Obesity treatment in elderly outpatients: Predictors of efficacy and drop-out

  • L. Busetto
  • M. Mazza
  • S. Salvalaio
  • F. De Stefano
  • M. Marangon
  • E. Calò
  • S. Sampietro
  • G. Enzi
Original Research Paper


Objective: Obesity is increasing in the elderly and it is associated with an increased risk of medical complications, decline in physical function and disability. Very few studies specifically evaluated the outcome of obesity treatment in the aging patients. Aim of this work is therefore the evaluation of the efficacy of medical therapy in a group of obese patients ≥65 years old. Methods: The study has been performed on the clinical records of obese outpatients treated at the medical branch of the Unit for Medical and Surgical Therapy of Obesity at the University of Padova. Patients were recruited from January 1st, 2001 to June 30th, 2006 in order to have patients with at least one year of potential follow-up. In particular two groups were enrolled: 100 patients ≥65 years old and 200 patients <65 years old. The baseline characteristics, the prescriptions and the treatment outcome were compared. Results: Mean age of the elderly patients was 69.1±3.7 years (range 65-80 years). We did not find any significant difference between elderly and adult patients in the sex distribution (female patients 76% in the elderly group and 72% in the adult group; p=0.276) and in the severity of overweight (body mass index: 37.8±6.0 kg/m2 in the elderly; 37.2±6.3 kg/m2 in adults; p=0.425). The elderly group was characterized by a higher incidence of comorbidities and a lower incidence of eating behavior disorders at baseline. No significant differences in the dietary prescription were found, whereas physical activity was prescribed in 27/100 elderly patients (27%) and in 97/200 (48%) adults patients (p<0.000). Weight loss was evaluated by analyzing the percentage of patients reaching at least a 10% weight loss from baseline after 12 months of treatment. In elderly patients still in active treatment after 12 months, only 5/28 (18%) patients reached the specified goal, whereas in adult patients still in treatment, 18/47 (38%) patients reached the goal (plt;0.05). Lower age at baseline, female sex, and lower body mass index were found to be the only significant predictors of 10% weight loss in logistic regression. In our experience, drop-out rate after 12 months was similar in adults (77%) and in older patients (72%). In a multivariate Cox regression model, the risk of drop-out was reduced by married or widowed status, the prescription of physical activity at baseline, and the presence of type 2 diabetes. The risk of drop-out was increased by the presence of osteoarthritis. Even after adjustments for these confounding variables, age did not play any significant role as drop-out predictor. Conclusion: Advanced age seems to be a predictor of poor response to treatment in obese outpatients treated by conventional medical therapy. Drop-out rate was not significantly influenced by age.

Key words

Elderly weight loss diet physical activity 


  1. 1.
    Hedley A.A., Ogden C.L., Johnson C.L., Carroll M.D., Curtin L.R., Flegal K.M.: Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. J.A.M.A., 291, 2847–2850, 2004.PubMedCrossRefGoogle Scholar
  2. 2.
    Villareal D.T., Apovian C.M., Kushner R.F., Klein S.: American Society for Nutrition; NAASO, The Obesity Society. Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society. Obes. Res., 13, 1849–1863, 2005.PubMedCrossRefGoogle Scholar
  3. 3.
    Whelton P.K., Appel L.J., Espeland M.A., Applegate W.B., Ettinger W.H. Jr., Kostis J.B., Kumanyka S., Lacy C.R., Johnson K.C., Folmar S., Cutler J.A.: Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). TONE Collaborative Research Group. J.A.M.A., 279, 839–846, 1998.PubMedCrossRefGoogle Scholar
  4. 4.
    Messier S.P., Loeser R.F., Miller G.D., Morgan T.M., Rejeski W.J., Sevick M.A., Ettinger W.H. Jr., Pahor M., Williamson J.D.: Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis. The Arthritis, Diet, and Activity Promotion Trial (ADAPT). Arthritis Rheum., 50, 1501–1510, 2004.PubMedCrossRefGoogle Scholar
  5. 5.
    Villareal D.T., Banks M., Sinacore D.R., Siener C., Klein S.: Effects of weight loss and exercise on frailty in obese older adults. Arch. Intern. Med., 166, 860–866, 2006.PubMedCrossRefGoogle Scholar
  6. 6.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC, American Psychiatric Association, 2000.Google Scholar
  7. 7.
    Busetto L., Segato G., De Marchi F., Foletto M., De Luca M., Caniato D., Favretti F., Lise M., Enzi G.: Outcome predictors in morbidly obese recipients of an adjustable gastric band. Obes. Surg., 12, 83–92, 2002.PubMedCrossRefGoogle Scholar
  8. 8.
    Stunkard A., Berkowitz R., Wadden T., Tanrikut C., Reiss E., Young L.: Binge eating disorder and the night eating sindrome. Int. J. Obes. Relat. Metab. Disord., 20, 1–6, 1996.PubMedGoogle Scholar
  9. 9.
    NHLBI Obesity Education Initiative Expert Panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults-the evidence report. Obes. Res., 6, 51S–209S, 1998.CrossRefGoogle Scholar
  10. 10.
    FAO/WHO/UNU. Energy and protein requirements. Report of a joint FAO/WHO/UNU Expert Con — sultation. World Health Organization Tech. Rep. Ser., 724, 1–206, 1985.Google Scholar
  11. 11.
    Grucza R.A., Przybeck T.R., Cloninger C.R.: Prevaklence and correlates of binge eating disorder in a community sample. Compr. Psychiatry, 48, 124–131, 2007.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Wing R.R., Hamman R.F., Bray G.A., Delahanty L., Edelstein S.L., Hill J.O., Horton E.S., Hoskin M.A., Kriska A., Lachin J., Mayer-Davis E.J., Pi-Sunyer X., Regensteiner J.G., Venditti B., Wylie-Rosett J., for the Diabetes Prevention Program Research Group: Achieving weight and activity goals among diabetes prevention program lifestyle participants. Obes. Res., 12, 1426–1434, 2004.PubMedCrossRefGoogle Scholar
  13. 13.
    Busetto L., Angrisani L., Basso N., Favretti F., Furbetta F., Lorenzo M., for the Italian Group for Lap-Band: Safety and efficacy of laparoscopic adjustable gastric banding in the elderly. Obesity, 16, 334–338, 2008.PubMedCrossRefGoogle Scholar
  14. 14.
    Sugerman H.J., DeMaria E.J., Kellum J.M., Sugerman E.L., Meador J.G., Wolfe L.G.: Effects of bariatric surgery in older patients. Ann. Surg., 240, 243–247, 2004.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Dixon J.B., O’Brien P.E.: Selecting the optimal patient for LAP-BAND placement. Am. J. Surg., 184, 17S–20S, 2002.PubMedCrossRefGoogle Scholar
  16. 16.
    Torp-Pedersen C., Caterson I., Coutinho W., Finer N., Van Gaal L., Maggioni A., Sharma A., Brisco W., Deaton R., Shepherd G., James P., on the behalf of the SCOUT Investigators: Cardiovascular responses to weight management and sibutramine in high-risk subjects: an analysis from the SCOUT trial. Eur. Heart J., 28, 2915–2923, 2007.PubMedCrossRefGoogle Scholar
  17. 17.
    Inelmen E.M., Toffanello E.D., Enzi G., Sergi G., Coin A., Busetto L., Manzato E.: Predictors of drop-out in overweight and obese outpatients. Int. J. Obes. Relat. Metab. Disord., 29, 122–128, 2005.CrossRefGoogle Scholar
  18. 18.
    Cresci B., Tesi F., La Ferlita T., Ricca V., Ravaldi C., Rotella C.M., Mannucci E.: Group versus individual cognitive-behavioral treatment for obesity: results after 36 months. Eating Weight Disord., 12, 147–153, 2007.CrossRefGoogle Scholar
  19. 19.
    Minniti A., Bissoli L., Di Francesco V., Fantin F., Mandragona R., Olivieri M., Fontana G., Rinaldi C., Bosello O., Zamboni M.: Individual versus group therapy for obesity: comparison of dropout rate and treatment outcome. Eating Weight Disord, 12, 161–17, 2007.CrossRefGoogle Scholar
  20. 20.
    James W.P., Astrup A., Finer N., Hilsted J., Kopelman P., Rössner S., Saris W.H., Van Gaal L.F.: Effect of sibutramine on weight maintenance after weight loss: a randomised trial. STORM Study Group. Sibutramine Trial of Obesity Reduction and Maintenance. Lancet, 356, 2119–2125, 2000.PubMedCrossRefGoogle Scholar
  21. 21.
    Torgerson J.S., Hauptman J., Boldrin M.N., Sjöström L.: XENical in the prevention of Diabetes in Obese subjects Study: a randomized study of 191 orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care, 27, 155–161, 2004.PubMedCrossRefGoogle Scholar
  22. 22.
    Pi-Sunyer F.X., Aronne L.J., Heshmati H.M., Devin J., Rosenstock J., for the RIO-North America Study Group: Effect of Rimonabant, a cannabinoid-1 receptor bocker, on wight and cardiometabolic risk factors in overweight or obese patients. RIO-North America: a randomized controlled trial. J.A.M.A., 295, 761–775, 2006.PubMedCrossRefGoogle Scholar
  23. 23.
    Teixeira P.J., Going S.B., Houtkooper L.B., Cussler E.C., Metcalfe L.L., Blew R.M., Sardinha L.B., Lohman T.G.: Pretreatment predictors of attrition and successful weight management in women. Int. J. Obes. Relat. Metab. Disord., 28, 1124–1133, 2004.PubMedCrossRefGoogle Scholar
  24. 24.
    Dalle Grave R., Calugi S., Molinari E., Petroni M.L., Bondi M., Compare A., Marchesini G. for the QUOVADIS Study Group: weight loss expectations in obese patients and treatment attrition: an observational multicentre study. Obes. Res., 13, 1961–1969, 2005.PubMedCrossRefGoogle Scholar
  25. 25.
    Andersson I., Rossner S.: Weight development, dropout pattern and changes in obesity-related risk factors after two years treatment of obese men. Int. J. Obes. Relat. Metab. Disord., 21, 211–216, 1997.PubMedCrossRefGoogle Scholar
  26. 26.
    Honas J.J., Early J.L., Frederickson D.D., O’Brien M.S.: Predictors of attrition in a large clinic-based weightloss program. Obes. Res., 11, 888–894, 2003.PubMedCrossRefGoogle Scholar

Copyright information

© Editrice Kurtis 2009

Authors and Affiliations

  • L. Busetto
    • 1
  • M. Mazza
    • 1
  • S. Salvalaio
    • 1
  • F. De Stefano
    • 1
  • M. Marangon
    • 1
  • E. Calò
    • 1
  • S. Sampietro
    • 1
  • G. Enzi
    • 1
  1. 1.Unit for Medical and Surgical Therapy of Obesity, Department of Medical and Surgical SciencesUniversity of PadovaPadovaItaly

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