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Age is no barrier to losing weight for patient with obesity

Mon, 11/23/2020 - 10:58
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Patients with obesity who are over the age of 60 can lose an equivalent amount of weight as younger people using only lifestyle changes, according to a study from the University of Warwick and University Hospitals Coventry and Warwickshire (UHCW) NHS Trust, demonstrating that age is no barrier to losing weight. The researchers believe that their findings will help to correct prevailing societal misconceptions about the effectiveness of weight loss programmes in older people, as well dispel myths about the potential benefits of older people trying to reduce their weight.

"Weight loss is important at any age, but as we get older we're more likely to develop the weight-related co-morbidities of obesity” said lead author, Dr Thomas Barber of Warwick Medical School at the University of Warwick. “Many of these are similar to the effects of aging, so you could argue that the relevance of weight loss becomes heightened as we get older, and this is something that we should embrace. Age should be no barrier to lifestyle management of obesity. Rather than putting up barriers to older people accessing weight loss programmes, we should be proactively facilitating that process. To do otherwise would risk further and unnecessary neglect of older people through societal ageist misconceptions."

There are more than 50 co-morbidities of obesity that can be lessened as we lose weight, including diabetes, psychiatric conditions such as depression and anxiety, osteoarthritis and other mechanical problems. Obesity is also linked to increased mortality and poor wellbeing. The hospital-based programme used only lifestyle-based changes tailored to each individual patient, focusing on dietary changes, psychological support and encouragement of physical activity. Most of the patients referred to the obesity service had morbid obesity with BMIs typically over 40Kgm2.

The study, ‘Older age does not influence the success of weight loss through the implementation of lifestyle modification’, based on analysis of patient records from a hospital-based obesity service and were reported in the journal Clinical Endocrinology, was designed to examine the effect of age on the ability to lose weight through lifestyle interventions, implemented within a hospital‐based obesity service.

This retrospective study was conducted at the Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM) at UHCW. The researchers randomly selected 242 patients who attended the WISDEM-based obesity service between 2005 and 2016, and compared two groups (those aged under 60 years and those aged between 60 and 78 years) for the weight loss that they achieved during their time within the service. The primary outcome measures were percentage weight loss (%WL) and percentage reduction in body mass index (%rBMI) following implemented lifestyle interventions. Data were stratified according to patient age at referral: group 1 (age < 60 years, n=167) and group 2 (age ≥ 60 years, n=75). All patients had their body weight measured both before and after lifestyle interventions administered and coordinated within the WISDEM-based obesity service, and the percentage reduction in body weight calculated across both groups. Weight loss was compared between groups, and correlations with age at referral were explored.

The duration of hospital‐based weight loss interventions ranged between one and 143 months (mean: 38.9 months; SD: 32.3). Baseline BMI at referral differed significantly between groups 1 and 2 (49.7 kgm−2 [SD: 8.7] vs 46.9 kgm−2 [SD: 6.1], respectively; p<0.05). Following implemented lifestyle interventions, between groups 1 and 2 there were no differences in %WL (6.9% [SD: 16.7] vs 7.3% [SD: 11.60], respectively; p=NS) or %rBMI (8.1% [SD: 14.9] vs 7.8% [SD: 11.7], respectively; p=NS). Overall, there was no significant correlation between patient age at referral and %WL (r = −.13, p=NS).

The authors concluded that older age does not influence the success of weight loss through the implementation of lifestyle modification within a hospital‐based obesity service, and age per se should not influence clinical decisions regarding acceptance of patients to hospital‐based obesity services.

“We present novel data from a relatively large retrospective study showing that older age does not influence the success of weight loss through the implementation of lifestyle modification within a hospital‐based obesity service. As obesity‐related co‐morbidities tend to worsen with ageing, older patients with obesity require additional attention and a careful and compassionate approach from a multi‐disciplinary obesity team, which will address barriers based on misconceptions,” the authors wrote. “To that aim, our data support the notion that age per se should not influence clinical decisions regarding acceptance of patients to hospital‐based obesity services and the provision of hospital‐based lifestyle management strategies. As existing evidence also suggests that older patients (≥60 years) respond very well to hospital‐based lifestyle interventions and given the importance of healthy ageing, appropriate referral and acceptance of older patients to hospital‐based obesity services should be encouraged and facilitated, overcoming the numerous barriers that currently impede this process.”

"There are a number of reasons why people may discount weight loss in older people. These include an 'ageist' perspective that weight-loss is not relevant to older people and misconceptions of reduced ability of older people to lose weight through dietary modification and increased exercise. Older people may feel that hospital-based obesity services are not for them,” explained Barber. “Service providers and policymakers should appreciate the importance of weight loss in older people with obesity, for the maintenance of health and wellbeing, and the facilitation of healthy ageing. Furthermore, age per se should not contribute towards clinical decisions regarding the implementation of lifestyle management of older people.”

To access this paper, please click here