Obesity, prevalent in almost 40% of Americans aged 60 years and older, ¹ increases the risk for disability, ² justifying weight loss as a strategy for preserving functional independence in older adults. However, declines in muscle mass and bone mineral density (BMD) accompanying rapid and large weight loss might attenuate the benefits of reduced adiposity. ³ In an era of increasingly potent weight-loss pharmacotherapies, long-term follow-up studies are critically needed to guide strategies for healthy aging in older adults with obesity. By examining long-term outcomes in the Look AHEAD study, Semelka et al. ⁴ provide timely insights into how obesity and weight loss in midlife relate to disability in later life. The Look AHEAD study enrolled ∼5100 mid-life and older adults with type 2 diabetes (T2D) and overweight or obesity, who were randomized to intensive lifestyle intervention (ILI, 7% or greater weight loss) or diabetes support and education (control). ⁵ During the 10-year intervention, ILI was associated with a slower decline in physical function, with stronger effects in older compared to younger participants, ⁵ which was projected to reduce late-life disability. ⁶ However, during the 6 years of post-intervention follow-up, no differences were observed in physical function between ILI and control. ⁷ Semelka et al. ⁴ report on the impacts of ILI and obesity on late-life disability during the 10 years of post-intervention follow-up (ie, up to 20 years after randomization) in 1,200 surviving Look AHEAD participants. The study reports age-dependent effects of midlife ILI on late-life disability: Among participants younger than 70 at the first post-intervention visit (ie, 60 years at randomization) experienced 50% higher odds for severe mobility disability after ILI. ⁴ Class 2 obesity (ie, body mass index [BMI] ≥35 kg/m²) at the first-post intervention visit was associated with higher odds for late-life mobility disability, severe disability, and IADL disability, but these findings did not extend to class 1 obesity (BMI 30-35 kg/m²). ⁴

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