These ambulatory programs generally include several counseling visits with a registered dietitian; they too appear to decrease hospitalizations. Other positive outcomes, such as better metabolic control as measured by glycosylated haemoglobin and blood sugar levels, also appear to be moderately affected by dietary education programs.23,49 In addition, there is some evidence that nutritional counseling services can help reduce the number of amputations resulting from diabetic vascular disease and achieve substantial cost savings.20

Weight Reduction

The effectiveness of interventions involving weight reduction in managing several chronic degenerative diseases is well demonstrated.23,78 Very little information is available, however, regarding the specific benefits of weight reduction in individuals over age 50. One study, conducted in the late 1950s by the Anticoronary Club of New York City, involved middle-aged men in a weight loss program that divided participants into treatment and control groups. The program was able to achieve much lower obesity rates among those individuals who were provided with treatment and given ongoing help to maintain weight loss than among controls.15 The problem was not the short-term efficacy of weight loss efforts but the need to include long-term maintenance as part of the therapeutic program. Quite apart from the effect of obesity on chronic degenerative diseases is the direct functional effect on activities of daily living—transferring, toileting, stooping, and climbing stairs.

The type, length, and location of weight loss programs for the elderly vary. Because many of the elderly are already taking several different drugs, there may be particular advantages to using diet and physical activity programs to bring weight into line instead of relying on anorectic or other drugs. In general, control of obesity is of particular importance among elderly persons who suffer from high blood pressure. Indeed, the positive effects of weight reduction in this group may be greater than the effects observed in younger populations.19 Of particular salience from the functional standpoint are the benefits weight loss brings in improving mobility and decreasing pain in osteoarthritis affecting weight-bearing joints.8 In addition, weight reduction may improve—in some cases, quite dramatically—ischemic and hypertensive cardiac disorders that decrease work performance. In many instances, when weight is brought to normal, symptomatology (including excessive urination and other annoying problems owing to poor glucose tolerance) may also come under control.52

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