Rethinking weight loss for older adults

Nearly a decade ago, Kristen Beavers, a professor of internal medicine at Wake Forest University School of Medicine and a research professor of health and exercise science at Wake Forest University, began exploring an unusual question: could weighted vests help older adults lose weight without losing vital bone mass and muscle?

Today, her work is gaining national attention as part of a growing conversation about how to make weight loss safer for aging adults. Supported by a $2.9 million grant from the National Institute on Aging, Beavers launched the INVEST (Incorporating Nutrition, Vests, Education, and Strength Training) in Bone Health study — one of the largest NIH-funded trials to examine the effects of weighted vests on bone health during weight loss.

“The impetus behind INVEST was twofold,” Beavers explained. “We think that the weighted vest can counter the unloading of the bone when people lose weight, and people can do it at home — they don’t have to go to a gym. There’s a scalability aspect that really makes a lot of sense.”

Why weight loss can be risky in later life

While maintaining a healthy weight can reduce the risk of heart disease, stroke, and diabetes, losing too much muscle and bone in the process can be dangerous — particularly for older adults.

After age 40, bone density naturally declines by about 0.5% to 1% per year, and that loss accelerates during menopause. Fractures, especially at the spine or hip, can lead to loss of independence or even death. Beavers notes that one in three women and one in five men will experience an osteoporotic fracture during their lifetime.

“Weight loss in older adults is controversial,” Beavers said. “When people want to lose weight, they want to lose fat. But some of what you lose is muscle and bone — and that can increase the risk of falls and fractures.”

Testing the weighted vest theory

The INVEST study followed 150 older adults with overweight or obesity over 12 months. Participants were assigned to one of three interventions: weight loss alone, weight loss with weighted vest use, or weight loss combined with resistance training.

The concept was simple but innovative: as participants lost weight, they replaced the lost weight externally by adding small increments to a vest — about one-eighth of a pound for every one-eighth of a pound lost. They wore the vest for up to eight hours a day during their most active hours.

Although the results, published in JAMA Network Open, showed that weighted vests alone did not significantly prevent bone loss, the study provided critical insights into how bones respond to mechanical loading and highlighted the need for combined strategies to protect bone during weight loss.

Combining exercise, nutrition, and practical tools

Beavers’ research points to a multi-faceted approach for healthy weight loss.

• Progressive resistance training remains the “tried and true” way to preserve bone and muscle.
• Adequate protein, calcium, and vitamin D intake are crucial.
• For those at high risk, bisphosphonate medications may help prevent fractures.

Still, the appeal of weighted vests lies in their practicality.

“Weighted vests are scalable,” Beavers said. “They allow you to exercise at home or in your neighborhood. They let you sneak mechanical loading into your daily life.”