Challenges in the Management of Geriatric Obesity in High Risk Populations

Abstract

The global prevalence of obesity in the older adult population is growing, an increasing concern in both the developed and developing countries of the world. The study of geriatric obesity and its management is a relatively new area of research, especially pertaining to those with elevated health risks. This review characterizes the state of science for this “fat and frail” population and identifies the many gaps in knowledge where future study is urgently needed. In community dwelling older adults, opportunities to improve both body weight and nutritional status are hampered by inadequate programs to identify and treat obesity, but where support programs exist, there are proven benefits. Nutritional status of the hospitalized older adult should be optimized to overcome the stressors of chronic disease, acute illness, and/or surgery. The least restrictive diets tailored to individual preferences while meeting each patient’s nutritional needs will facilitate the energy required for mobility, respiratory sufficiency, immunocompentence, and wound healing. Complications of care due to obesity in the nursing home setting, especially in those with advanced physical and mental disabilities, are becoming more ubiquitous; in almost all of these situations, weight stability is advocated, as some evidence links weight loss with increased mortality. High quality interdisciplinary studies in a variety of settings are needed to identify standards of care and effective treatments for the most vulnerable obese older adults.

Health Indicators of US Older Adults Who Received or Did Not Receive Meals Funded by the Older Americans Act

“…There was a significant percent of older adults with obesity in our study. Malnutrition is possible for older adults with obesity when diet quality is inadequate [ 29 ]. We found no significant difference in obesity for participants versus nonparticipants.…”

“…It is recommended that OAA meal programs provide adequate nutrition education and counseling that address and help to reduce food insecurity [ 24 ]. OAA meal programs should provide nutritionally dense meals and meal enhancements for older adults with undernutrition and possibly for obese, older adults with malnutrition [ 24 , 29 ].…”

Severe central obesity or diabetes can replace weight loss in the detection of frailty in obese younger elderly – a preliminary study

“…Presently, both the disorders are also associated with overweight and/or obesity and not only with underweight. 1 , 3 – 6 The functional profile of the “fat and frail” population 7 is apparently different from that of the better recognized, classical phenotype seen in frail underweight older adults, as they may have higher risk for metabolic impairment (diabetes and metabolic syndrome) and may exhibit a significantly elevated rate of death. 5 , 8 …”

Has Older Adults Bmi a Multifactorial Aetiology?

“…The relation between obesity and high blood pressure is pointed out on literature (Cetin & Nasr, 2014;Gill, Bartels, & Batsis, 2015;Porter Starr et al, 2016). High blood pressure was associated with higher odds of having obesity in our sampled population.…”