Management of Obesity in the Elderly

Abstract

Over the last few decades, there has been an unprecedented increase in the prevalence of obesity, especially in economically developed countries. Furthermore, it is becoming an increasingly recognized health problem in the elderly. The precise mechanisms underlying increased adiposity in the elderly are not known. Aging is associated with a host of biologic changes that limit the ability of the individual to regulate energy homeostasis. Thus, it is likely that older individuals may be more likely to develop the two extremes of the spectrum of nutritional abnormalities, namely malnutrition and increased adiposity. These nutritional abnormalities are associated with significant morbidity and mortality. Current guidelines define overweight as a body mass index (BMI) of 25-29.9 kg/m2 and obesity as a BMI of 30 kg/m2 or more. However, the optimal BMI may be different in older individuals. Management strategies should attempt to optimize the nutritional status of older individuals. Age per se cannot be used as a justification for denying medical management of obesity to elderly individuals. Individualized programs with the goal of achieving modest weight reduction in obese patients are likely to result in immediate (e.g. alleviation of arthritic pains and reduction of glucose intolerance) and possibly long-term (e.g. reduction in cardiovascular risk) healthcare benefits. Management should emphasize lifestyle modifications, while the use of pharmacologic agents such as sibutramine and orlistat should be reserved for select groups of patients who do not respond to lifestyle modification.

Nutrition Recommendations and Interventions for Diabetes

“…For obese individuals, a modest weight loss of 5-10% of body weight may be indicated (93,94). However, an involuntary gain or loss of Ͼ10 lb or 10% of body weight in Ͻ6 months should be addressed in the MNT evaluation (1,95,96). Physical activity is needed to attenuate loss of lean body mass that can occur with energy restriction.…”

The aging population – Is there a role for endocrine interventions?

“…Involuntary weight loss in people over 60 years of age is predictive of mortality [23,24] and leads to frailty. In addition while fat mass increases in middle age, it declines beyond 70 years of age [25]. The NHANES III found the prevalence of obesity in the 70-79-year age group to be 20% in men and 25% in women, while in those over 80 years old the prevalence was only 8% in men and 15% in women [26].…”

A multistate model to project elderly disability in case of limited data

“…This may play a part especially later in life. Furthermore, if persons lose height as a result of vertebral compression fractures, his or her BMI will become higher, even with no change in weight (Horani and Mooradian 2002), while persons may not be recognized as obese if they gain fat which remains unnoticed as they simultaneously lose muscle weight, which also is related to ageing (Roubenoff 2004). For these reasons, at higher ages, the group of people with low BMI includes persons who have always been lean and at the same time persons that lost weight through illness or persons that may have health problems similar to those with too much weight, but that are not classified as obese.…”