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Life sciences · Journal article
The Lancet. Healthy Longevity · July 1, 2027
Well-designed and adequately powered for the question it asks.
In older adults with obesity, adding metformin to intensive lifestyle intervention (weight management and exercise) provided no additional improvement in physical function compared to placebo at 6 months. Intensive lifestyle intervention alone was superior to healthy lifestyle education regardless of metformin, supporting lifestyle modification as the primary strategy for functional outcomes in this population.
Randomised, placebo-controlled trial. Adults aged 65-85 years with BMI ≥30 kg/m², enrolled at Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine (Houston, TX, USA); mean age 72·8 years (SD 5·2); 89% men, 11% women; 56% White, 44% Black, 13% Hispanic or Latino. Intervention: Intensive lifestyle intervention (weight-management and exercise training) plus metformin. Compared with: Intensive lifestyle intervention plus placebo, and healthy lifestyle (diet education) plus metformin. n = 114. Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA.
Physical performance test improvement did not differ between intensive lifestyle plus metformin versus intensive lifestyle plus placebo (mean difference 0·1 points, 95% CI -1·2 to 1·4; p=0·92) Intensive lifestyle plus metformin was superior to healthy lifestyle plus metformin (mean difference 2·5 points, 95% CI 1·2-3·8; p=0·0002) Changes in physical performance test differed significantly between groups (group-by-time interaction p<0·0001)
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Clinicians treating older adults with obesity should prioritise intensive lifestyle interventions including weight management and exercise training over pharmacologic adjuncts like metformin to improve physical function. Metformin does not enhance functional outcomes when added to lifestyle intervention in this population.
Randomised placebo-controlled trial showing intensive lifestyle intervention improves physical function in older adults with obesity, but metformin adds no benefit beyond placebo.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians treating older adults with obesity should prioritise intensive lifestyle interventions including weight management and exercise training over pharmacologic adjuncts like metformin to improve physical function. Metformin does not enhance functional outcomes when added to lifestyle intervention in this population.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Obesity in older adults is associated with functional decline and increased risk of disability. Lifestyle interventions improve physical function, but the role of metformin as an adjunct to lifestyle intervention in this population remains unclear. In this randomised clinical trial, we evaluated whether metformin enhances the effects of an intensive lifestyle intervention on physical function in older adults with obesity. The Diet and Exercise plus Metformin to Treat Frailty in Obese Seniors (DEMFOS) trial (ClinicalTrials.gov: NCT04221750 [completed]) was a randomised, placebo-controlled trial conducted at the Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine (Houston, TX, USA). Older adults (aged 65-85 years) with obesity (BMI ≥30 kg/m2) were randomly assigned to intensive lifestyle intervention (weight-management and exercise training) plus placebo, intensive lifestyle intervention plus metformin, or healthy lifestyle (diet education) plus metformin groups. The primary outcome was change in the modified physical performance test score at 6 months. The primary analysis was by intention-to-treat. Of 221 participants assessed for eligibility between March 30, 2021, and Dec 12, 2024, 114 were included in this study (mean age 72·8 years [SD 5·2]; 101 [89%] men and 13 [11%] women). 64 (56%) participants were White, 50 (44%) were Black, and 15 (13%) were Hispanic or Latino. Changes in physical performance test differed between groups (group-by-time interaction p<0·0001). At 6 months, physical performance test improvement was greater in the intensive lifestyle plus metformin group than in the healthy lifestyle plus metformin group (mean difference 2·5 points, 95% CI 1·2-3·8; p=0·0002), whereas there was no difference between the intensive lifestyle plus metformin and intensive lifestyle plus placebo groups (0·1 points, -1·2 to 1·4; p=0·92). Serious adverse events were infrequent and not attributed to the study interventions. Our findings suggest that in older adults with obesity undergoing intensive lifestyle intervention, metformin does not provide additional improvement in physical function. These results support prioritising lifestyle-based strategies to improve functional outcomes in this population. US Department of Veterans Affairs.
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