Lifestyle Behavioral Strategies for Weight Loss in Older Adults

Main Article Content

Julia M. Scarcella, BS Sarah H. Smitherman, BS Gary D. Miller, PhD

Abstract

There is a rising prevalence of both obesity (defined as a body mass index of > 30.0 kg/m2) and the number of individuals over the age of 60 years.  Currently ~40% of older adults are obese and the number of individuals over the age of 65 is expected to reach 82 million by 2050.  Obesity is also estimated to affect 50% of older adults in next few decades.  This combination makes this a very concerning health issue.  While intentional weight loss benefits young- to middle- aged adults, this is not so clear with older adults.  Due to the loss of fat free mass, including skeletal muscle and bone mineral density, there is an increased risk of impaired physical function, fractures, and even mortality in this older cohort.  Complicating whether to advise older adults to attempt to lose weight or not is the fact that about 1 in 5 individuals rescind and gain back most if not all of lost weight.  This weight regain is mostly as fat and it is deposited into ectopic fat depots, potentially making cardiometabolic risk worse.  Caloric restriction using a variety of diet patterns and macronutrient distributions can be successful, at least in the short-term.  Additionally, combining resistance and aerobic exercise training with caloric restriction seems to provide the best results with regards to protecting loss of skeletal muscle and bone mineral density.  Finally, time restricted eating is a novel approach for combating the detrimental effects of obesity and aging.

Article Details

How to Cite
SCARCELLA, Julia M.; SMITHERMAN, Sarah H.; MILLER, Gary D.. Lifestyle Behavioral Strategies for Weight Loss in Older Adults. Medical Research Archives, [S.l.], v. 12, n. 7, july 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5650>. Date accessed: 05 aug. 2024. doi: https://doi.org/10.18103/mra.v12i7.5650.
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Research Articles

References

1. Massetti GM, Dietz WH, Richardson LC. Excessive Weight Gain, Obesity, and Cancer: Opportunities for Clinical Intervention. JAMA. 2017;318(20):1975-1976. Doi;10.1001/jama.2017.15519
2. National Health Statistics Reports, Number 158, June 14, 2021. 2021;(158).
3. Flegal KM, Kruszon-Moran D, Carroll MD, et al. Trends in Obesity Among Adults in the United States, 2005 to 2014. Jama. 2016;315(21):2284-2284. Doi;10.1001/jama.2016.6458
4. Ageing and health. Accessed June 1, 2024. https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
5. Siervogel RM, Wisemandle W, Maynard LM, et al. Serial changes in body composition throughout adulthood and their relationships to changes in lipid and lipoprotein levels. The Fels Longitudinal Study. Arterioscler Thromb Vasc Biol. 1998;18(11):1759-1764. Doi;10.1161/01.atv.18.11.1759
6. Kuk JL, Saunders TJ, Davidson LE, Ross R. Age-related changes in total and regional fat distribution. Ageing Res Rev. 2009;8(4):339-348. Doi;10.1016/j.arr.2009.06.001
7. Hughes VA, Frontera WR, Roubenoff R, Evans WJ, Singh MA. Longitudinal changes in body composition in older men and women: role of body weight change and physical activity. AmJClinNutr. 2002;76(2):473-481.
8. Colleluori G, Villareal DT. Aging, obesity, sarcopenia and the effect of diet and exercise intervention. Exp Gerontol. 2021;155:111561. Doi;10.1016/j.exger.2021.111561
9. Sun H, Saeedi P, Karuranga S, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. Doi;10.1016/j.diabres.2021.109119
10. Tieland M, Dirks ML, van der Zwaluw N, et al. Protein supplementation increases muscle mass gain during prolonged resistance-type exercise training in frail elderly people: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc. 2012;13(8):713-719. Doi;10.1016/j.jamda.2012.05.020
11. Rejeski WJ, Marsh a. P, Chmelo E, Rejeski JJ. Obesity, intentional weight loss and physical disability in older adults. ObesRev. 2010;11(9):671-685. Doi;10.1111/j.1467-789X.2009.00679.x
12. Houston DK, Nicklas BJ, Zizza C a. Weighty Concerns: The Growing Prevalence of Obesity among Older Adults. J Am Diet Assoc. 2009;109(11):1886-1895. Doi;10.1016/j.jada.2009.08.014
13. Agha M, Agha R. The rising prevalence of obesity: part A: impact on public health. Int J Surg Oncol. 2017;2(7):e17. Doi;10.1097/IJ9.0000000000000017
14. Doucet E, St Pierre S, Alméras N, Mauriège P, Richard D, Tremblay A. Changes in energy expenditure and substrate oxidation resulting from weight loss in obese men and women: is there an important contribution of leptin? J Clin Endocrinol Metab. 2000;85(4):1550-1556. Doi;10.1210/jcem.85.4.6500
15. Sowers M, Zheng H, Tomey K, et al. Changes in body composition in women over six years at midlife: ovarian and chronological aging. J Clin Endocrinol Metab. 2007;92(3):895-901. Doi;10.1210/jc.2006-1393
16. Villareal DT, Apovian CM, Kushner RF, Klein S. Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society. ObesRes. 2005;13(11):1849-1863. Doi;10.1038/oby.2005.228
17. Cummings SR, Black DM, Nevitt MC, et al. Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet Lond Engl. 1993;341(8837):72-75. Doi;10.1016/0140-6736(93)92555-8
18. Villareal DT, Banks M, Siener C, Sinacore DR, Klein S. Physical Frailty and Body Composition in Obese Elderly Men and Women. Obes Res. 2004;12(6):913-920. http://www.obesityresearch.org/cgi/content/abstract/12/6/913
19. Nielson CM, Marshall LM, Adams AL, et al. BMI and fracture risk in older men: the osteoporotic fractures in men study (MrOS). J Bone Miner Res Off J Am Soc Bone Miner Res. 2011;26(3):496-502. Doi;10.1002/jbmr.235
20. Johnson KC, Bray GA, Cheskin LJ, et al. The Effect of Intentional Weight Loss on Fracture Risk in Persons With Diabetes: Results From the Look AHEAD Randomized Clinical Trial. J Bone Miner Res. 2017;32(11):2278-2287. Doi;10.1002/jbmr.3214
21. Wu H, Ballantyne CM. Skeletal muscle inflammation and insulin resistance in obesity. J Clin Invest. 2017;127(1):43-54. Doi;10.1172/JCI88880
22. Burd NA, Gorissen SH, van Loon LJC. Anabolic resistance of muscle protein synthesis with aging. Exerc Sport Sci Rev. 2013;41(3):169-173. Doi;10.1097/JES.0b013e318292f3d5
23. Mundstock E, Sarria EE, Zatti H, et al. Effect of obesity on telomere length: Systematic review and meta-analysis. Obes Silver Spring Md. 2015;23(11):2165-2174. Doi;10.1002/oby.21183
24. Salvestrini V, Sell C, Lorenzini A. Obesity May Accelerate the Aging Process. Front Endocrinol. 2019;10:266. Doi;10.3389/fendo.2019.00266
25. Susmallian S, Barnea R, Weiss Y, Raziel A. Outcome of bariatric surgery in older patients. Surg Obes Relat Dis. 2018;14(11):1705-1713. Doi;10.1016/j.soard.2018.08.007
26. Aryannezhad S, Khalaj A, Hosseinpanah F, Mahdavi M, Valizadeh M, Barzin M. One-year outcomes of bariatric surgery in older adults: a case-matched analysis based on the Tehran Obesity Treatment Study. Surg Today. 2021;51(1):61-69. Doi;10.1007/s00595-020-02079-3
27. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults. J Am Coll Cardiol. 2014;63(25):2985-3023. Doi;10.1016/j.jacc.2013.11.004
28. 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(2):257-268. Doi;10.1111/jgs.14514
29. Locher JL, Goldsby TU, Goss AM, Kilgore ML, Gower B, Ard JD. Calorie restriction in overweight older adults: Do benefits exceed potential risks? Exp Gerontol. 2016;86:4-13. Doi;10.1016/j.exger.2016.03.009
30. Tirosh A, de Souza RJ, Sacks F, Bray GA, Smith SR, LeBoff MS. Sex Differences in the Effects of Weight Loss Diets on Bone Mineral Density and Body Composition: POUNDS LOST Trial. J Clin Endocrinol Metab. 2015;100(6):2463-2471. Doi;10.1210/jc.2015-1050
31. Colleluori G, Villareal DT. Weight strategy in older adults with obesity: calorie restriction or not? Curr Opin Clin Nutr Metab Care. 2023;26(1):17-22. Doi;10.1097/MCO.0000000000000879
32. Chaston TB, Dixon JB, O’Brien PE. Changes in fat-free mass during significant weight loss: a systematic review. Int J Obes 2005. 2007;31(5):743-750. Doi;10.1038/sj.ijo.0803483
33. Gielen E, Beckwée D, Delaere A, et al. Nutritional interventions to improve muscle mass, muscle strength, and physical performance in older people: an umbrella review of systematic reviews and meta-analyses. Nutr Rev. 2021;79(2):121-147. Doi;10.1093/nutrit/nuaa011
34. Wu X, Zhang C, Liang Z, Liang Y, Li Y, Qiu J. Exercise Combined with a Low-Calorie Diet Improves Body Composition, Attenuates Muscle Mass Loss, and Regulates Appetite in Adult Women with High Body Fat Percentage but Normal BMI. Sports. 2024;12(4):91. Doi;10.3390/sports12040091
35. Beavers KM, Beavers DP, Martin SB, et al. Change in Bone Mineral Density During Weight Loss with Resistance Versus Aerobic Exercise Training in Older Adults. J Gerontol Ser A. 2017;72(11):1582-1585. Doi;10.1093/gerona/glx048
36. Martínez-Amat A, Aibar-Almazán A, Fábrega-Cuadros R, et al. Exercise alone or combined with dietary supplements for sarcopenic obesity in community-dwelling older people: A systematic review of randomized controlled trials. Maturitas. 2018;110:92-103. Doi;10.1016/j.maturitas.2018.02.005
37. Frank LL, Sorensen BE, Yasui Y, et al. Effects of exercise on metabolic risk variables in overweight postmenopausal women: a randomized clinical trial. Obes Res. 2005;13(3):615-625. Doi;10.1038/oby.2005.66
38. Wannamethee SG, Shaper AG, Walker M. Weight change, weight fluctuation, and mortality. Arch Intern Med. 2002;162(22):2575-2580. Doi;10.1001/archinte.162.22.2575
39. Volpato S, Guralnik JM, Ferrucci L, et al. Cardiovascular disease, interleukin-6, and risk of mortality in older women: the women’s health and aging study. Circulation. 2001;103(7):947-953. Doi;10.1161/01.cir.103.7.947
40. 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(12):1263-1273. Doi;10.1001/jama.2013.277669
41. Beavers KM, Ambrosius WT, Nicklas BJ, Rejeski WJ. Independent and combined effects of physical activity and weight loss on inflammatory biomarkers in overweight and obese older adults. J Am Geriatr Soc. 2013;61(7):1089-1094. Doi;10.1111/jgs.12321
42. Whelton PK, Appel LJ, Espeland MA, et al. 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. JAMA. 1998;279(11):839-846. http://www.ncbi.nlm.nih.gov/pubmed/9515998
43. Espeland MA, Rejeski WJ, West DS, et al. Intensive weight loss intervention in older individuals: results from the Action for Health in Diabetes Type 2 diabetes mellitus trial. J Am Geriatr Soc. 2013;61(6):912-922. Doi;10.1111/jgs.12271
44. Studenski S, Perera S, Patel K, et al. Gait speed and survival in older adults. JAMA. 2011;305(1):50-58. Doi;10.1001/jama.2010.1923
45. 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(13):1218-1229. Doi;10.1056/NEJMoa1008234
46. Messier SP, Loeser RF, Miller GD, et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis Rheum. 2004;50(5):1501-1510. http://www.ncbi.nlm.nih.gov/pubmed/15146420
47. Lee JS, Kritchevsky SB, Tylavsky FA, et al. Weight-loss intention in the well-functioning, community-dwelling elderly: associations with diet quality, physical activity, and weight change. Am J Clin Nutr. 2004;80(2):466-474. http://www.ajcn.org/cgi/content/abstract/80/2/466
48. Rejeski WJ, Brubaker PH, Goff Jr. DC, et al. Translating weight loss and physical activity programs into the community to preserve mobility in older, obese adults in poor cardiovascular health. ArchInternMed. 2011;171(10):880-886. Doi;10.1001/archinternmed.2010.522
49. Kritchevsky SB, Beavers KM, Miller ME, et al. Intentional Weight Loss and All-Cause Mortality: A Meta-Analysis of Randomized Clinical Trials. Wu WCH, ed. PLOS ONE. 2015;10(3):e0121993. Doi;10.1371/journal.pone.0121993
50. Harrington M, Gibson S, Cottrell RC. A review and meta-analysis of the effect of weight loss on all-cause mortality risk. Nutr Res Rev. 2009;22(1):93-108. Doi;10.1017/S0954422409990035
51. Bales CW, Buhr G. Is obesity bad for older persons? A systematic review of the pros and cons of weight reduction in later life. JAmMedDirAssoc. 2008;9(5):302-312. http://www.ncbi.nlm.nih.gov/pubmed/18519110
52. Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr. 2005;82(1 Suppl):222S-225S. Doi;10.1093/ajcn/82.1.222S
53. Anderson JW, Konz EC, Frederich RC, Wood CL. Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr. 2001;74(5):579-584. Doi;10.1093/ajcn/74.5.579
54. Dabas J, Shunmukha Priya S, Alawani A, Budhrani P. What could be the reasons for not losing weight even after following a weight loss program? J Health Popul Nutr. 2024;43(1):37. Doi;10.1186/s41043-024-00516-4
55. Paintin J, Cooper C, Dennison E. Osteosarcopenia. Br J Hosp Med Lond Engl 2005. 2018;79(5):253-258. Doi;10.12968/hmed.2018.79.5.253
56. Kirk B, Zanker J, Duque G. Osteosarcopenia: epidemiology, diagnosis, and treatment-facts and numbers. J Cachexia Sarcopenia Muscle. 2020;11(3):609-618. Doi;10.1002/jcsm.12567
57. Beavers KM, Lyles MF, Davis CC, Wang X, Beavers DP, Nicklas BJ. Is lost lean mass from intentional weight loss recovered during weight regain in postmenopausal women? AmJClinNutr. 2011;94(3):767-774. Doi;10.3945/ajcn.110.004895
58. Chmelo EA, Beavers DP, Lyles MF, Marsh AP, Nicklas BJ, Beavers KM. Legacy effects of short-term intentional weight loss on total body and thigh composition in overweight and obese older adults. Nutr Diabetes. 2016;6(4):e203. Doi;10.1038/nutd.2016.8
59. Kammire DE, Walkup MP, Ambrosius WT, et al. Effect of Weight Change Following Intentional Weight Loss on Bone Health in Older Adults with Obesity. Obes Silver Spring Md. 2019;27(11):1839-1845. Doi;10.1002/oby.22604
60. Mitchell NS, Furniss AL, Helmkamp LJ, Van Pelt RE. Factors Associated with Achievement of Clinically Significant Weight Loss by Women in a National Nonprofit Weight Loss Program. J Womens Health 2002. 2017;26(8):911-917. Doi;10.1089/jwh.2016.6264
61. Burgess E, Hassmén P, Pumpa KL. Determinants of adherence to lifestyle intervention in adults with obesity: a systematic review. Clin Obes. 2017;7(3):123-135. Doi;10.1111/cob.12183
62. Speakman JR, Mitchell SE. Caloric restriction. Mol Aspects Med. 2011;32(3):159-221. Doi;10.1016/j.mam.2011.07.001
63. Villareal DT, Smith GI, Shah K, Mittendorfer B. Effect of Weight Loss on the Rate of Muscle Protein Synthesis During Fasted and Fed Conditions in Obese Older Adults. Obesity. 2012;20(9):1780-1786. Doi;10.1038/oby.2011.280
64. Ho E, Qualls C, Villareal DT. Effect of Diet, Exercise, or Both on Biological Age and Healthy Aging in Older Adults with Obesity: Secondary Analysis of a Randomized Controlled Trial. J Nutr Health Aging. 2022;26(6):552-557. Doi;10.1007/s12603-022-1812-x
65. Johnston BC, Kanters S, Bandayrel K, et al. Comparison of Weight Loss Among Named Diet Programs in Overweight and Obese Adults. JAMA. 2014;312(9):923-923. Doi;10.1001/jama.2014.10397
66. 66. Bazzano LA, He J, Ogden LG, et al. Fruit and vegetable intake and risk of cardiovascular disease in US adults: the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Am J Clin Nutr. 2002;76(1):93-99. Doi;10.1093/ajcn/76.1.93
67. Al-Reshed F, Sindhu S, Al Madhoun A, et al. Low carbohydrate intake correlates with trends of insulin resistance and metabolic acidosis in healthy lean individuals. Front Public Health. 2023;11. Doi;10.3389/fpubh.2023.1115333
68. Kahleova H, Petersen KF, Shulman GI, et al. Effect of a Low-Fat Vegan Diet on Body Weight, Insulin Sensitivity, Postprandial Metabolism, and Intramyocellular and Hepatocellular Lipid Levels in Overweight Adults: A Randomized Clinical Trial. JAMA Netw Open. 2020;3(11):e2025454. Doi;10.1001/jamanetworkopen.2020.25454
69. Verreijen AM, Engberink MF, Memelink RG, van der Plas SE, Visser M, Weijs PJM. Effect of a high protein diet and/or resistance exercise on the preservation of fat free mass during weight loss in overweight and obese older adults: a randomized controlled trial. Nutr J. 2017;16(1):10. Doi;10.1186/s12937-017-0229-6
70. Campos-Nonato I, Hernandez L, Barquera S. Effect of a High-Protein Diet versus Standard-Protein Diet on Weight Loss and Biomarkers of Metabolic Syndrome: A Randomized Clinical Trial. Obes Facts. 2017;10(3):238-251. Doi;10.1159/000471485
71. Kostogrys RB, Franczyk-Żarów M, Maślak E, Topolska K. Effect of low carbohydrate high protein (LCHP) diet on lipid metabolism, liver and kidney function in rats. Environ Toxicol Pharmacol. 2015;39(2):713-719. Doi;10.1016/j.etap.2015.01.008
72. Traylor DA, Gorissen SHM, Phillips SM. Perspective: Protein Requirements and Optimal Intakes in Aging: Are We Ready to Recommend More Than the Recommended Daily Allowance? Adv Nutr. 2018;9(3):171-182. Doi;10.1093/advances/nmy003
73. Kim IY, Park S, Jang J, Wolfe RR. Understanding Muscle Protein Dynamics: Technical Considerations for Advancing Sarcopenia Research. Ann Geriatr Med Res. 2020;24(3):157-165. Doi;10.4235/agmr.20.0041
74. Bhasin S, Apovian CM, Travison TG, et al. Effect of Protein Intake on Lean Body Mass in Functionally Limited Older Men: A Randomized Clinical Trial. JAMA Intern Med. 2018;178(4):530. Doi;10.1001/jamainternmed.2018.0008
75. Olaniyan ET, O’Halloran F, McCarthy AL. Dietary protein considerations for muscle protein synthesis and muscle mass preservation in older adults. Nutr Res Rev. 2021;34(1):147-157. Doi;10.1017/S0954422420000219
76. Kim IY, Schutzler S, Schrader A, et al. Quantity of dietary protein intake, but not pattern of intake, affects net protein balance primarily through differences in protein synthesis in older adults. Am J Physiol Endocrinol Metab. 2015;308(1):E21-28. Doi;10.1152/ajpendo.00382.2014
77. Offringa LC, Hartle JC, Rigdon J, Gardner CD. Changes in Quantity and Sources of Dietary Fiber from Adopting Healthy Low-Fat vs. Healthy Low-Carb Weight Loss Diets: Secondary Analysis of DIETFITS Weight Loss Diet Study. Nutrients. 2021;13(10):3625. Doi;10.3390/nu13103625
78. Heiman ML, Greenway FL. A healthy gastrointestinal microbiome is dependent on dietary diversity. Mol Metab. 2016;5(5):317-320. Doi;10.1016/j.molmet.2016.02.005
79. Grembi JA, Nguyen LH, Haggerty TD, Gardner CD, Holmes SP, Parsonnet J. Gut microbiota plasticity is correlated with sustained weight loss on a low-carb or low-fat dietary intervention. Sci Rep. 2020;10(1):1405. Doi;10.1038/s41598-020-58000-y
80. Home | Dietary Guidelines for Americans. Accessed June 1, 2024. https://www.dietaryguidelines.gov/
81. Murff HJ. In patients with CHD, a Mediterranean vs. low-fat diet reduced major CV events at 7 y. Ann Intern Med. 2022;175(9):JC100. Doi;10.7326/J22-0061
82. Salas-Salvadó J. Effect of a Mediterranean Diet Supplemented With Nuts on Metabolic Syndrome StatusOne-Year Results of the PREDIMED Randomized Trial. Arch Intern Med. 2008;168(22):2449-2449. Doi;10.1001/archinte.168.22.2449
83. Medicine GFIG. Paleo diet: What it is and why it’s not for everyone. good-food. Accessed June 1, 2024. https://health.ucdavis.edu/blog/good-food/paleo-diet-what-it-is-and-why-its-not-for-everyone/2022/04
84. Masharani U, Sherchan P, Schloetter M, et al. Metabolic and physiologic effects from consuming a hunter-gatherer (Paleolithic)-type diet in type 2 diabetes. Eur J Clin Nutr. 2015;69(8):944-948. Doi;10.1038/ejcn.2015.39
85. Stomby A, Simonyte K, Mellberg C, et al. Diet-induced weight loss has chronic tissue-specific effects on glucocorticoid metabolism in overweight postmenopausal women. Int J Obes. 2015;39(5):814-819. Doi;10.1038/ijo.2014.188
86. Intermittent Fasting: What is it, and how does it work? Published September 29, 2023. Accessed June 1, 2024. https://www.hopkinsmedicine.org/health/wellness-and-prevention/intermittent-fasting-what-is-it-and-how-does-it-work
87. de Cabo Rafael, Mattson Mark P. Effects of Intermittent Fasting on Health, Aging, and Disease. N Engl J Med. 2019;381(26):2541-2551. Doi;10.1056/NEJMra1905136
88. Guo Y, Luo S, Ye Y, Yin S, Fan J, Xia M. Intermittent Fasting Improves Cardiometabolic Risk Factors and Alters Gut Microbiota in Metabolic Syndrome Patients. J Clin Endocrinol Metab. 2021;106(1):64-79. Doi;10.1210/clinem/dgaa644
89. Chair SY, Cai H, Cao X, Qin Y, Cheng HY, Ng MT. Intermittent Fasting in Weight Loss and Cardiometabolic Risk Reduction: A Randomized Controlled Trial. J Nurs Res. 2022;30(1):e185. Doi;10.1097/jnr.0000000000000469
90. Domaszewski P, Konieczny M, Dybek T, et al. Comparison of the effects of six-week time-restricted eating on weight loss, body composition, and visceral fat in overweight older men and women. Exp Gerontol. 2023;174:112116. Doi;10.1016/j.exger.2023.112116
91. Schroder JD, Falqueto H, Mânica A, et al. Effects of time-restricted feeding in weight loss, metabolic syndrome and cardiovascular risk in obese women. J Transl Med. 2021;19(1):3. Doi;10.1186/s12967-020-02687-0
92. Panda S, Maier G, Villareal DT. Targeting Energy Intake and Circadian Biology to Engage Mechanisms of Aging in Older Adults With Obesity: Calorie Restriction and Time-Restricted Eating. Lipsitz LA, ed. J Gerontol Ser A. 2023;78(Supplement_1): 79-85. Doi;10.1093/gerona/glad069
93. Aoyama S, Shibata S. The Role of Circadian Rhythms in Muscular and Osseous Physiology and Their Regulation by Nutrition and Exercise. Front Neurosci. 2017;11. Doi;10.3389/fnins.2017.00063
94. Hood S, Amir S. The aging clock: circadian rhythms and later life. J Clin Invest. 2017;127(2):437-446. Doi;10.1172/JCI90328
95. Choi YI, Park DK, Chung JW, Kim KO, Kwon KA, Kim YJ. Circadian rhythm disruption is associated with an increased risk of sarcopenia: a nationwide population-based study in Korea. Sci Rep. 2019;9(1):12015. Doi;10.1038/s41598-019-48161-w
96. Moro T, Tinsley G, Pacelli FQ, Marcolin G, Bianco A, Paoli A. Twelve Months of Time-restricted Eating and Resistance Training Improves Inflammatory Markers and Cardiometabolic Risk Factors. Med Sci Sports Exerc. 2021;53(12):2577. Doi;10.1249/MSS.0000000000002738
97. Villanueva JE, Livelo C, Trujillo AS, et al. Time-restricted feeding restores muscle function in Drosophila models of obesity and circadian-rhythm disruption. Nat Commun. 2019;10(1):2700. Doi;10.1038/s41467-019-10563-9
98. 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(20):1943-1955. Doi;10.1056/NEJMoa1616338
99. Beavers KM, Ambrosius WT, Rejeski WJ, et al. Effect of Exercise Type During Intentional Weight Loss on Body Composition in Older Adults with Obesity. Obes Silver Spring Md. 2017;25(11):1823-1829. Doi;10.1002/oby.21977
100. Waters DL, Aguirre L, Gurney B, et al. Effect of Aerobic or Resistance Exercise, or Both, on Intermuscular and Visceral Fat and Physical and Metabolic Function in Older Adults With Obesity While Dieting. Lipsitz L, ed. J Gerontol Ser A. 2022;77(1):131-139. Doi;10.1093/gerona/glab111
101. Ard JD, Miller GD. Lifestyle Therapy as Medicine for the Treatment of Obesity. In: Mechanick JI, Kushner RF, eds. Lifestyle Medicine: A Manual for Clinical Practice. Springer International Publishing; 2016:199-220. Doi;10.1007/978-3-319-24687-1_21
102. Berge J, Hjelmesaeth J, Hertel JK, et al. Effect of Aerobic Exercise Intensity on Energy Expenditure and Weight Loss in Severe Obesity-A Randomized Controlled Trial. Obes Silver Spring Md. 2021;29(2):359-369. Doi;10.1002/oby.23078
103. Kerksick C, Thomas A, Campbell B, et al. Effects of a popular exercise and weight loss program on weight loss, body composition, energy expenditure and health in obese women. Nutr Metab. 2009;6:23. Doi;10.1186/1743-7075-6-23