau: 65+ in the United States: 2010. Washington, DC: US Department of Health and Human Services: National Institutes of Health; 2014.Google Scholar
  4. 4.
    Facts for Features: Older Americans Month: May 2017. In: Bureau USC (ed.). Census Bureau: Washington, DC 2019.Google Scholar
  5. 5.
    Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N Engl J Med. 2007;356:2388–98.CrossRefGoogle Scholar
  6. 6.
    Ganguli I, Souza J, McWilliams JM, Mehrotra A. Trends in use of the US Medicare annual wellness visit, 2011-2014. JAMA. 2017;317:2233–5.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Batsis JA, Bynum JP. Uptake of the centers for Medicare and Medicaid obesity benefit: 2012-2013. Obesity (Silver Spring). 2016;24:1983–8.CrossRefGoogle Scholar
  8. 8.
    Basu S, Phillips RS, Bitton A, Song Z, Landon BE. Medicare chronic care management payments and financial returns to primary care practices: a modeling study. Ann Intern Med. 2015;163:580–8.CrossRefGoogle Scholar
  9. 9.
    • Hales CM, Fryar CD, Carroll MD, Freedman DS, Ogden CL. Trends in obesity and severe obesity prevalence in US youth and adults by sex and age, 2007–2008 to 2015–2016. JAMA. 2018;319:1723–5 Most recent prevalence rates of obesity within the USA demonstrating rising trends. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010;303:235–41.CrossRefGoogle Scholar
  11. 11.
    Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006;295:1549–55.CrossRefGoogle Scholar
  12. 12.
    Sayer AA, Syddall H, Martin H, Patel H, Baylis D, Cooper C. The developmental origins of sarcopenia. J Nutr Health Aging. 2008;12:427–32.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Yeap BB. Are declining testosterone levels a major risk factor for ill-health in aging men? Int J Impot Res. 2009;21:24–36.CrossRefGoogle Scholar
  14. 14.
    Meyer HE, Tverdal A, Selmer R. Weight variability, weight change and the incidence of hip fracture: a prospective study of 39,000 middle-aged Norwegians. Osteoporos Int. 1998;8:373–8.CrossRefGoogle Scholar
  15. 15.
    Fontenelle LC, Feitosa MM, Severo JS, Freitas TE, Morais JB, Torres-Leal FL, et al. Thyroid function in human obesity: underlying mechanisms. Horm Metab Res. 2016;48:787–94.CrossRefGoogle Scholar
  16. 16.
    Conley KE, Esselman PC, Jubrias SA, Cress ME, Inglin B, Mogadam C, et al. Ageing, muscle properties and maximal O(2) uptake rate in humans. J Physiol. 2000;526(Pt 1):211–7.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Conley KE, Jubrias SA, Esselman PC. Oxidative capacity and ageing in human muscle. J Physiol. 2000;526(Pt 1):203–10.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Bauer J, Biolo G, Cederholm T, Cesari M, Cruz-Jentoft AJ, Morley JE, et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc. 2013;14:542–59.CrossRefGoogle Scholar
  19. 19.
    Kuk JL, Saunders TJ, Davidson LE, Ross R. Age-related changes in total and regional fat distribution. Ageing Res Rev. 2009;8:339–48.CrossRefGoogle Scholar
  20. 20.
    Noppa H, Andersson M, Bengtsson C, Bruce A, Isaksson B. Longitudinal studies of anthropometric data and body composition. The population study of women in Gotenberg, Sweden. Am J Clin Nutr. 1980;33:155–62.CrossRefGoogle Scholar
  21. 21.
    Katzman W, Cawthon P, Hicks GE, Vittinghoff E, Shepherd J, Cauley JA, et al. Association of spinal muscle composition and prevalence of hyperkyphosis in healthy community-dwelling older men and women. J Gerontol A Biol Sci Med Sci. 2012;67:191–5.CrossRefGoogle Scholar
  22. 22.
    Demontiero O, Vidal C, Duque G. Aging and bone loss: new insights for the clinician. Ther Adv Musculoskelet Dis. 2012;4:61–76.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Cheng FW, Gao X, Mitchell DC, Wood C, Still CD, Rolston D, et al. Body mass index and all-cause mortality among older adults. Obesity (Silver Spring). 2016;24:2232–9.CrossRefGoogle Scholar
  24. 24.
    Padwal R, Leslie WD, Lix LM, Majumdar SR. Relationship among body fat percentage, body mass index, and all-cause mortality: a cohort study. Ann Intern Med. 2016;164:532–41.CrossRefGoogle Scholar
  25. 25.
    Batsis JA, Mackenzie TA, Bartels SJ, Sahakyan KR, Somers VK, Lopez-Jimenez F. Diagnostic accuracy of body mass index to identify obesity in older adults: NHANES 1999-2004. Int J Obes. 2016;40:761–7.CrossRefGoogle Scholar
  26. 26.
    Alley DE, Chang VW. The changing relationship of obesity and disability, 1988-2004. JAMA. 2007;298:2020–7.CrossRefGoogle Scholar
  27. 27.
    Rosemann T, Grol R, Herman K, Wensing M, Szecsenyi J. Association between obesity, quality of life, physical activity and health service utilization in primary care patients with osteoarthritis. Int J Behav Nutr Phys Act. 2008;5:4.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Elkins JS, Whitmer RA, Sidney S, Sorel M, Yaffe K, Johnston SC. Midlife obesity and long-term risk of nursing home admission. Obesity (Silver Spring). 2006;14:1472–8.CrossRefGoogle Scholar
  29. 29.
    Zizza CA, Herring A, Stevens J, Popkin BM. Obesity affects nursing-care facility admission among whites but not blacks. Obes Res. 2002;10:816–23.CrossRefGoogle Scholar
  30. 30.
    Stenholm S, Head J, Aalto V, Kivimaki M, Kawachi I, Zins M, et al. Body mass index as a predictor of healthy and disease-free life expectancy between ages 50 and 75: a multicohort study. Int J Obes. 2017;41:769–75.CrossRefGoogle Scholar
  31. 31.
    Gregg EW, Cheng YJ, Cadwell BL, Imperatore G, Williams DE, Flegal KM, et al. Secular trends in cardiovascular disease risk factors according to body mass index in US adults. JAMA. 2005;293:1868–74.CrossRefGoogle Scholar
  32. 32.
    Jehan S, Zizi F, Pandi-Perumal SR, Wall S, Auguste E, Myers AK, et al. Obstructive Sleep Apnea and Obesity: Implications for Public Health. Sleep Med Disord. 2017;1(4). pii: 00019.Google Scholar
  33. 33.
    Felson DT, Anderson JJ, Naimark A, Walker AM, Meenan RF. Obesity and knee osteoarthritis. The Framingham Study. Ann Intern Med. 1988;109:18–24.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Basen-Engquist K, Chang M. Obesity and cancer risk: recent review and evidence. Curr Oncol Rep. 2011;13:71–6.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Deckers. Obesity and cognitive decline in adults. J Nutr Health Aging. 2016.Google Scholar
  36. 36.
    Knudtson MD, Klein BE, Klein R, Shankar A. Associations with weight loss and subsequent mortality risk. Ann Epidemiol. 2005;15:483–91.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Blaum CS, Xue QL, Michelon E, Semba RD, Fried LP. The association between obesity and the frailty syndrome in older women: the Women’s Health and Aging Studies. J Am Geriatr Soc. 2005;53:927–34.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Batsis JA, Mackenzie TA, Lopez-Jimenez F, Bartels SJ. Sarcopenia, sarcopenic obesity, and functional impairments in older adults: National Health and Nutrition Examination Surveys 1999-2004. Nutr Res. 2015;35:1031–9.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    •• Batsis JA, Gill LE, Masutani RK, Adachi-Mejia AM, Blunt HB, Bagley PJ, et al. Weight loss interventions in older adults with obesity: a systematic review of randomized controlled trials since 2005. J Am Geriatr Soc. 2017;65:257–68 A systematic review of randomized trials in older adults with obesity that demonstrates the importance of improved physical function after diet and exercise.CrossRefGoogle Scholar
  40. 40.
    Mei KL, Batsis JA, Mills JB, Holubar SD. Sarcopenia and sarcopenic obesity: do they predict inferior oncologic outcomes after gastrointestinal cancer surgery? Perioper Med (Lond). 2016;5:30.CrossRefGoogle Scholar
  41. 41.
    Baumgartner RN, Wayne SJ, Waters DL, Janssen I, Gallagher D, Morley JE. Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly. Obes Res. 2004;12:1995–2004.CrossRefGoogle Scholar
  42. 42.
    Studenski SA, Peters KW, Alley DE, Cawthon PM, McLean RR, Harris TB, et al. The FNIH sarcopenia project: rationale, study description, conference recommendations, and final estimates. J Gerontol A Biol Sci Med Sci. 2014;69:547–58.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Cawthon PM, Travison TG, Manini TM, Patel S, Pencina KM, Fielding RA, et al. Establishing the link between lean mass and grip strength cut-points with mobility disability and other health outcomes: proceedings of the sarcopenia definition and outcomes consortium conference. J Gerontol A Biol Sci Med Sci. 2019.  https://doi.org/10.1093/gerona/glz081.
  44. 44.
    Batsis JA, Barre LK, Mackenzie TA, Pratt SI, Lopez-Jimenez F, Bartels SJ. Variation in the prevalence of sarcopenia and sarcopenic obesity in older adults associated with different research definitions: dual-energy X-ray absorptiometry data from the National Health and Nutrition Examination Survey 1999-2004. J Am Geriatr Soc. 2013;61:974–80.CrossRefGoogle Scholar
  45. 45.
    Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16–31.  https://doi.org/10.1093/ageing/afy169.
  46. 46.
    •• Batsis JA, Villareal DT. Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies. Nat Rev Endocrinol. 2018;14:513–37 A recent review article outlining the underlying pathophysiology and treatment strategies in older adults with sarcopenic obesity. CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Bosch X, Monclús E, Escoda O, Guerra-García M, Moreno P, Guasch N, et al. Unintentional weight loss: clinical characteristics and outcomes in a prospective cohort of 2677 patients. PLoS One. 2017;12:e0175125.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Kim M, Kim J, Won CW. Association between involuntary weight loss with low muscle mass and health-related quality of life in community-dwelling older adults: nationwide surveys (KNHANES 2008–2011). Exp Gerontol. 2018;106:39–45.CrossRefGoogle Scholar
  49. 49.
    Gaddey HL, Holder K. Unintentional weight loss in older adults. Am Fam Physician. 2014;89:718–22.PubMedGoogle Scholar
  50. 50.
    Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, et al. The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999;15:116–22.CrossRefGoogle Scholar
  51. 51.
    Huffman GB. Evaluating and treating unintentional weight loss in the elderly. Am Fam Physician. 2002;65:640–50.PubMedGoogle Scholar
  52. 52.
    Gruberg L, Weissman NJ, Waksman R, Fuchs S, Deible R, Pinnow EE, 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.CrossRefGoogle Scholar
  53. 53.
    Banack HR, Kaufman JS. Does selection bias explain the obesity paradox among individuals with cardiovascular disease? Ann Epidemiol. 2015;25:342–9.CrossRefGoogle Scholar
  54. 54.
    Brida M, Dimopoulos K, Kempny A, Liodakis E, Alonso-Gonzalez R, Swan L, et al. Body mass index in adult congenital heart disease. Heart. 2017;103:1250–7.CrossRefGoogle Scholar
  55. 55.
    Flegal KM, Graubard BI, Williamson DF, Cooper RS. Reverse causation and illness-related weight loss in observational studies of body weight and mortality. Am J Epidemiol. 2011;173:1–9.CrossRefGoogle Scholar
  56. 56.
    Pocock SJ, McMurray JJ, Dobson J, Yusuf S, Granger CB, Michelson EL, et al. Weight loss and mortality risk in patients with chronic heart failure in the candesartan in heart failure: assessment of reduction in mortality and morbidity (CHARM) programme. Eur Heart J. 2008;29:2641–50.CrossRefGoogle Scholar
  57. 57.
    Flegal KM, Ioannidis JPA. The obesity paradox: a misleading term that should be abandoned. Obesity (Silver Spring). 2018;26:629–30.CrossRefGoogle Scholar
  58. 58.
    Park SY, Wilkens LR, Maskarinec G, Haiman CA, Kolonel LN, Marchand LL. Weight change in older adults and mortality: the multiethnic cohort study. Int J Obes. 2018;42:205–12.CrossRefGoogle Scholar
  59. 59.
    Darmon P. Intentional weight loss in older adults: useful or wasting disease generating strategy? Curr Opin Clin Nutr Metab Care. 2013;16:284–9.CrossRefGoogle Scholar
  60. 60.
    Wannamethee SG, Shaper AG, Lennon L. Reasons for intentional weight loss, unintentional weight loss, and mortality in older men. Arch Intern Med. 2005;165:1035–40.CrossRefGoogle Scholar
  61. 61.
    Wannamethee SG, Shaper AG, Whincup PH, Walker M. Characteristics of older men who lose weight intentionally or unintentionally. Am J Epidemiol. 2000;151:667–75.CrossRefGoogle Scholar
  62. 62.
    Wang S, Ren J. Obesity paradox in aging: from prevalence to pathophysiology. Prog Cardiovasc Dis. 2018;61:182–9.CrossRefGoogle Scholar
  63. 63.
    •• Khan SS, Ning H, Wilkins JT, Allen N, Carnethon M, Berry JD, et al. Association of body mass index with lifetime risk of cardiovascular disease and compression of morbidity. JAMA Cardiol. 2018;3:280–7 This report aggregates ten cardiovascular studies providing data that disproves the obesity paradox. CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Felix HC, West DS. Effectiveness of weight loss interventions for obese older adults. Am J Health Promot. 2013;27:191–9.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Schutzer KA, Graves BS. Barriers and motivations to exercise in older adults. Prev Med. 2004;39:1056–61.CrossRefGoogle Scholar
  66. 66.
    Guralnik JM, LaCroix AZ, Branch LG, Kasl SV, Wallace RB. Morbidity and disability in older persons in the years prior to death. Am J Public Health. 1991;81:443–7.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Jette AM, Branch LG. Impairment and disability in the aged. J Chronic Dis. 1985;38:59–65.CrossRefGoogle Scholar
  68. 68.
    Haywood C, Sumithran P. Treatment of obesity in older persons—a systematic review. Obes Rev. 2019;20:588–98.CrossRefGoogle Scholar
  69. 69.
    •• Villareal DT, Aguirre L, Gurney AB, Waters DL, Sinacore DR, Colombo E, et al. Aerobic or resistance exercise, or both in dieting obese older adults. N Engl J Med. 2017;376:1943–55 A 1-year multicomponent caloric restriction and exercise trial of frail older adults with obesity demonstrating the synergistic improvements in physical function after weight loss and exercise. CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    • Kritchevsky SB, Beavers KM, Miller ME, Shea MK, Houston DK, Kitzman DW, et al. Intentional weight loss and all-cause mortality: a meta-analysis of randomized clinical trials. PLoS One. 2015;10:e0121993 A meta-analysis evaluating randomized trials of weight loss interventions in older adults on risk of future death. CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Johnson KC, Bray GA, Cheskin LJ, Clark JM, Egan CM, Foreyt JP, et al. The effect of intentional weight loss on fracture risk in persons with diabetes: results from the Look AHEAD randomized clinical trial. J Bone Miner Res. 2017;32:2278–87.CrossRefPubMedPubMedCentralGoogle Scholar
  72. 72.
    Villareal DT, Chode S, Parimi N, Sinacore DR, Hilton T, Armamento-Villareal R, et al. Weight loss, exercise, or both and physical function in obese older adults. N Engl J Med. 2011;364:1218–29.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    • Rejeski WJ, Ambrosius WT, Burdette JH, Walkup MP, Marsh AP. Community weight loss to combat obesity and disability in at-risk older adults. J Gerontol A Biol Sci Med Sci. 2017;72:1547–53 An 18-month, community-based, randomized trial of older adults at a YMCA that demonstrated weight loss and enhanced improvements in mobility when dietary weight-loss is coupled with resistance or aerobic training. PubMedPubMedCentralGoogle Scholar
  74. 74.
    Messier SP, Mihalko SL, Legault C, Miller GD, Nicklas BJ, DeVita P, et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA. 2013;310:1263–73.CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Nicklas BJ, Brinkley TE, Houston DK, Lyles MF, Hugenschmidt CE, Beavers KM, et al. Effects of caloric restriction on cardiorespiratory fitness, fatigue, and disability responses to aerobic exercise in older adults with obesity: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2019;74:1084–1090.Google Scholar
  76. 76.
    • Ard JD, Gower B, Hunter G, Ritchie CS, Roth DL, Goss A, et al. Effects of calorie restriction in obese older adults: the CROSSROADS randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2017;73(1):73–80.  https://doi.org/10.1093/gerona/glw237 A 52-week randomized trial of older adults with obesity that demonstated reductions in overall fat and cardiovascular risk factors without significantly more adverse events. CrossRefPubMedGoogle Scholar
  77. 77.
    Look ARG. Eight-year weight losses with an intensive lifestyle intervention: the look AHEAD study. Obesity (Silver Spring). 2014;22:5–13.CrossRefGoogle Scholar
  78. 78.
    Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393–403.CrossRefGoogle Scholar
  79. 79.
    So ES. The impacts of weight change and weight change intention on health-related quality of life in the Korean elderly. J Aging Health. 2018.  https://doi.org/10.1177/0898264318761908.
  80. 80.
    Napoli N, Shah K, Waters DL, Sinacore DR, Qualls C, Villareal DT. Effect of weight loss, exercise, or both on cognition and quality of life in obese older adults. Am J Clin Nutr. 2014;100:189–98.CrossRefPubMedPubMedCentralGoogle Scholar
  81. 81.
    Bosy-Westphal A, Kossel E, Goele K, Later W, Hitze B, Settler U, et al. Contribution of individual organ mass loss to weight loss-associated decline in resting energy expenditure. Am J Clin Nutr. 2009;90:993–1001.CrossRefPubMedPubMedCentralGoogle Scholar
  82. 82.
    Coutinho T, Goel K, Correa de Sa D, Carter RE, Hodge DO, Kragelund C, et al. Combining body mass index with measures of central obesity in the assessment of mortality in subjects with coronary disease: role of “normal weight central obesity”. J Am Coll Cardiol. 2013;61:553–60.CrossRefGoogle Scholar
  83. 83.
    Groessl EJ, Kaplan RM, Rejeski WJ, Katula JA, King AC, Frierson G, et al. Health-related quality of life in older adults at risk for disability. Am J Prev Med. 2007;33:214–8.CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Sao Romao Preto L, Dias Conceicao MDC, Figueiredo TM, Pereira Mata MA, Barreira Preto PM, Mateo Aguilar E. Frailty, body composition and nutritional status in non-institutionalised elderly. Enferm Clin. 2017;27:339–45.CrossRefGoogle Scholar
  85. 85.
    •• Li R, Xia J, Zhang XI, Gathirua-Mwangi WG, Guo J, Li Y, et al. Associations of muscle mass and strength with all-cause mortality among US older adults. Med Sci Sports Exerc. 2018;50:458–67 Using epidemiologic data, these authors applied the recent cutoffs for sarcopenia and found that strength was more predictive of mortality than muscle mass. CrossRefPubMedPubMedCentralGoogle Scholar
  86. 86.
    Welch C, Hassan-Smith ZK, Greig CA, Lord JM, Jackson TA. Acute sarcopenia secondary to hospitalisation - an emerging condition affecting older adults. Aging Dis. 2018;9:151–64.CrossRefPubMedPubMedCentralGoogle Scholar
  87. 87.
    English KL, Paddon-Jones D. Protecting muscle mass and function in older adults during bed rest. Curr Opin Clin Nutr Metab Care. 2010;13:34–9.CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    Zibellini J, Seimon RV, Lee CM, Gibson AA, Hsu MS, Sainsbury A. Effect of diet-induced weight loss on muscle strength in adults with overweight or obesity - a systematic review and meta-analysis of clinical trials. Obes Rev. 2016;17:647–63.CrossRefGoogle Scholar
  89. 89.
    Weinheimer EM, Sands LP, Campbell WW. A systematic review of the separate and combined effects of energy restriction and exercise on fat-free mass in middle-aged and older adults: implications for sarcopenic obesity. Nutr Rev. 2010;68:375–88.CrossRefGoogle Scholar
  90. 90.
    Weiss EP, Jordan RC, Frese EM, Albert SG, Villareal DT. Effects of weight loss on lean mass, strength, bone, and aerobic capacity. Med Sci Sports Exerc. 2017;49:206–17.CrossRefPubMedPubMedCentralGoogle Scholar
  91. 91.
    Gallagher D, Kelley DE, Thornton J, Boxt L, Pi-Sunyer X, Lipkin E, et al. Changes in skeletal muscle and organ size after a weight-loss intervention in overweight and obese type 2 diabetic patients. Am J Clin Nutr. 2017;105:78–84.CrossRefGoogle Scholar
  92. 92.
    Weiss EP, Albert SG, Reeds DN, Kress KS, Ezekiel UR, McDaniel JL, et al. Calorie restriction and matched weight loss from exercise: independent and additive effects on glucoregulation and the incretin system in overweight women and men. Diabetes Care. 2015;38:1253–62.CrossRefPubMedPubMedCentralGoogle Scholar
  93. 93.
    Weiss EP, Racette SB, Villareal DT, Fontana L, Steger-May K, Schechtman KB, et al. Lower extremity muscle size and strength and aerobic capacity decrease with caloric restriction but not with exercise-induced weight loss. J Appl Physiol (1985). 2007;102:634–40.CrossRefGoogle Scholar
  94. 94.
    Frimel TN, Sinacore DR, Villareal DT. Exercise attenuates the weight-loss-induced reduction in muscle mass in frail obese older adults. Med Sci Sports Exerc. 2008;40:1213–9.CrossRefPubMedPubMedCentralGoogle Scholar
  95. 95.
    Chomentowski P, Dube JJ, Amati F, Stefanovic-Racic M, Zhu S, Toledo FG, et al. Moderate exercise attenuates the loss of skeletal muscle mass that occurs with intentional caloric restriction-induced weight loss in older, overweight to obese adults. J Gerontol A Biol Sci Med Sci. 2009;64:575–80.CrossRefGoogle Scholar
  96. 96.
    Wang X, Miller GD, Messier SP, Nicklas BJ. Knee strength maintained despite loss of lean body mass during weight loss in older obese adults with knee osteoarthritis. J Gerontol A Biol Sci Med Sci. 2007;62:866–71.CrossRefGoogle Scholar
  97. 97.
    Nicklas BJ, Chmelo E, Delbono O, Carr JJ, Lyles MF, Marsh AP. Effects of resistance training with and without caloric restriction on physical function and mobility in overweight and obese older adults: a randomized controlled trial. Am J Clin Nutr. 2015;101:991–9.CrossRefPubMedPubMedCentralGoogle Scholar
  98. 98.
    Schaap LA, Koster A, Visser M. Adiposity, muscle mass, and muscle strength in relation to functional decline in older persons. Epidemiol Rev. 2013;35:51–65.CrossRefGoogle Scholar
  99. 99.
    Cooper R, Kuh D, Cooper C, Gale CR, Lawlor DA, Matthews F, et al. Objective measures of physical capability and subsequent health: a systematic review. Age Ageing. 2011;40:14–23.CrossRefPubMedPubMedCentralGoogle Scholar
  100. 100.
    Li R, Xia J, Zhang XI, Gathirua-Mwangi WG, Guo J, Li Y, et al. Associations of muscle mass and strength with all-cause mortality among US older adults. Med Sci Sports Exerc. 2018;50:458–67.CrossRefPubMedPubMedCentralGoogle Scholar
  101. 101.
    Shapses SA, Riedt CS. Bone, body weight, and weight reduction: what are the concerns? J Nutr. 2006;136:1453–6.CrossRefPubMedPubMedCentralGoogle Scholar
  102. 102.
    Ensrud KE, Fullman RL, Barrett-Connor E, Cauley JA, Stefanick ML, Fink HA, et al. Voluntary weight reduction in older men increases hip bone loss: the osteoporotic fractures in men study. J Clin Endocrinol Metab. 2005;90:1998–2004.CrossRefGoogle Scholar
  103. 103.
    Ensrud KE, Ewing SK, Stone KL, Cauley JA, Bowman PJ, Cummings SR, et al. Intentional and unintentional weight loss increase bone loss and hip fracture risk in older women. J Am Geriatr Soc. 2003;51:1740–7.CrossRefGoogle Scholar
  104. 104.
    Langlois JA, Mussolino ME, Visser M, Looker AC, Harris T, Madans J. Weight loss from maximum body weight among middle-aged and older white women and the risk of hip fracture: the NHANES I epidemiologic follow-up study. Osteoporos Int. 2001;12:763–8.CrossRefGoogle Scholar
  105. 105.
    Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17:1726–33.CrossRefGoogle Scholar
  106. 106.
    Sanchez-Riera L, Wilson N. Fragility fractures & their impact on older people. Best Pract Res Clin Rheumatol. 2017;31:169–91.CrossRefGoogle Scholar
  107. 107.
    Bertram M, Norman R, Kemp L, Vos T. Review of the long-term disability associated with hip fractures. Inj Prev. 2011;17:365–70.CrossRefGoogle Scholar
  108. 108.
    Sernbo I, Johnell O. Consequences of a hip fracture: a prospective study over 1 year. Osteoporos Int. 1993;3:148–53.CrossRefGoogle Scholar
  109. 109.
    Zibellini J, Seimon RV, Lee CM, Gibson AA, Hsu MS, Shapses SA, et al. Does diet-induced weight loss Lead to bone loss in overweight or obese adults? A systematic review and meta-analysis of clinical trials. J Bone Miner Res. 2015;30:2168–78.CrossRefGoogle Scholar
  110. 110.
    Soltani S, Hunter GR, Kazemi A, Shab-Bidar S. The effects of weight loss approaches on bone mineral density in adults: a systematic review and meta-analysis of randomized controlled trials. Osteoporos Int. 2016;27:2655–71.CrossRefGoogle Scholar
  111. 111.
    Batsis JA, Miranda WR, Prasad C, Collazo-Clavell ML, Sarr MG, Somers VK, et al. Effect of bariatric surgery on cardiometabolic risk in elderly patients: a population-based study. Geriatr Gerontol Int. 2016;16:618–24.CrossRefGoogle Scholar
  112. 112.
    Ko BJ, Myung SK, Cho KH, Park YG, Kim SG, Kim do H, et al. Relationship between bariatric surgery and bone mineral density: a meta-analysis. Obes Surg. 2016;26:1414–21.CrossRefGoogle Scholar
  113. 113.
    Gagnon C, Schafer AL. Bone health after bariatric surgery. JBMR plus. 2018;2:121–33.CrossRefPubMedPubMedCentralGoogle Scholar
  114. 114.
    Ensrud KE, Ewing SK, Stone KL, Cauley JA, Bowman PJ, Cummings SR, et al. Intentional and unintentional weight loss increase bone loss and hip fracture risk in older women. J Am Geriatr Soc. 2003;51:1740–7.CrossRefGoogle Scholar
  115. 115.
    Tirosh A, de Souza RJ, Sacks F, Bray GA, Smith SR, LeBoff MS. Sex differences in the effects of weight loss diets on bone mineral density and body composition: POUNDS LOST trial. J Clin Endocrinol Metab. 2015;100:2463–71.CrossRefPubMedPubMedCentralGoogle Scholar
  116. 116.
    Weaver AA, Houston DK, Shapses SA, Lyles MF, Henderson RM, Beavers DP, et al. Effect of a hypocaloric, nutritionally complete, higher-protein meal plan on bone density and quality in older adults with obesity: a randomized trial. Am J Clin Nutr. 2019;109:478–86.CrossRefGoogle Scholar
  117. 117.
    Shah K, Armamento-Villareal R, Parimi N, Chode S, Sinacore DR, Hilton TN, et al. Exercise training in obese older adults prevents increase in bone turnover and attenuates decrease in hip bone mineral density induced by weight loss despite decline in bone-active hormones. J Bone Miner Res. 2011;26:2851–9.CrossRefPubMedPubMedCentralGoogle Scholar
  118. 118.
    Villareal DT, Fontana L, Weiss EP, Racette SB, Steger-May K, Schechtman KB, et al. Bone mineral density response to caloric restriction-induced weight loss or exercise-induced weight loss: a randomized controlled trial. Arch Intern Med. 2006;166:2502–10.CrossRefGoogle Scholar
  119. 119.
    Liu CJ, Latham N. Adverse events reported in progressive resistance strength training trials in older adults: 2 sides of a coin. Arch Phys Med Rehabil. 2010;91:1471–3.CrossRefGoogle Scholar
  120. 120.
    Little RM, Paterson DH, Humphreys DA, Stathokostas L. A 12-month incidence of exercise-related injuries in previously sedentary community-dwelling older adults following an exercise intervention. BMJ Open. 2013;3:e002831.CrossRefPubMedPubMedCentralGoogle Scholar
  121. 121.
    Pahor M, Guralnik JM, Ambrosius WT, Blair S, Bonds DE, Church TS, 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.CrossRefPubMedPubMedCentralGoogle Scholar
  122. 122.
    Bone mass measurements. Centers for Medicare and Medicaid Services: 2019.Google Scholar
  123. 123.
    Clark RV, Walker AC, Miller RR, O'Connor-Semmes RL, Ravussin E, Cefalu WT. Creatine ( methyl-d3) dilution in urine for estimation of total body skeletal muscle mass: accuracy and variability vs. MRI and DXA. J Appl Physiol (1985). 2018;124:1–9.CrossRefGoogle Scholar
  124. 124.
    Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008;19:385–97.CrossRefPubMedPubMedCentralGoogle Scholar
  125. 125.
    Viswanathan M, Reddy S, Berkman N, Cullen K, Middleton JC, Nicholson WK, et al. Screening to prevent osteoporotic fractures: updated evidence report and systematic review for the US preventive services task ForceUSPSTF evidence report: screening to prevent osteoporotic FracturesUSPSTF evidence report: screening to prevent osteoporotic fractures. JAMA. 2018;319:2532–51.CrossRefGoogle Scholar
  126. 126.
    Mol A, Bui Hoang PTS, Sharmin S, Reijnierse EM, van Wezel RJA, Meskers CGM, et al. Orthostatic hypotension and falls in older adults: a systematic review and meta-analysis. J Am Med Dir Assoc. 2019;20:589–97.e5.CrossRefGoogle Scholar
  127. 127.
    Whelton PK, Appel LJ, Espeland MA, Applegate WB, Ettinger WH Jr, Kostis JB, et al. Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group. JAMA. 1998;279:839–46.CrossRefGoogle Scholar
  128. 128.
    Look AHEAD Research Group, Greenway FL. Severe hypoglycemia in the Look AHEAD trial. J Diabetes Complicat. 2016;30:935–43.CrossRefGoogle Scholar
  129. 129.
    Beavers KM, Beavers DP, Nesbit BA, Ambrosius WT, Marsh AP, Nicklas BJ, et al. Effect of an 18-month physical activity and weight loss intervention on body composition in overweight and obese older adults. Obesity (Silver Spring). 2014;22:325–31.CrossRefGoogle Scholar
  130. 130.
    Riebe D, Franklin BA, Thompson PD, Garber CE, Whitfield GP, Magal M, et al. Updating ACSM’s recommendations for exercise preparticipation health screening. Med Sci Sports Exerc. 2015;47:2473–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Peter R. DiMilia
    • 1
    • 2
    • 3
  • Alexander C. Mittman
    • 1
  • John A. Batsis
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    Email author
  1. 1.The Dartmouth Institute for Health Policy & Clinical PracticeGeisel School of Medicine at DartmouthLebanonUSA
  2. 2.Dartmouth Centers for Health and AgingDartmouth CollegeHanoverUSA
  3. 3.Collaboratory for Implementation Science at DartmouthLebanonUSA
  4. 4.Health Promotion Research Center at DartmouthLebanonUSA
  5. 5.Section of General Internal MedicineDartmouth-Hitchcock Medical CenterLebanonUSA
  6. 6.Section of Weight & Wellness, Department of Medicine, Dartmouth-HitchcockLebanonUSA

Personalised recommendations