An Enhanced Protein (Dairy) Weight Loss Intervention for Dynapenic Obesity: Impact on Muscle Quality and Composition

Obese older adults (≥60 yrs) with moderate functional impairment will be randomized to 1 of 2
study arms. Outcomes to be measured at 0, 3 and 6 months are as follows: Primary outcomes—
(1) Muscle Quality (MQ): muscle power (time to perform ten chair rises, height of the chair,
leg length, body mass, and acceleration of gravity) in relation to muscle mass (CT-scan) and
(2) Muscle adipose infiltration (MAI) (CT-scan). Secondary outcomes- Bone Mineral Density
(BMD; DXA scan) physical function (Short Physical Performance Battery (SPPB); 6 minute walk;
8-foot up and go; and 30 second chair stands; handgrip strength; body weight; fat mass; waist
circumference; activity (accelerometers); mental health (sleep, depression, quality of life);
and feasibility factors (adherence, protein intake, nutrition adequacy). BMD will only be
accessed at 0 and 6 months.

Study Arms:

- Weight loss plus low-intensity exercise intervention (WL-LoEX; n = 35): Subjects follow
a calorie-reduction diet for a weight loss of ≥10%, protein~0.8g/g/d. Subjects will also
participate in three 30-minute low-intensity exercise sessions weekly. One serving of
dairy protein/day will be provided to WL-LoEX participants.

- High protein weight loss plus low-intensity exercise intervention (PRO-WL-LoEX; n = 35):
Subjects follow a calorie-reduction diet for a weight loss of ≥10%, with a high
proportion of high quality protein at each meal. Intakes of > 30g of protein will be
achieved three times a day by subjects in this group, with all or predominantly all from
animal sources (high quality) and 60-70% of animal protein from dairy foods that will be
provided. Subjects will also participate in three 30-minute low-intensity exercise
sessions weekly.

Inclusion Criteria:

- BMI >30;

- SPPB score of ≥4 to <10;

- GFR <45 mL/min

Exclusion Criteria:

- Body weight >495 lbs. (BodPod limits);

- estimated glomerular filtration rates (eGFR) less than 45 mL/min;

- symptomatic cardiac disease;

- receiving chemotherapy;

- hemophilia;

- presence of unstable or symptomatic life-threatening illness;

- neurological disease or disorder causing functional impairments;

- inability to walk,

- dementia;

- prescription weight loss medications;

- use of monamine oxidase inhibitors (MAOIs); or

- primary medical provider advises against participation.