Cited by 52Nutrition and Health in AgingFrailty in Older AdultsDiabetes, Cardiovascular Risks, and Lipoproteins

Long-term maintenance of weight loss after lifestyle intervention in frail, obese older adults

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Waters, D.L., Vawter, R., Qualls, C., Chode, S., Armamento-Villareal, R., Villareal, Dennis T.·2013·The Journal of nutrition, health and aging

Abstract

OBJECTIVES: To determine if long-term weight loss with associated improvement in physical and metabolic health can be maintained after lifestyle intervention in frail, obese older adults. DESIGN: Thirty-month follow-up pilot study of a 1-year lifestyle intervention trial. SETTING: Community. PARTICIPANTS: Sixteen frail, obese (body mass index=36±2 kg/m2) older (71±1 yr.) adults. MEASUREMENTS: Body weight and composition, physical function, markers of the metabolic syndrome, glucose and insulin response to an oral glucose tolerance test, bone mineral density (BMD), liver and renal function tests, and food diaries. RESULTS: At 30-month follow-up, weight (101.5±3.8 vs. 94.5±3.9 kg) and BMI (36.0 ±1.7 vs. 33.5±1.7 kg/m2) remained significantly below baseline (all p<0.05). No significant change in fat-free mass (56.7±2.1 vs. 56.9±2.2 kg) or appendicular lean mass (24.1±1.0 vs. 24.1±1.1kg, all p>0.05) occurred between 12 months (end of trial) and 30 months. Improvements in the physical performance test (PPT 27±0.7 vs. 30.2±0.6), insulin sensitivity (4.1±0.8 vs. 3.0±0.6), and insulin area under the curve (12484±2042 vs. 9270±1139 min.mg/dl) remained at 30 months compared to baseline (all p<0.05). Waist circumference (116±3 vs. 109±3 cm) and systolic blood pressure (134±6 vs. 123±5 mm HG) remained decreased at 30 months compared to baseline (all p<0.05). Whole body and lumbar spine BMD did not change; however, total hip BMD progressively decreased at 30 months compared to baseline (0.985±.026 vs. 0.941±.024 g/cm2; p<0.05). There were no adverse effects on liver or renal function. Food frequency questionnaire data showed lower overall caloric intake (-619±157 kcal/day) at 30 months compared to baseline (p<0.05). CONCLUSION: These findings suggest that long-term maintenance of clinically important weight loss is possible in frail, obese older adults. Weight maintenance appears to be achieved through continued caloric restriction. Larger, long-term studies are needed to follow up on these findings and investigate mechanisms and behaviors underlying maintenance of weight loss and physical function.

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  • Adults who undergo multiple cycles of weight loss and regain are at risk of progressive decline in lean mass and bone mineral density with each unsuccessful maintenance attempt.

    “adults who struggle through multiple cycles of weight loss and regain are at risk of progressive decline in lean mass and BMD with each unsuccessful attempt to maintain their weight.”

    From The Benefits of Exercise Training in Combination With Weight Loss Therapies (2025) · cites this paper as [28]

    The Results (page unavailable) report that lean-mass measures fell during the initial intervention and that total-hip BMD declined over 30 months. The Discussion (page unavailable) says lean mass did not decrease further during follow-up. The study followed weight-loss maintenance, not repeated cycles of loss and regain, so it does not support a progressive decline in both measures with each unsuccessful maintenance attempt. (LLM, conf=0.84)

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  • In a study of total hip bone mineral density changes 30 months after a 1-year weight loss intervention trial, patients continued to show bone mineral density decline even with substantial weight regain.

    “of changes in BMD at the total hip 30 months following a 1-year weight loss intervention trial, investigators found that patients continued to show decline in BMD even with substantial weight regain (28).”

    From The Benefits of Exercise Training in Combination With Weight Loss Therapies (2025) · cites this paper as [28]

    The Results report a progressive decline in total-hip BMD over the 30-month study. The Discussion says participants lost about 10% of their weight during the one-year intervention and remained about 7% below baseline at 30 months; it does not characterize the regain as substantial. The 30-month measurement was from baseline, 18 months after the intervention ended, not 30 months afterward. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • In older adults with obesity, bone mineral density loss appears to continue during long-term lifestyle change in the opposite direction to weight changes.

    “Loss of BMD in older adults with obesity seems to continue during long-term lifestyle change in the opposite direction to the weight changes321.”
  • Thirty months after completion of a 1-year weight loss intervention in frail, obese older adults, despite continued reduced total body mass from baseline, about one-half (45%) of total fat mass had been regained but lost lean mass was not recovered.

    “Similarly, 30 months after completion of a 1-year weight loss intervention in frail, obese older adults, despite continued reduced total body mass from baseline, about one-half (45%) of total fat mass had been regained but lost lean mass was not recovered.24”
  • Long-term follow-up studies of RCTs that resulted in weight loss show that weight regain following significant intentional weight loss is comprised predominantly of fat mass.

    “This finding is echoed in the few long-term follow-up studies of RCTs that resulted in weight loss, where weight regain following significant intentional weight loss is shown to be comprised predominantly of fat mass.13, 24, 25”

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Authors
Waters, D. L., Vawter, R., Qualls, C., Chode, S., Armamento-Villareal, R., & Villareal, D. T.
Affiliations
  • New Mexico VA Health Care System (US)
  • University of New Mexico (US)
  • Washington University in St. Louis (US)
Corresponding author
Villareal, Dennis T.
Venue
The Journal of nutrition, health and aging
Publisher
Elsevier BV
Published
2013-01
Volume
17
Issue
1
Pages
3-7
ISSN
1279-7707 (ISSN-L)
OpenAlex
W2131218791
Cited by
51
References
31
Citations by year
2026: 2 · 2025: 4 · 2024: 1 · 2023: 2 · 2022: 4 · 2021: 4 · 2020: 3 · 2019: 9 · 2018: 6 · 2016: 2 · 2015: 5 · 2014: 3 · 2013: 6
FWCI
2.98
Type
journal article
Language
en
Open access
Locations
  • The journal of nutrition health & aging (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (5p60dk020579-35, UL1TR000448, 7r01ag025501-06)
  • National Institute on Aging (R01-AG025501, R01AG031176)
  • National Institute of Diabetes and Digestive and Kidney Diseases (DK20579, P60-DK-020579, P30DK020579)
  • National Center for Research Resources (UL1RR024992)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
weight loss maintenance, obesity, frailty, older adults, lifestyle intervention, physical function, insulin sensitivity, metabolic syndrome, bone mineral density, hip bone loss, fat-free mass, waist circumference, energy intake, dietary adherence, long-term follow-up, food frequency questionnaire, liver and kidney function, physical activity, food diary, physical performance tests, oral glucose tolerance test
MeSH terms
Aged, Black or African American, Blood Glucose, Body Composition, Feeding Behavior, Female, Follow-Up Studies, Glucose Tolerance Test, Humans, Insulin, Insulin Resistance, Life Style, Male, Obesity, Pilot Projects, Quality of Life, Surveys and Questionnaires, Weight Loss, Bone Density, Body Mass Index, Metabolic Syndrome, Caloric Restriction, White People

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