Highlights:
The paper reviews evidence on lifestyle-based weight loss in older adults with obesity, showing that caloric restriction reliably reduces fat mass but often leads to concurrent losses in muscle and bone. It identifies resistance training, adequate protein intake, and vitamin D supplementation as the most effective strategies to preserve musculoskeletal health during weight loss, and emphasizes the importance of structured, multimodal interventions..
Key takeaway:
Effective weight-loss programs for older adults should balance fat reduction with muscle and bone preservation. Combining moderate calorie reduction with targeted exercise and nutritional support yields safer, more sustainable outcomes and helps maintain physical function as individuals age.
Dr. Cortes is an assistant professor with the Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes at UT Health San Antonio and a clinical investigator at the Sam and Ann Barshop Institute for Longevity and Aging Studies.
The impact of lifestyle-based weight loss in older adults with obesity on muscle and bone health: a balancing act
Tiffany M Cortes, Kacey Chae, Colleen M Foy, Denise K Houston, Kristen M Beavers
Obesity (Silver Spring). 2025 Nov;33 Suppl 1(Suppl 1):22-40. doi: 10.1002/oby.24229. Epub 2025 Mar 10.
Abstract:
Despite adverse metabolic and functional consequences of obesity (BMI ≥30 kg/m2), clinical recommendations for weight loss (WL) in older adults (65+ years) with obesity remain controversial. Reluctance stems partly from epidemiologic data demonstrating musculoskeletal tissue loss with WL and increased risk of disability and osteoporotic fracture. Randomized controlled trials in older adults complement and extend knowledge in this area showing: (1) lifestyle-based WL interventions often yield clinically meaningful (~8%-10%) WL in older adults; (2) lean mass loss is significant, although fat mass loss is preferential and physical performance is often improved, particularly when combined with aerobic and resistance training (RT); (3) bone loss is also significant, with some evidence that RT can attenuate WL-associated bone loss; and (4) fat mass regain after intervention cessation is common, yet physical performance gains appear to be maintained. Best practices for treating older adults with obesity include comprehensive assessment of baseline musculoskeletal health; patient-centered goal setting; moderate (i.e., -500 kcal/day) caloric restriction ensuring protein (1-1.2 g/kg/day), calcium (1000-1200 mg/day), and vitamin D (800-1000 IU/day) needs are met; incorporation of RT (≥2 days/week) and moderate-intensity weight-bearing aerobic training (≥150 min/week); and delivery of care by a multidisciplinary team.