Community-based Weight-Loss Intervention Feasible for Rural Older Adults

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Approximately 37% of older adults in the U.S. have obesity, which increases their risk of falls, mobility impairment, institutionalization and death. In a previous qualitative study, reported in the Journal of Nutrition in Gerontology and Geriatrics, Massachusetts General Hospital researchers found that many such patients are interested in weight-loss interventions even if they have distance and transportation challenges.

As the first step in a new research program, the team demonstrated the feasibility of a multicomponent weight-loss intervention delivered at a community aging center. Stephen J. Bartels, MD, MS, director of the Mongan Institute and James J. and Jean H. Mongan chair in Health Policy and Community Health in the Department of Medicine at Mass General, and colleagues report their findings in the Journal of Nutrition in Gerontology and Geriatrics.

Study Methods

The 12-week intervention was conducted in Lebanon, New Hampshire (population 13,522) at a community-based aging center affiliated with Dartmouth–Hitchcock, a rural academic medical center. Patients ages 65 and older with a body mass index >30 kg/m² were recruited from the primary care clinic.

The intervention comprised of:

• Creation of individualized meal plans at baseline using data patients reported on the ASA24, a web-based dietary recall tool
• 30 minutes/week of education and behavioral therapy with a registered dietitian
• Distribution of digital scales for self-monitoring of body weight
• Baseline assessment by a physical therapist of strength, flexibility, balance and aerobic capacity; creation of personalized exercise plans for home use; and group exercise sessions, twice weekly at the center

Participation Outcomes

• Feasibility was predefined as enrolling eight participants; of 14 patients screened, 10 were eligible and nine consented
• Successful retention was predefined as a dropout rate <20%; the dropout rate was zero
• Acceptability was predefined as attending >75% of sessions and completing >80% of study measures; patients attended an average of 11.6/12 nutrition classes and 23/24 exercise sessions, and all completed anthropometric, objective and subjective study measures

Study Measures

• Average weight loss was 4.3 kg (5%, P<0.001), the average change in waist circumference was −7.5 cm (P=0.002), and the average change in waist–hip ratio was −0.03 (P=0.04)
• There were significant improvements in three of four objective functional measures (gait speed, grip strength and sit-to-stand but not the six-minute walk test)
• Among subjective measures, there was a significant improvement in the Patient Activation Measure and the mental health score on PROMIS (Patient-Reported Outcome Measurement Information System)

Countering the "Obesity Paradox"

Many clinicians believe weight loss is unimportant for older adults, partly because they accept the notion that fat protects against mortality. There is no scientific evidence for that so-called "obesity paradox." Older adults in this small study showed improved function, not weight loss–induced sarcopenia.

The feasibility and acceptability criteria for the study were met even though participants traveled an average of 15 miles to the center (they were given a $25 gas card after each visit). This suggests similar trials could be run elsewhere. Where necessary, it may be possible to adapt the program to a telehealth platform.

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Learn more about the Mongan Institute

Refer a patient to the Department of Palliative Care and Geriatric Medicine