Multimodale Interventionen in der Therapie von Adipositas im
                    Alter

Eva Kiesswetter; Gabriel Torbahn; Daniel Schoene

doi:10.1055/a-2496-1556

Adipositas - Ursachen, Folgeerkrankungen, Therapie, Table of Contents

Adipositas - Ursachen, Folgeerkrankungen, Therapie 2025; 19(01): 30-38
DOI: 10.1055/a-2496-1556

Review

Multimodale Interventionen in der Therapie von Adipositas im Alter

Multimodal Interventions in the Treatment of Obesity in Older Adults

Eva Kiesswetter

¹Institut für Evidenz in der Medizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs-Universität Freiburg, Freiburg, Deutschland

,

Gabriel Torbahn

²Klinik für Neugeborene, Kinder und Jugendliche, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Universität, Nürnberg, Deutschland

³Universitätsklinik für Kinder- und Jugendheilkunde, Uniklinikum Salzburg/Landeskrankenhaus, Uniklinikum der Paracelsus Medizinischen Universität, Salzburg, Österreich

⁴Universitätsklinik für Kinder- und Jugendheilkunde, Obesity Research Unit, Uniklinikum Salzburg/Landeskrankenhaus, Uniklinikum der Paracelsus Medizinischen Universität, Salzburg, Österreich

,

Daniel Schoene

⁵Abteilung für Geriatrie, Robert Bosch Krankenhaus, Stuttgart, Deutschland

⁶Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm, Ulm, Deutschland

⁷Institut für Radiologie, Universitätsklinikum Erlangen, Erlangen, Deutschland

› Author Affiliations

Abstract

Zusammenfassung

Mit der zunehmenden Prävalenz von Adipositas bei älteren Menschen gewinnen maßgeschneiderte therapeutische Strategien an Bedeutung. Aktuelle Leitlinien empfehlen multimodale Ansätze für das Gewichtsmanagement bei Erwachsenen, enthalten jedoch keine spezifischen Empfehlungen für ältere Menschen. Altersbedingte Veränderungen der Körperzusammensetzung, geriatrische Syndrome und Multimorbidität sind bei Therapieentscheidungen zu berücksichtigen. Eine Gewichtsreduktion kann den altersbedingten Verlust von Muskel- und Knochenmasse verstärken und das Risiko ungünstiger Folgen erhöhen. Daher sind Therapiekonzepte notwendig, die den Verlust von Fettmasse, den Erhalt von Muskel- und Knochenmasse sowie die Verbesserung des funktionellen Status anstreben.

Dieser Artikel gibt einen Überblick über die multimodale Adipositastherapie im Alter und fasst klinische Studien zusammen, die solche Interventionen bei älteren Menschen mit spezifischen Komorbiditäten durchgeführt haben. Multimodale Interventionen, die moderate Kalorienrestriktion, kombiniertes Kraft- und Ausdauertraining sowie verhaltenstherapeutische Strategien umfassen, haben sich als sicher und effektiv erwiesen. Allerdings wurden Komorbiditäten und geriatrische Syndrome in den Studien selten berücksichtigt. Zudem gibt es wenige Studien, die spezielle Krankheitsbilder oder Syndrome wie Herzinsuffizienz, Arthrose oder Gebrechlichkeit als Einschlusskriterium adressieren, was die Übertragbarkeit der Ansätze einschränkt.

Abstract

With the increasing prevalence of obesity in older adults, effective therapeutic strategies tailored to this population are gaining importance. Current guidelines recommend multimodal approaches for weight management in adults but do not provide specific recommendations for older individuals. However, age-related changes in body composition, geriatric syndromes, and multimorbidity, which contribute to functional impairments, must be considered in therapeutic decisions. Weight loss can inadvertently exacerbate the age-induced loss of muscle and bone mass, increasing the risk of adverse outcomes. This highlights the need for therapeutic concepts that target fat mass reduction, muscle and bone mass preservation, and functional status improvement.

This article provides an overview of multimodal obesity therapy in older adults and summarizes clinical studies that have implemented such interventions in older individuals with specific comorbidities. Multimodal interventions combining moderate caloric restriction, strength and endurance training, and behavioral strategies have been shown to be safe and effective for older adults with obesity. However, the underlying studies have largely overlooked comorbidities and geriatric syndromes. Additionally, few studies have included specific diseases or syndromes, such as heart failure, osteoarthritis, or frailty, as inclusion criteria, limiting the applicability of these approaches to these groups.

Schlüsselwörter

Altern - Adipositas - multimodale Interventionen - Komorbiditäten - Frailty

Keywords

Aged - obesity - multimodal interventions - comorbidities - frailty

Full Text

References

Literatur
1 Hajek A, Lehnert T, Ernst A. et al. Prevalence and determinants of overweight and obesity in old age in Germany. BMC Geriatr 2015; 15: 83
2 Fischer B, Sedlmeier AM, Hartwig S. et al. Anthropometric measures in the German National Cohort-more than weight and height. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63: 290-300
3 Gemeinsamer Bundesausschuss (G-BA). Regionale Verträge für ein DMP Adipositas ab sofort möglich [press release]. 2024. https://www.g-ba.de/presse/pressemitteilungen-meldungen/1196/
4 Deutsche Adipositas-Gesellschaft (DAG) e.V. S3-Leitlinie Adipositas – Prävention und Therapie Version 5.0 Oktober 2024. Zugriff am 08.11.2024 unter: https://register.awmf.org/de/leitlinien/detail/050-001
5 Henney AE, Wilding JPH, Alam U. et al Obesity pharmacotherapy in older adults: a narrative review of evidence. Int J Obes (Lond) 2024; Online ahead of print
6 Colleluori G, Villareal DT. Aging, obesity, sarcopenia and the effect of diet and exercise intervention. Exp Gerontol 2021; 155: 111561
7 Schoene D, Kiesswetter E, Sieber CC. et al. Musculoskeletal factors, sarcopenia and falls in old age. Z Gerontol Geriatr 2019; 52: 37-44
8 Ferrucci L, de Cabo R, Knuth ND. et al. Of Greek heroes, wiggling worms, mighty mice, and old body builders. J Gerontol A Biol Sci Med Sci 2012; 67: 13-16
9 Kirk B, Cawthon PM, Arai H. et al The Conceptual Definition of Sarcopenia: Delphi Consensus from the Global Leadership Initiative in Sarcopenia (GLIS). Age Ageing 2024; 53: afae052 DOI:
10 Petermann-Rocha F, Balntzi V, Gray SR. et al. Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2022; 13: 86-99
11 Donini LM, Busetto L, Bischoff SC. et al. Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement. Clin Nutr 2022; 41: 990-1000
12 Lynch DH, Petersen CL, Fanous MM. et al. The relationship between multimorbidity, obesity and functional impairment in older adults. J Am Geriatr Soc 2022; 70: 1442-1449
13 Inouye SK, Studenski S, Tinetti ME. et al. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc 2007; 55: 780-791
14 Clegg A, Young J, Iliffe S. et al. Frailty in elderly people. Lancet 2013; 381: 752-762
15 Mathus-Vliegen EM. Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline. Obes Facts 2012; 5: 460-483
16 Torbahn G, Schoene D, Schwingshackl L. et al. Effective SLOPE: EffectS of Lifestyle interventions in Older PEople with obesity: a systematic review and network meta-analysis protocol. BMJ Open 2020; 10: e038330
17 Villareal DT, Aguirre L, Gurney AB. et al. Aerobic or Resistance Exercise, or Both, in Dieting Obese Older Adults. N Engl J Med 2017; 376: 1943-1955
18 Villareal DT, Banks M, Sinacore DR. et al. Effect of weight loss and exercise on frailty in obese older adults. Arch Intern Med 2006; 166: 860-866
19 Villareal DT, Chode S, Parimi N. et al. Weight loss, exercise, or both and physical function in obese older adults. N Engl J Med 2011; 364: 1218-1229
20 Volkert D, Beck AM, Cederholm T. et al. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 2019; 38: 10-47
21 Miller GD, Nicklas BJ, Davis C. et al. Intensive weight loss program improves physical function in older obese adults with knee osteoarthritis. Obesity (Silver Spring) 2006; 14: 1219-1230
22 Görlitz A, Koching M, Torbahn G. et al. Lebensstilinterventionen bei älteren Menschen mit Adipositas: Gründe, Barrieren und Unterstützungsbedarfe – eine qualitative Studie. Adipositas 2022; 26: 159-165
23 Yin YH, Liu JYW, Valimaki M. Dietary behaviour change intervention for managing sarcopenic obesity among community-dwelling older people: a pilot randomised controlled trial. BMC Geriatr 2023; 23: 597
24 Muscariello E, Nasti G, Siervo M. et al. Dietary protein intake in sarcopenic obese older women. Clin Interv Aging 2016; 11: 133-140
25 Richter M, Baerlocher K, Bauer JM. et al. Revised Reference Values for the Intake of Protein. Ann Nutr Metab 2019; 74: 242-250
26 Kim JE, O'Connor LE, Sands LP. et al. Effects of dietary protein intake on body composition changes after weight loss in older adults: a systematic review and meta-analysis. Nutr Rev 2016; 74: 210-224
27 Coppock JA, McNulty AL, Porter Starr KN. et al. The effects of a 6-month weight loss intervention on physical function and serum biomarkers in older adults with and without osteoarthritis. Osteoarthr Cartil Open 2023; 5: 100376
28 Porter Starr KN, Pieper CF, Orenduff MC. et al. Improved Function With Enhanced Protein Intake per Meal: A Pilot Study of Weight Reduction in Frail, Obese Older Adults. J Gerontol A Biol Sci Med Sci 2016; 71: 1369-1375
29 Villareal DT, Apovian CM, Kushner RF. et al. Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society. Obesity research 2005; 13: 1849-1863
30 Batsis JA, Gill LE, Masutani RK. et al. Weight Loss Interventions in Older Adults with Obesity: A Systematic Review of Randomized Controlled Trials Since 2005. J Am Geriatr Soc 2017; 65: 257-268
31 Stiegler P, Cunliffe A. The role of diet and exercise for the maintenance of fat-free mass and resting metabolic rate during weight loss. Sports Med 2006; 36: 239-262
32 Pedersen BK, Saltin B. Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 2015; 25: 1-72
33 Deschenes MR. Effects of aging on muscle fibre type and size. Sports Med 2004; 34: 809-824
34 Kraemer WJ, Ratamess NA. Fundamentals of resistance training: progression and exercise prescription. Med Sci Sports Exerc 2004; 36: 674-688
35 Kemmler W, Teschler M, Weissenfels A. et al. Whole-body electromyostimulation to fight sarcopenic obesity in community-dwelling older women at risk. Resultsof the randomized controlled FORMOsA-sarcopenic obesity study. Osteoporos Int 2016; 27: 3261-3270
36 Kemmler W, Weissenfels A, Teschler M. et al. Whole-body electromyostimulation and protein supplementation favorably affect sarcopenic obesity in community-dwelling older men at risk: the randomized controlled FranSO study. Clin Interv Aging 2017; 12: 1503-1513
37 Schoene D, Gross M, von Stengel S. et al. Recommendations on Physical Exercise and Fall Prevention in Older Community-Dwelling Adults. Osteologie 2023; 32: 183-195
38 Bull FC, Al-Ansari SS, Biddle S. et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020; 54: 1451-1462
39 Jackson SE, Holter L, Beeken RJ. ‘Just because Iʼm old it doesnʼt mean I have to be fat’: a qualitative study exploring older adultsʼ views and experiences of weight management. BMJ Open 2019; 9: e025680
40 Koca M, Dobbie LJ, Ciudin A. et al Behaviour therapy for obesity in older adults. Eur J Intern Med 2024; Online ahead of print
41 Nicklas BJ, Gaukstern JE, Beavers KM. et al. Self-monitoring of spontaneous physical activity and sedentary behavior to prevent weight regain in older adults. Obesity (Silver Spring) 2014; 22: 1406-1412
42 Villareal DT, Shah K, Banks MR. et al. Effect of weight loss and exercise therapy on bone metabolism and mass in obese older adults: a one-year randomized controlled trial. J Clin Endocrinol Metab 2008; 93: 2181-2187
43 Serra-Prat M, Terradellas M, Lorenzo I. et al. Effectiveness of a Weight-Loss Intervention in Preventing Frailty and Functional Decline in Community-Dwelling Obese Older People. A Randomized Controlled Trial. J Frailty Aging 2022; 11: 91-99
44 Brubaker PH, Nicklas BJ, Houston DK. et al. A Randomized, Controlled Trial of Resistance Training Added to Caloric Restriction Plus Aerobic Exercise Training in Obese Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2023; 16: e010161
45 Kitzman DW, Brubaker P, Morgan T. et al. Effect of Caloric Restriction or Aerobic Exercise Training on Peak Oxygen Consumption and Quality of Life in Obese Older Patients With Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial. Jama 2016; 315: 36-46
46 Ard JD, Carson TL, Shikany JM. et al. Weight loss and improved metabolic outcomes amongst rural African American women in the Deep South: six-month outcomes from a community-based randomized trial. J Intern Med 2017; 282: 102-113
47 Nabuco HCG, Tomeleri CM, Fernandes RR. et al. Effect of whey protein supplementation combined with resistance training on body composition, muscular strength, functional capacity, and plasma-metabolism biomarkers in older women with sarcopenic obesity: A randomized, double-blind, placebo-controlled trial. Clin Nutr ESPEN 2019; 32: 88-95
48 Nicklas BJ, Brinkley TE, Houston DK. et al. Effects of Caloric Restriction on Cardiorespiratory Fitness, Fatigue, and Disability Responses to Aerobic Exercise in Older Adults With Obesity: A Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2019; 74: 1084-1090
49 Normandin E, Yow D, Crotts C. et al. Feasibility of Weighted Vest Use during a Dietary Weight Loss Intervention and Effects on Body Composition and Physical Function in Older Adults. J Frailty Aging 2018; 7: 198-203
50 O'Leary VB, Jorett AE, Marchetti CM. et al. Enhanced adiponectin multimer ratio and skeletal muscle adiponectin receptor expression following exercise training and diet in older insulin-resistant adults. Am J Physiol Endocrinol Metab 2007; 293: E421-E4217
51 Solomon TP, Haus JM, Marchetti CM. et al. Effects of exercise training and diet on lipid kinetics during free fatty acid-induced insulin resistance in older obese humans with impaired glucose tolerance. Am J Physiol Endocrinol Metab 2009; 297: E552-E559
52 Yassine HN, Marchetti CM, Krishnan RK. et al. Effects of exercise and caloric restriction on insulin resistance and cardiometabolic risk factors in older obese adults--a randomized clinical trial. J Gerontol A Biol Sci Med Sci 2009; 64: 90-95
53 Beavers KM, Walkup MP, Weaver AA. et al. Effect of Exercise Modality During Weight Loss on Bone Health in Older Adults With Obesity and Cardiovascular Disease or Metabolic Syndrome: A Randomized Controlled Trial. J Bone Miner Res 2018; 33: 2140-2149
54 Rejeski WJ, Ambrosius WT, Burdette JH. et al. Community Weight Loss to Combat Obesity and Disability in At-Risk Older Adults. J Gerontol A Biol Sci Med Sci 2017; 72: 1547-1553
55 Celli A, Barnouin Y, Jiang B. et al. Lifestyle Intervention Strategy to Treat Diabetes in Older Adults: A Randomized Controlled Trial. Diabetes Care 2022; 45: 1943-1952
56 Messier SP, Beavers DP, Queen K. et al. Effect of Diet and Exercise on Knee Pain in Patients With Osteoarthritis and Overweight or Obesity: A Randomized Clinical Trial. JAMA 2022; 328: 2242-2251
57 Messier SP, Mihalko SL, Legault C. et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA 2013; 310: 1263-1273
58 Andonian BJ, Ross LM, Sudnick AM. et al. Effect of Remotely Supervised Weight Loss and Exercise Training Versus Lifestyle Counseling on Cardiovascular Risk and Clinical Outcomes in Older Adults With Rheumatoid Arthritis: A Randomized Controlled Trial. ACR Open Rheumatol 2024; 6: 124-136
59 Goisser S, Kiesswetter E, Schoene D. et al. Dietary weight-loss interventions for the management of obesity in older adults. Rev Endocr Metab Disord 2020; 21: 355-368