Interventions to achieve long-term weight loss in obese older people: a systematic review and meta-analysis.
OBJECTIVE
the prevalence of obesity is rapidly increasing in older adults. Information is required about what interventions are effective in reducing obesity and influencing health outcomes in this age group.


METHODS
systematic review and meta-analysis.


METHODS
thirteen databases were searched, earliest date 1966 to December 2008, including Medline, CINAHL, PsycINFO, the Cochrane database and EMBASE.


METHODS
we included studies with participants' mean age > or = 60 years and mean body mass index > or = 30 kg/m(2), with outcomes at a minimum of 1 year. Data were independently extracted by two reviewers and differences resolved by consensus.


METHODS
nine eligible trials were included. Study interventions targeted diet, physical activity and mixed approaches. Populations included patients with coronary artery disease, diabetes mellitus and osteoarthritis.


RESULTS
meta-analysis (seven studies) demonstrated a modest but significant weight loss of 3.0 kg [95% confidence interval (CI) 5.1-0.9] at 1 year. Total cholesterol (four studies) did not show a significant change: -0.36 mmol/l (95% CI -0.75 to 0.04). There was no significant change in high-density lipoprotein, low-density lipoprotein or triglycerides. In one study, recurrence of hypertension or cardiovascular events was significantly reduced (hazard ratio 0.65, 95% CI 0.50-0.85). Six-minute walk test did not significantly change in one study. Health-related quality of life significantly improved in one study but did not improve in a second study.


CONCLUSIONS
although modest weight reductions were observed, there is a lack of high-quality evidence to support the efficacy of weight loss programmes in older people.
Witham
Miles D
MD
Section of Ageing and Health, University of Dundee, Ninewells Hospital, Dundee DD1 9SY, UK. m.witham@dundee.ac.uk
Avenell
Alison
A
D000368:Aged; D000375:Aging / Q000502:physiology*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D015431:Weight Loss / Q000502:physiology*