Chronic disease and decreased mobility associated with obesity in older (65+ yrs) adults emphasize the urgent need to identify obesity treatments in this population that are evidenced-based, effective in the long-term, and perhaps age-specific. The latest obesity treatment guidelines for all ages recommend an intensive intervention involving behavioral counseling, caloric restriction, and increased physical activity to achieve weight loss. However weight regain after treatment cessation is very common, especially in older adults in whom the currently recommended strategy of continued performance of high-volume structured exercise of 200-300 min/wk may be less feasible and effective. A key factor contributing to weight regain is the decrease in energy expenditure that occurs in response to weight loss, due mainly to a decline in non-exercise or spontaneous physical activity (SPA) that is the direct result of an increase in sedentary behavior (SB), or time spent sitting or reclining. Our pilot data show that decreases in SPA predict magnitude of weight regain. Since older adults spend 65-80% of their waking day sitting or prone, we hypothesize that intervening on SB will be a more effective method for preventing weight regain than the conventional approach of intervening on exercise behavior in this age group. The proposed research will test the efficacy of a novel, acceptable, behavioral intervention (SitLess) that focuses on increased awareness of SB employing inclinometer-based self-monitoring throughout the day. Our pilot data show that this intervention may improve weight loss during the intensive phase of treatment and prevents weight regain during a short (5-month) follow-up phase. The primary aim of this study is to determine whether addition of this intervention that targets SB to a conventional weight loss intervention that targets exercise results in lower long-term reduction in weight in older, obese adults. This will be accomplished with a 24-month trial in 225 obese (BMI=30-40 kg/m2) older (65-79 yrs) adults randomized to one of three treatments (n=75), all with dietary caloric restriction plus either: 1) moderate-intensity aerobic exercise (WL+EX); 2) intervening on SB (WL+SitLess); or 3) (WL+EX+SitLess). The primary hypothesis is that: WL+EX+SitLess will have lower 24-month body weight than either WL+EX or WL+SitLess. Secondary outcomes, including resting and physical activity energy expenditure, SB, dietary intake and appetite, body composition/bone density, physical function, cardiometabolic risk and intervention process measures, will also be examined. The results will provide the first randomized, controlled trial data on the efficacy of self-monitoring of a key contributor to the adaptive thermogenic response to weight loss. Increasing awareness of weight loss-induced reductions in SPA, and behavioral promotion of decreasing SB to counteract these reductions, may provide for a more effective, safe, non- pharmacologic, and sustainable strategy to reduce weight regain after weight loss in older adults.

Public Health Relevance

Science has discovered that the difficulty in maintaining weight loss is partially because of declines in energy expenditure that occur when a person loses weight. One of the behaviors that contribute to this is increased sedentary behavior, or awake time spent sitting or lying down. This study will use a randomized, controlled design to determine whether an intervention focused on increasing awareness of sedentary behavior and strategies to reduce sitting will help prevent weight regain following weight loss in obese older adults. We expect to show that adding this component to a standard weight loss intervention will result in lower body weight and improve other health parameters after two years. In older adults, who have difficulty sustaining a high volume of moderate-intensity exercise, this could prove to be a more effective method for preventing weight regain following weight loss than the conventional approach of intervening on exercise behavior in this population.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
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Clinical and Integrative Diabetes and Obesity Study Section (CIDO)
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Radziszewska, Barbara
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Wake Forest University Health Sciences
Internal Medicine/Medicine
Schools of Medicine
United States
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