The Ewing Weight Loss Clinic in Reno, Nevada, stands as a modern medical weight loss center, established in 1998 by osteopathic physician Robert K. Ewing II. For over two decades, the clinic has been dedicated to serving patients in Northern Nevada, providing physician-supervised bariatric programs designed for healthy and lasting weight control.
Personalized Weight Loss Programs at Ewing Weight Loss Reno
Recognizing that there is no one-size-fits-all solution to weight loss, Ewing Weight Loss Reno emphasizes personalized approaches. The clinic acknowledges that individuals achieve successful weight loss through diverse efforts and methodologies. Some patients seek healthier eating programs for gradual weight reduction, while others desire rapid weight loss with trusted medical prescription assistance.
Ewing Weight Loss Reno specializes in four proven weight loss programs, each tailored to individual needs. With over 25 years of experience, their weight loss advisors collaborate with patients to ensure safe and effective weight management.
Program Highlights
Ewing Weight Loss Clinic's rapid weight loss program aims for speedy and safe weight reduction. This program combines an individually customized weight loss plan with meal supplements, potent vitamins and minerals, and affective appetite control medicine. The clinic's medical professionals may prescribe FDA-approved medications targeting both appetite suppression and insulin resistance, such as Phentermine and Metformin.
The Importance of Weight Management
Weight management is crucial for older adults, especially given the risks associated with abdominal adiposity, which is a typical fat redistribution during aging, and the prevalence of comorbid conditions in this age group. However, weight loss approaches must be considered critically, given the dangers of sarcopenia (a condition that occurs when muscle mass and quality is lost), the increase risk of hip fracture with weight loss, and the association between reduced mortality and increased BMI in older adults.
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Obesity in Older Adults: A Growing Concern
Obesity is a pandemic and is increasingly prevalent across the globe. Often overlooked, between 2004 and 2012, the prevalence of obesity in adults aged 60 and older in the United States increased by 4.4% from 31.0% to 35.4%. Such a growing prevalence in older adults is particularly concerning due to the well-established association between obesity, disability and the increase in absolute mortality risk up to age 75.
Obesity is associated with multiple conditions including hypertension, hyperlipidemia, diabetes, and sleep apnea as well as osteoarthritis, cancer, and cognitive dysfunction. The relationship between obesity and many of these conditions helps explain why people with obesity often experience premature death. In addition to increasing disability, morbidity, and mortality, obesity, is associated with greater health care costs. Obesity accounts for up to 2.8% of healthcare expenditure and this number is likely to grow as the prevalence of obesity increases.
Obesity in Older Adults
Aging is associated with loss of fat-free mass (primarily skeletal muscle) and increases in fat mass up to age 70. In the aging process, fat is redistributed centrally from the limbs to the trunk of the body. Physical manifestations of aging lead to a progressive increase in body fat, but also promote sarcopenia, the loss of skeletal muscle mass combined with low muscle function.
Some of the risks associated with obesity differ by age group. For example, higher BMI is associated with lower odds of having hypertension in older adults compared to younger adults and greater body weight increases the risk of death from any cause and cardiovascular disease between age 30 and 74 years.
Limitations of BMI
Body mass index (BMI) is the traditional metric used to assess adiposity by dividing weight (in kg) by height (in m2). This assessment is inexpensive and quick to perform, making it a practical measure to use in clinical settings. However, there are numerous ways in which BMI is a suboptimal measure for obesity in older adults. First, age-typical loss of height due to vertebral body compression and angulation of the spine cause BMI values to overestimate fatness. Second, BMI does not account for fat distribution and it has been shown that visceral fat is characteristic of metabolic syndrome, type 2 diabetes, impaired glucose tolerance, aortic stiffness, and myocardial infarction in women.
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Hence, BMI has been largely criticized for use in older adult populations because it does not account for age related changes in adipose tissue - specifically the ratio between fat mass and fat-free mass. As people age, fat-free mass is replaced by fat mass, therefore BMI underestimates fatness. This change can often lead to normal weight obesity, which is defined as a normal BMI (18.5-25kg/m2) but a high body fat percentage. Normal weight obesity increases risk for cardiometabolic dysregulation, metabolic syndrome, endothelial dysfunction, cardiovascular risk factors, mortality, and disability in older adults.
Alternative Approaches for Assessing Fatness
Clinically valid alternative approaches exist for assessing fatness that range in ease of use and cost to perform. In a study comparing weight, BMI, waist circumference, hip circumference, and waist-hip ratio, waist circumference was the best predictor of mobility disability in men and women. Waist-hip ratio also accurately predicts disability outcomes in men. These anthropometric measures are as inexpensive and easy to perform in practice therefore, they may be used practically to provide additional risk stratification among overweight and obese individuals.
Densitometry can also be used to estimate body composition by measuring total body density. This method involves recording the individual’s weight in air and underwater, and uses density properties to estimate adiposity. Though it is accurate, it is time-consuming, complicated, and places physical demands on the individual, making it unsuitable for many older adults and those with morbid obesity.
Benefits of Weight Loss in Older Adults
Given the plethora of health risks associated with aging, some might ask, why treat obesity in older adults? Obesity is associated with many medical complications, such as metabolic abnormalities, arthritis, pulmonary abnormalities, urinary incontinence, cataracts, and cancer, as well as decreased physical function, quality of life and increased frailty. Compared to other chronic conditions, there is a limited literature base supporting the benefits of weight loss in older adults.
Multiple weight loss interventions have been designed to address cardiovascular disease in obese older adults. Cardiovascular disease is the leading causes of death for persons over 65 years of age. A 12-week weight loss intervention showed improved insulin resistance and cardiometabolic risk factors in obese older adults (mean age of 65.5 years). Exercise and exercise plus caloric restriction were shown to improve insulin sensitivity by 31% and 30% and reduce fasting glucose by 27% and 37% respectively. Blood pressure and lipid profile improved in both groups without a significant difference between comparison and control groups.
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An 18-month weight loss and physical activity intervention significantly improved mobility based on a 400-meter walk test in overweight and obese older adults with cardiovascular disease or cardiometabolic dysfunction. Of particular importance, a study by Rejeski and colleagues found that weight loss must be coupled with physical activity in order to have a significant effect, as opposed to physical activity alone.
An 18-month trial of 288 overweight and obese older adults with, or at risk for, cardiovascular disease showed weight loss and physical activity reduced leptin and high sensitivity interleukin-6, which are two common inflammatory biomarkers. Chronic inflammation is associated with adiposity and increases risk for cardiovascular disease, diabetes, and physical disability.
A randomized controlled trial of an approximately 7-month weight loss and diet intervention in 585 obese older adults (subset of mean age of 66.5 years) with hypertension resulted in a mean 3.5kg reduction in body weight and a decreased the need for antihypertensive medications by 30%. However, this study did not evaluate loss of lean mass and bone density as a potential risk of dietary weight loss interventions in older adults that do not include an exercise component.
In a trial of 316 overweight and obese older adults (mean age of 69.0 years) with knee osteoarthritis, Messier et al. demonstrated an 18-month intervention including exercise and dietary weight loss significantly improved physical function as it related to activities of daily living. Pain was reduced by 30.3% within the 18-month intervention period and mobility also improved. A recent study found that diet and exercise-induced weight loss effectively reduces pain and improves function and quality of life in older adults (mean age of 66.0 years) with knee osteoarthritis in comparison to diet or exercise alone. The authors achieved greater improvements in function and mobility than in their previous study, which they attribute to the use of a social cognitive behavioral framework. Additionally, lean mass increased by 3% relative to total body weight at 18-months which substantially contributes to the encouraging results from weight loss interventions for older adults.
Villareal and colleagues reported that a 1-year weight loss and exercise intervention for obese older adults (mean age of about 70 years) was associated with a loss of 9% of body weight, improved measures of frailty, including the Physical Performance Test, VO2peak, and the Functional Status Questionnaire. This study underscores that exercise should be combined with dietary changes in order to achieve weight loss and treat frailty in older adults.
Two studies by Beavers and colleagues looked at the effects of a weight loss and physical activity in older adults. In the first study of 271 older adults (mean age of 65.4 years), overall weight loss predicted improvement in mobility disability and walking speed. Loss of fat mass was associated with larger improvements in walking speed than loss for body mass. Results also showed loss of lean mass during intentional weight loss did not negatively impact physical function. Based on this finding, the authors suggest that implies muscle quality, rather than quantity, is important for functional performance in older adults.
Two hundred and eighty-eight overweight and obese older adults (mean age of 67.0 years) participated in the second study. During the 12- to 18-month intervention, the physical activity and weight loss group significantly reduced lean and fat mass compared to the physical activity and the weight loss groups, which resulted in a greater percentage of lean mass overall. Improvement in diastolic blood pressure, glucose and HDL-C were associated with loss of fat mass where as improvement in triglycerides, insulin and HOMA-IR were associated with change in fat mass and lean mass. The authors suggest reduction of fat mass and preservation of lean mass should provide maximal cardiometabolic benefits, however, the relationship between the two is complex and should be further explored. Consistent with the other studies discussed in this section, maximal benefit was experienced by individuals in the weight loss and physical activity group as opposed to physical activity alone.
Risks of Weight Loss in Older Adults
The dangers of weight loss in older adults are a legitimate concern of providers and researchers. As demonstrated in both observational and clinical trials, weight loss leads to loss of fat mass and fat-free mass. Approximately one-quarter of all weight lost in older adults during intentional weight loss interventions is fat-free mass which contributes to sarcopenia, the loss of muscle mass and quality. Sarcopenia is associated with impaired instrumental activities of daily living, disability, and frailty. Those with obesity are at high risk of developing sarcopenic obesity, which affects 42.9% and 18.1% of men and women aged 60 and older respectively. Though sarcopenia and sarcopenic obesity are more prevalent in men, women with these conditions have a higher mortality risk. However, studies of sarcopenia and sarcopenic obesity are limited by definitional and case identification discrepancies as well as difficulty measuring muscle quality.
Sarcopenia is also associated with increased healthcare costs. It was estimated that in 2000, the direct cost of sarcopenia in the United States was $18.5 billion or 1.5% of total direct healthcare costs. The same study found if the prevalence of moderate to severe sarcopenia was reduced by 10% than $1.1 billion would be saved annually. Unfortunately, very little has been done to emphasize the importance of resistance training and nutritional management to mitigate weight loss induced sarcopenia.
The Obesity Paradox
Unfortunately, some clinical providers have also resisted recommending weight loss in older adults due to the finding of an “obesity paradox” which describes the relative reduction of risk of mortality for older adults with increase BMI. This phenomenon has been observed for overall mortality and disease-specific mortality, including heart failure, hypertension and coronary artery disease, stroke, and others. Not only is weight a potential protective factor, but longitudinal studies show weight loss is predictive of mortality in older adults.
Though multiple studies support the obesity paradox, it is important to note that this observation does not suggest that obesity is a benign condition in older adults. First, much of the obesity paradox might be due to the associated declining health of unintentional weight loss in older adults. In this respect, low BMI associated with end-stage chronic illness and failure to thrive is associated with high rates of mortality. Though longitudinal studies show weight loss is associated with mortality, results do not delineate between unintentional versus intentional loss and therefore may be confounded by weight loss accompanying serious disease. Second, It has been suggested that increased BMI is not actually protective but instead, a small remaining life span hides impact of obesity and persons susceptible to complications of obesity died younger. Though being overweight might be modestly protective, there are numerous complications of obesity that are associated with reduced function and increased mortality. Finally, multiple instances show limits to the protective factors of the paradox.
Medicare Obesity Counseling Benefit
In 2011, the Centers for Medicare and Medicaid Services introduced a Medicare obesity counseling benefit for individuals with a BMI of 30kg/m2 or higher. This benefit supports Intensive Behavioral Therapy that is delivered in a 15-minute individual session or a 30-minute group session. Therapy is offered for 6 months and if patients have lost 3kg in that period, they are eligible for an additional 6 months of behavioral counseling. Though this benefit is a significant step towards addressing the growing obesity epidemic in older adults, there are three notable criticisms. Firstly, the benefit was largely developed based on data from studies of adults less than 65 years old, and as previously explained, older adults typically lose fat-free mass as they age as …