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Weight Loss, Exercise, or Both and Physical Function in Obese Older Adults
Open accessAbstract
BACKGROUND: Obesity exacerbates the age-related decline in physical function and causes frailty in older adults; however, the appropriate treatment for obese older adults is controversial. METHODS: In this 1-year, randomized, controlled trial, we evaluated the independent and combined effects of weight loss and exercise in 107 adults who were 65 years of age or older and obese. Participants were randomly assigned to a control group, a weight-management (diet) group, an exercise group, or a weight-management-plus-exercise (diet-exercise) group. The primary outcome was the change in score on the modified Physical Performance Test. Secondary outcomes included other measures of frailty, body composition, bone mineral density, specific physical functions, and quality of life. RESULTS: A total of 93 participants (87%) completed the study. In the intention-to-treat analysis, the score on the Physical Performance Test, in which higher scores indicate better physical status, increased more in the diet-exercise group than in the diet group or the exercise group (increases from baseline of 21% vs. 12% and 15%, respectively); the scores in all three of those groups increased more than the scores in the control group (in which the score increased by 1%) (P<0.001 for the between-group differences). Moreover, the peak oxygen consumption improved more in the diet-exercise group than in the diet group or the exercise group (increases of 17% vs. 10% and 8%, respectively; P<0.001); the score on the Functional Status Questionnaire, in which higher scores indicate better physical function, increased more in the diet-exercise group than in the diet group (increase of 10% vs. 4%, P<0.001). Body weight decreased by 10% in the diet group and by 9% in the diet-exercise group, but did not decrease in the exercise group or the control group (P<0.001). Lean body mass and bone mineral density at the hip decreased less in the diet-exercise group than in the diet group (reductions of 3% and 1%, respectively, in the diet-exercise group vs. reductions of 5% and 3%, respectively, in the diet group; P<0.05 for both comparisons). Strength, balance, and gait improved consistently in the diet-exercise group (P<0.05 for all comparisons). Adverse events included a small number of exercise-associated musculoskeletal injuries. CONCLUSIONS: These findings suggest that a combination of weight loss and exercise provides greater improvement in physical function than either intervention alone. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT00146107.).
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“Unopposed diet therapy without exercise in older frail adults ≥65 years with obesity (BMI ≥30 kg/m2) led to a marked loss of lean mass at 6 months and 1 year (−3.5 kg and −3.2 kg, respectively) compared with the diet and exercise group, where the loss of lean mass was partially mitigated (−1.7 kg and −1.8 kg, respectively)246.”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [246]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“CR resulting in an average total weight loss of 10% improved physical function as assessed with modified Physical Performance Test (PPT) by 12%; however, combining CR with regular exercise training led to a 21% improvement in PPT scores in comparison with placebo.”
From The Benefits of Exercise Training in Combination With Weight Loss Therapies (2025) · cites this paper as [17]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“A study comparing the independent and combined effects of caloric restriction and exercise in 107 elderly (70 years) individuals with obesity reported that, after 12 months, the exercise group increased LM by 2.3% (11.3 kg), while the dietplus-exercise and diet-only groups experienced decreases in LM of 3.1% (À1.8 kg) and 5.2% (À3.2 kg).”
From Incretin-Based Weight Loss Pharmacotherapy: Can Resistance Exercise Optimize Changes in Body Composition? (2024) · cites this paper as [70]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“weight loss improves global physical function, most likely because of reduced fat mass”
From Preserving Healthy Muscle during Weight Loss (2017) · cites this paper as [55]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Several investigators found that a progressive resistance exercise training program in conjunction with a hypocaloric diet attenuated the weight-loss-associated loss of muscle mass in middle-aged and older men and women (55,65,66).”
From Preserving Healthy Muscle during Weight Loss (2017) · cites this paper as [55]
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“The reductions in muscle mass in young and old men and women with obesity after diet-induced weight-loss of 8-10% were ;2-10% (47, 52-56, 59, 62-66).”
From Preserving Healthy Muscle during Weight Loss (2017) · cites this paper as [55]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Diet-induced weight loss reduces muscle lipid content (assessed by X-ray attenuation or MRI) (52,62,63,74) and does not affect (55,65,93), or slightly decreases (48,52,56), leg muscle strength.”
From Preserving Healthy Muscle during Weight Loss (2017) · cites this paper as [55]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“Grip strength and global measures of physical function, such as balance, walking speed, or climbing stairs, improve after weight loss (52, 54-56, 93, 115, 127).”
From Preserving Healthy Muscle during Weight Loss (2017) · cites this paper as [55]
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In the citing paper
“a combination of weight loss and regular exercise improved physical function and ameliorated frailty more than either intervention alone246”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [246]
The cited source says what the claim attributes to it.
In the citing paper
“the addition of exercise training to CR reduced the loss of lean mass from 5% to 3% and decline in BMD at the hip from 3% to 1% (17).”
From The Benefits of Exercise Training in Combination With Weight Loss Therapies (2025) · cites this paper as [17]
The cited source says what the claim attributes to it.
In the citing paper
“diet-induced weight loss reduces muscle mass without adversely affecting muscle strength”
From Preserving Healthy Muscle during Weight Loss (2017) · cites this paper as [55]
The cited source says what the claim attributes to it.
In the citing paper
“both endurance-and resistance-type exercise help preserve muscle mass during weight loss”
From Preserving Healthy Muscle during Weight Loss (2017) · cites this paper as [55]
The cited source says what the claim attributes to it.
In the citing paper
“resistance-type exercise also improves muscle strength”
From Preserving Healthy Muscle during Weight Loss (2017) · cites this paper as [55]
The cited source says what the claim attributes to it.
In the citing paper
“The combination with J o u r n a l P r e -p r o o f exercise training had comparable if not greater effects than the singular weight-reducing diets regarding the reduction of BW and fat mass, while often preserving lean mass better than diet alone (289-291, 295-297, 299).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [289]
The cited source says what the claim attributes to it.
In the citing paper
“Twelve RCTs were identified that compared the effects of a dietary weight loss intervention alone to a combination of the same dietary intervention with an exercise intervention in older persons (288)(289)(290)(291)(292)(293)(294)(295)(296)(297)(298)(299).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [289]
The cited source says what the claim attributes to it.
In the citing paper
“Moreover, for several physical and strengthperformance measures, greater improvements were observed in the combined groups than in the diet-only groups (288-291, 293-297, 299).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [289]
In the citing paper
“Weight loss due to diet alone in older adults with obesity leads to loss of lean tissue (muscle and bone), exacerbating age-related sarcopenia and osteopenia [390].”
From Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR) (2025) · cites this paper as [390]
In the citing paper
“This finding is consistent with a previous study of exercise performance and weight loss, where obese adults who exercised during weight loss exhibited VO2 max levels greater than those who dieted alone [24].”
From Antibody blockade of activin type II receptors preserves skeletal muscle mass and enhances fat loss during GLP-1 receptor agonism (2024) · cites this paper as [24]
In the citing paper
“Dietary intervention produces greater weight loss, whereas physical activity produces better physical function, although the combination of interventions provides superior improvement in physical function than either intervention alone [66].”
From Obesity pharmacotherapy in older adults: a narrative review of evidence (2025) · cites this paper as [66]
In the citing paper
“muscle loss following diet-induced intentional weight loss may be more frequently observed in older adults with pre-existing sarcopenia159,165,167.”
From Sarcopenic obesity in older adults: a clinical overview (2024) · cites this paper as [167]
In the citing paper
“Several clinical trials have shown that nutrition interventions and physical exercise improve relevant parameters regarding sarcopenic obesity such as grip strength, body fat and muscle mass [5, 13–17].”
From Effects of nutrition and exercise interventions on persons with sarcopenic obesity: an umbrella review of meta-analyses of randomised controlled trials (2023) · cites this paper as [13]
In the citing paper
“which may be a key mediator through which DR improves physical performance.(Jensen, Roy, Buchanan, and Berg 2004;Villareal, Chode, Parimi, Sinacore, Hilton, Armamento-Villareal, Napoli, Qualls, and Shah 2011)”
From Successful aging: Advancing the science of physical independence in older adults (2015) · cites this paper as Villareal, Chode, Parimi, Sinacore, Hilton, Armamento-Villareal, Napoli, Qualls, and Shah 2011
In the citing paper
“Although the weight loss plus exercise group showed the greatest improvements, the DR weight loss only group performed significantly better than the control group on measures of physical function.”
From Successful aging: Advancing the science of physical independence in older adults (2015) · cites this paper as Villareal, Chode, Parimi, Sinacore, Hilton, Armamento-Villareal, Napoli, Qualls, and Shah 2011
In the citing paper
“In a one-year randomized controlled trial examining DR weight loss alone, exercise alone, and weight loss plus exercise compared to an educational control group, significant benefits related to physical function were found for all intervention groups.(Villareal, Chode, Parimi, Sinacore, Hilton, Armamento-Villareal, Napoli, Qualls, and Shah 2011)”
From Successful aging: Advancing the science of physical independence in older adults (2015) · cites this paper as Villareal, Chode, Parimi, Sinacore, Hilton, Armamento-Villareal, Napoli, Qualls, and Shah 2011
In the citing paper
“Although age and diabetes conspire to reduce fitness and strength, physical activity interventions improve functional status in older adults91 with and without diabetes.”
From Diabetes in Older Adults: A Consensus Report (2012) · cites this paper as [91]
In the citing paper
“Even modest exercise can lead to improvement in features of the metabolic syndrome (29) and to improvements in muscle mass, bone density, and physical function in such men (30).”
From A Perspective on Middle-Aged and Older Men With Functional Hypogonadism: Focus on Holistic Management (2017) · cites this paper as [30]
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Metadata
- Authors
- Villareal, D. T., Chode, S., Parimi, N., Sinacore, D. R., Hilton, T., Armamento-Villareal, R., Napoli, N., Qualls, C., & Shah, K.
- Affiliations
- University of New Mexico (US)
- Washington University in St. Louis (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2011-03-31
- Volume
- 364
- Issue
- 13
- Pages
- 1218-1229
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC3114602
- OpenAlex
- W2031434074
- Semantic Scholar
- 150add39059ebaaec079c78a2d7c485a8ac6f901
- Cited by
- 1,096
- References
- 39
- Citations by year
- 2026: 70 · 2025: 60 · 2024: 56 · 2023: 48 · 2022: 69 · 2021: 78 · 2020: 78 · 2019: 57 · 2018: 75 · 2017: 66 · 2016: 92 · 2015: 85 · 2014: 78 · 2013: 93 · 2012: 66
- FWCI
- 57.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Digital Commons@Becker (Washington University School of Medicine) (submittedVersion)
- Funders
- Institute of Clinical and Translational Sciences
- Foundation for Physical Therapy
- National Institutes of Health (5p60dk020579-35, UL1TR000448, 7r01ag025501-06, DK20579, DK56341, RR024992, RO1-AG025501)
- National Institute on Aging (R01-AG025501)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK20579, P30-DK56341, P60-DK-020579, P30DK056341, P30DK020579)
- National Institute of Child Health and Human Development
- National Center for Research Resources (UL1RR024992)
- National Center for Advancing Translational Sciences
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD-007434, T32HD007434)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Keywords
- obesity, older adults, weight loss, diet, physical activity, physical function, frailty, peak oxygen uptake, lean body mass, bone mineral density, quality of life, gait, musculoskeletal injuries, physical performance tests, body composition, sarcopenia, osteoporosis
- MeSH terms
- Activities of Daily Living, Aged, Body Composition, Diet, Reducing, Exercise Test, Female, Humans, Male, Obesity, Quality of Life, Weight Loss, Exercise, Bone Density, Frail Elderly, Intention to Treat Analysis
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