Want to lose more weight? Intensive therapy from dietitians can help older adults, study finds

Older adults may have better success at losing weight if they do it with the help of intensive behavioral therapy from dietitians, a new study suggests.

Intensive behavioral therapy for obesity, or IBTO, is a customized treatment that helps people change their eating and exercise behaviors through a series of one-on-one counseling sessions.

It’s also a treatment that can be difficult for primary care doctors to do on top of other responsibilities, so a research team from East Carolina University set out to discover IBTO’s effectiveness if a dietitian is added to the team.

RDNs, or registered dietitian nutritionists, are trained for both weight loss and nutrition therapy, and can help support physicians in addressing underlying diet and lifestyle risk factors for chronic diseases, said Dr. Lauren Sastre, an author of the study and assistant nutrition science professor at East Carolina University.

And, the study notes, IBTO is already provided and reimbursed for Medicare B recipients, who would be age 65 or older. As the prevalence of obesity in the US has increased to include nearly 40% of the adult population, Sastre and her team found that IBTO with a dietitian is an effective method to addressing not only obesity in older adults but its associated conditions, such as type 2 diabetes.

Their results showed that the patients who received the treatment lost nearly three pounds on average and improved other health outcomes in comparison to those who did not receive IBTO.

“Coupled with the fact that nutrition is not required content in medical school curricula, medical professionals may not have the time or the skills to develop and implement nutrition interventions for patients,” said Dr. Emily Wilcox Gier, Dietetics Program Leader for the Division of Nutritional Sciences at Cornell University, who wasn’t part of the study. “Referring patients to [dietitians] is an easy, cost-effective and necessary step to ensure that patients receive the treatment they need to meet weight loss goals.”

Losing weight with a dietitian

The study involved 2,097 women age 65 and older who received Medicare insurance. They all had a body mass index above 30, which classified them as obese, according to the CDC. The women were then divided into a treatment group and a non-treatment group, with nearly 700 of the participants receiving IBTO.

At the first visit, dietitians helped patients establish their calorie limit and food-tracking method based on their personal habits and preferences. Subsequent sessions were check-ins in which patients focused on improving their exercise habits and diet.

The researchers also measured the patients’ weight, BMI, A1C and medication use. A1C is a blood test that helps doctors make a diagnosis for pre-diabetes and type 2 diabetes by measuring your average blood sugar level over the past three months. It also can show how well a person has been managing their diabetes.

After three years of treatment, from 2016 to 2019, patients who received IBTO experienced greater BMI decreases, larger A1C declines and stopped taking their prescription medication sooner, the study found.

Patients in the treatment group lost nearly three pounds on average, compared with patients in the control group who gained an average of a half a pound. They also had an average A1C decline of nearly 0.2, which previous research has associated with an up to 10% reduction in death risk.

“[Dietitians] have the knowledge and skills to work with patients [or] clients on an individual basis to develop interventions that work,” said Dr. Emily Wilcox Gier, dietetics program leader for the Division of Nutritional Sciences at Cornell University, who wasn’t part of the study. “[Dietitians] know how to tailor nutrition recommendations to fit one’s needs, including medical conditions, living situations and preferences. This evidence helps support the fact that our training helps patients meet their weight loss goals.”

Demographic differences did affect the patients’ results, however, as the study notes that minorities and older respondents experienced smaller results.

Yet given the overall results found for lowering A1C, the researchers think the intensive therapy model advised by a dietitian could be helpful for people who aren’t obese but do have diabetes — although current requirements for Medicare IBTO include having a BMI of more than 30.