Weighted vests may help older adults meet weight loss goals — but bone loss remains an issue
A new randomized clinical trial, led by a team of researchers from Wake Forest University School of Medicine and Wake Forest University, did not find evidence that wearing a weighted vest or engaging in resistance training prevented bone loss in older adults undergoing intentional weight loss.
The study, published today in JAMA Network Open, underscores the persistent need for alternative strategies to protect skeletal health in aging populations with obesity.
While weight loss is commonly advised to enhance cardiovascular and joint health in older adults with obesity, it may also lead to bone loss, raising the risk of fractures that can diminish both quality and longevity of life.
The 12-month INVEST in Bone Health trial enrolled 150 older adults with obesity with a mean age of 66.4 years. Participants were randomized into three groups: weight loss alone, weight loss plus daily weighted vest use and weight loss plus resistance training. All groups achieved similar, significant weight loss (9% to 11.2% of body weight), and adherence to interventions conducted at Wake Forest University was high.
The INVEST research team represents a multidisciplinary collaboration of Wake Forest University's departments of Health and Exercise and Statistical Sciences with Wake Forest University School of Medicine's departments of Internal Medicine, Biomedical Engineering, Biostatistics and Data Science, and Radiology.
The researchers set out to expand on the findings of a pilot study, in which participants wearing weighted vests seemed to mitigate bone loss that accompanies weight loss in this population.
However, all three INVEST study groups experienced a similar rate of significant decreases in hip bone mineral density.
'While we hoped that replacing lost weight externally or increasing mechanical loading through exercise would preserve bone, but our findings show that these strategies alone may not be enough,' said Kristen M. Beavers, the study's corresponding author and professor of internal medicine, section of gerontology and geriatric medicine, at Wake Forest University School of Medicine and research professor of health and exercise science at Wake Forest University.
The weighted vest group wore the vest for an average of 7.1 hours per day, replacing approximately 78% of lost weight. The resistance training group attended 71% of the prescribed sessions.
Beavers said the study highlights the complexity of managing obesity in older adults, where the benefits of weight loss must be balanced against potential harm to bone health and need to consider alternate or adjuvant countermeasure strategies. An ongoing collaboration between Wake Forest University and Wake Forest University School of Medicine researchers is studying how an osteoporosis drug might help. That study is called the Bone, Exercise, Alendronate, and Caloric Restriction (BEACON) trial.
The INVEST in Bone Health findings are in no way a reason to stop using weighted vests in exercise regimens, Beavers said, and more than half of study participants said they did not mind using them. Studies have shown that, in addition to helping older adults lose weight, such vests also help improve strength and sit-to-stand performance, a key predictor of disability. INVEST was based on a body of research showing that wearing weighted vests during exercise can improve strength, reduce bone loss and improve muscle performance.
Bone health is only one predictor of fractures. Beavers said INVEST also points to the potential role of preserving lean muscle mass as a protective factor for bone health.
'Fractures in older adults can be life-altering,' she said. 'Our study reinforces that we need to think beyond traditional exercise and consider new or combined approaches to protect bone during weight loss.'
INVEST in Bone Health is the latest in a series of Wake Forest University research studies on safe weight loss for older adults. Scientists there have studied, for instance, the effects of higher-protein diets, resistance training and community-based programs in weight-loss interventions for this population.
The timing of such research is vital: It's estimated that 72 million Americans will be age 65 or older by 2030, and the majority of them will be overweight or obese. Moreover, Beavers said the emergence of new and highly effective weight-loss medications, such as Wegovy and Mounjaro, have raised concerns about the bone loss that accompanies rapid weight loss in this population. Developing safe, effective weight-loss protocols for older people is essential to supporting independent living and quality of life.
The INVEST research team included Daniel Beavers, associate professor of statistical sciences at Wake Forest University; Barbara J. Nicklas, professor of gerontology and geriatrics at Wake Forest University School of Medicine; Dr. Leon Lenchik, professor of musculoskeletal imaging at Wake Forest University School of Medicine; and Ashley Weaver, associate professor of biomedical engineering at Wake Forest University School of Medicine; and Jason Fanning, associate professor of health and exercise science at Wake Forest University.
Learn more about research at Wake Forest University School of Medicine.
Atrium Health Wake Forest Baptist is a pre-eminent academic learning health system based in Winston-Salem, North Carolina, and part of Advocate Health. Atrium Health Wake Forest Baptist's two main components are an integrated clinical system with locations throughout the region and Wake Forest University School of Medicine, the academic core of Advocate Health and a recognized leader in experiential medical education and groundbreaking research.
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Both near and far patients undergoing AVR had similar adjusted mean increases (2.2 percentage points vs 3.4 percentage points; P = .45) in 30-day MACE. The authors concluded that: 'MISSION Act implementation was associated with substantial decreases in travel times among veterans who became geographically eligible for non-VA care. For these patients undergoing PCI or CABG, MISSION Act implementation was also associated with worsened 30-day MACE rates.' I remember thinking this was going to be the likely result. Yes, it's nice to get care closer to home. I often see rich endurance athletes who travel to see me. If they should have a procedure, I tell them to get it close to home. Because AF ablation is a well-practiced procedure that can be done in all major cities. But PCI, CABG, and AVR are procedures that not only require a skilled doctor but also a skilled team and a system. And while VA hospitals may not have great food or great decorations, they often have great processes and dedicated staff. In fact, in the introduction of this paper, the authors cite three observational studies finding that VA cath labs have better mortality rates than non-VA cath labs. I don't find this a surprising finding at all. So, the MISSION act focuses on improving access to care. And it does. Veterans have shorter drive times to get care. But increasing care outside the VA results in worse results — at least for PCI and CABG. I should add that this is observational and there may be confounding. While baseline characteristics in the two groups were similar, those who live farther from the VA may be sicker. I doubt this because if there is one thing US hospitals are good at, it is making patients look sicker on paper. So I find these results highly likely. Care in the US has lots of variability. VA care is standardized. I see a similarity to say Canadian healthcare. When I visit Canada, I am struck by how cardiac procedures are done in small numbers of hospitals. This means Canadians having procedures have doctors and teams who do a lot of the procedure. They may have to travel and wait, but when they have the procedure, it is done by experts. In the periphery of major cities in the US, it's the Wild West. For instance, in Louisville, there are about 8 or 9 centers doing AF ablation. You may get a skilled doctor in the US who has tons of experience, but you may not. This paper suggests the policy of allowing veterans to seek faster and closer care resulted in worse outcomes. The lessons are both specific and general. Specifically, it was a bad idea to think that in the US, more convenient healthcare was a positive. And generally, it would have been far better to implement this policy in RCT pilot form first. Then, instead of looking back and seeing the harm it caused, policymakers could have adjusted midstream and mitigated harm. I don't why we feel that trials are needed for new drugs and devices but not policies. In fact, policies may affect more people than drugs and procedures, and I think it's even more important to study these in RCT form.
