The Optimal Health Weight and Lifestyle (OHWL) Clinic: Comprehensive, Multidisciplinary and Geriatric-Focused Care for Multimorbid Older Adults With Obesity

Abstract

Background

The prevalence of obesity among older adults is increasing, and care is complicated by comorbidities.

Objectives

This study describes the baseline cohort of the Optimal Health, Weight, and Lifestyle clinic, designed to address weight management using geriatric principles with focus on comorbidities, function, and quality of life. It also highlights the need for multidisciplinary, coordinated care for this population.

Methods

This is a retrospective study of patients (n = 58) with a body mass index (BMI) ≥ 30 kg/m² referred for weight management. Assessments included obesity-related comorbidities; self-reported measures for pain, physical health, and mental health using Patient-Reported Outcomes Measurement Information System (PROMIS) scores; grip strength using an in-clinic dynamometer; and specialist care.

Results

The mean (standard deviation) age of the 58 patients was 73.4 (4.8) y, and they were predominantly female (76%) and White (81%). With a mean of over 12 comorbidities, common comorbidities included chronic kidney disease (98%), hypertension (97%), osteoarthritis (93%), obstructive sleep apnea (83%), prediabetes (42%), and diabetes (42%). Patients were comanaged by an average of 4 specialists. PROMIS physical and mental health scores were low at 40 and 45 y, respectively, and worsened with increasing BMI. Thirty-six percent had physical activity limitations, and 30% were dissatisfied with social activities and relationships. Grip strength was below age/gender norms in most patients.

Conclusions

Older adults with obesity have multiple comorbidities, low strength, and high pain interference, and receive care from multiple specialists, placing them at risk of fragmented care. A person-centered, geriatric-focused approach incorporating the Medication, Mentation, Mobility, and What Matters (4Ms) framework is needed, along with comprehensive obesity care provided by a team-based approach. Further evidence-based interventions adapting lifestyle and medication management to this cohort are also needed.