For older patients, diet restrictions are controversial, since weight loss from dieting leads to loss of muscle and bone as well as fat. But new research shows that dieting and exercise together may be significantly better for obese older adults than either alone. In the study, 107 obese patients over 65 were randomly assigned to one of four groups — one that changed their diet, one that changed exercise habits, one that changed both diet and exercise, and a control group that made no lifestyle changes. Each group was evaluated after 6 and 12 months, using tests of frailty and functional status.
In the diet and exercise group, the participants increased an average of 21 percent on a test of physical fitness, compared with 12 percent in the diet group and 15 percent in the exercise group, and their strength, balance, and gait also improved. Overall body weight decreased 9 percent in the diet and exercise group and 10 percent in the diet group, but remained constant in the other two groups. The diet and exercise group also managed to keep their weight off for one year. Dr. Dennis Villareal of Washington University School of Medicine in St. Louis said he hopes the study will convince older obese people that diet and exercise are viable options to maintain overall physical health.
BOTTOM LINE: Exercise and diet combined may be better for overall physical fitness of obese older adults.
CAUTIONS: The sample size was small, and did not include anyone over the age of 74.
WHERE TO FIND IT: New England Journal of Medicine, March 31
Digital divide in use of online health records
The “digital divide’’ between people who have easy access to the Internet and those who don’t extends to online personal health records, according to a new report. Within one unidentified health network, researchers compared patients who used online records with those who didn’t. Of the 75,056 patients in the network, 43 percent created an account for themselves to track basic medical information like prescription refills and lab tests, as well as contact their doctors or gain access to credible information online. Blacks, Hispanics, and lower-income people were less likely to set up an account than whites and higher-income people. The study showed that blacks were half as likely to use online personal health records as whites, and Hispanics were two-thirds as likely.Dr. David Bates of Brigham and Women’s Hospital, one of the authors, said the findings for personal health records are similar to those found for other digital divide studies. However, once patients had created an account, researchers found no racial or socioeconomic differences in number of log-ins or time spent on the system.
BOTTOM LINE: Black and Hispanic patients were less likely to use online health records than whites.
CAUTIONS: This study was conducted within only one network of health care providers.
WHERE TO FIND IT: Archives of Internal Medicine, March 28
MARY PARKER 
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