Obesity in Older Adults: A Systematic Review of the Evidence for Diagnosis and Treatment

Abstract

MCTIGUE, KATHLEEN M., RACHEL HESS, AND JENNIFER ZIOURAS. Obesity in older adults: a systematic review of the evidence for diagnosis and treatment. Obesity. 2006;14:1485-1497. Objective: Although obesity is increasing in older U.S. adults, treatment is controversial in this age group. We sought to examine evidence concerning obesity's healthrelated risks, diagnostic methods, and treatment outcomes in older individuals. Research Methods and Procedures:We searched MED-LINE and Cochrane Library databases, consulted with experts, and examined bibliographies for English language studies discussing obesity in older adults (mean age Ն 60), published between January 1980 and November 2005. Inclusion criteria were met by 32 longitudinal analyses, seven diagnostic studies, and 17 randomized controlled trial articles. At least two authors independently reviewed and abstracted study design, population, results, and quality information. Results: Correlations between body fat and three anthropometric measures (BMI, waist circumference, waist-to-hip ratio) decrease with age but remain clinically significant. Obesity contributes to risk for several cardiovascular endpoints, some cancers, and impaired mobility but protects against hip fracture. The association between obesity and mortality declines as age increases. Intensive counseling strategies incorporating behavioral, dietary, and exercise components promote a weight loss of 3 to 4 kg over 1 to 3.3 years. The loss is linked with improved glucose tolerance, improved physical functioning, reduced incidence of diabetes and a combined hypertension and cardiovascular endpoint, and reduced bone density. Discussion: In older adults, obesity can be diagnosed with standard clinical measures. Intensive counseling can promote modest sustained weight loss, but data are insufficient to evaluate surgical or pharmacological options. Obesity treatment is most likely to benefit individuals with high cardiovascular risk. Limited data suggest possible functional improvement. Treatment should incorporate measures to avoid bone loss.

Prevalence, Pathophysiology, Health Consequences and Treatment Options of Obesity in the Elderly: A Guideline

“…Every kilogram of weight loss through diet and exercise reduced the incidence of type 2 diabetes by 16% over a period of 3.2 years and by 3.3 cases per 100-patient years in the 60-to 85-year-age group, half of that obtained in the younger age group of 25-44 years of age. Systematic reviews of weight loss interventions in people aged over 60 years revealed significant improvements in glucose tolerance and physical functioning, a reduced incidence of diabetes and significant benefits for those with osteo-arthritis, diabetes and coronary heart disease ( table 1 ) [41,48,60] . Negative outcomes included slightly decreased bone mineral density and lean body mass.…”

“…Increased waist circumference and percentage body fat also predicted this risk [39] . Other obesity-related disorders are osteo-arthritis (with an OR of 4.8 for males and 4.0 for females), pulmonary dysfunction including the obesity hypoventilation syndrome and obstructive sleep apnoea syndrome, certain cancer types, reduced cognitive skills, sexual dysfunction and urinary incontinence [1,10,14,32,[40][41][42] . Obesity may also contribute to cataract formation and the progression of age-related macular degeneration.…”

Analysis of Predictive Factors of Mortality in Hemorrhagic Stroke Patients at Soebandi Hospital Jember

“…Faktor yang mendukung probabilitas kematian adalah berat badan tidak normal, hal ini didukung oleh Haslam (2005) dan McTigue et al (2006). Menurut Pezzini (dalam Sarikaya, 2011), faktor usia >55 tahun pada pasien stroke hemoragik yang disertai dengan obesitas dapat meningkatkan terjadinya resiko perdarahan yang lebih dalam dan lebih rentan untuk terjadinya komplikasi venous thromboembolisme.…”

Challenges with the Medicare Obesity Benefit: Practical Concerns & Proposed Solutions

“…Nearly half of the studies cited in the determination examined populations predominantly < 65 years of age. [13][14][15][16][17][18] Only three studies were pertinent to older adults: a weight-loss systematic review; 19 the ADAPT study; 20 and a study by Villareal,21 all aimed at encouraging functional improvement following weight loss. Studies conducted in primary care settings using IBT were limited, 22 as were those using function as the sole outcome measure.…”