Health consequences of obesity in the elderly: a review of four unresolved questions

Abstract

Obesity prevalence is growing progressively even among older age groups. Controversy exists about the potential harms of obesity in the elderly. Debate persists about the relation between obesity in old age and total or disease-specific mortality, the definition of obesity in the elderly, its clinical relevance, and about the need for its treatment. Knowledge of age-related body composition and fat distribution changes will help us to better understand the relationships between obesity, morbidity and mortality in the elderly. Review of the literature supports that central fat and relative loss of fat-free mass may become relatively more important than BMI in determining the health risk associated with obesity in older ages. Weight gain or fat redistribution in older age may still confer adverse health risks (for earlier mortality, comorbidities conferring independent adverse health risks, or for functional decline). Evaluation of comorbidity and weight history should be performed in the elderly in order to generate a comprehensive assessment of the potential adverse health effects of overweight or obesity. The risks of obesity in the elderly have been underestimated by a number of confounders such as survival effect, competing mortalities, relatively shortened life expectancy in older persons, smoking, weight change and unintentional weight loss. Identification of elderly subjects with sarcopenic obesity is probably clinically relevant, but the definition of sarcopenic obesity, the benefits of its clinical identification, as well as its relation to clinical consequences require further study. Studies on the effect of voluntary weight loss in the elderly are scarce, but they suggest that even small amounts of weight loss (between 5-10% of initial body weight) may be beneficial. In older as well as in younger adults, voluntary weight loss may help to prevent the adverse health consequences of obesity.

Body composition and pulmonary function in the elderly: a 7-year longitudinal study

“…Thus, our findings seem to be in line with previous observations that a combination of FFM loss and fat gain with aging, recently called 'sarcopenic obesity', 37 is more strongly associated with disability than either body composition type alone. 32,38,39 Some limitations of our study should be mentioned. First, for technical reasons we needed to move from DXA Hologic 2000 (used at baseline examination) to the DXA Hologic 4500.…”

BMI Change Patterns and Disability Development of Middle-aged Adults with Diabetes: A Dual Trajectory Modeling Approach

“…For example, people who do not gain weight may be those who are not adhering to diabetic medications (e.g., insulin use), 20 thus leading to greater disability. However, since there is increasing evidence that in older persons with longer diabetes duration, increases rather than decreases in weight may be in better diabetes control [21][22][23] and normal or low BMI in older adults may be associated with greater disease burden 24 or mortality 25 , it may be more likely that stable normal weight actually masks disease burden.…”

Muscle loss and obesity: the health implications of sarcopenia and sarcopenic obesity

“…BMI may remain relatively unchanged (3,14,15) . Since BMI does not distinguish between fat mass and fat-free mass, which have opposing effects on the risk of morbidity and mortality, the use of BMI in the elderly may have limitations.…”

“…Obesity prevalence in middle-aged and older adults continues to increase worldwide and has doubled since 1980 (1,2) . However, there is controversy surrounding the effects of overweight and obesity in older people, with many studies showing that being overweight, as defined by BMI of 25-29 kg/m 2 , does not appear to be as harmful in the elderly as in middle-aged populations and may even be associated with lower, rather than higher, mortality (3)(4)(5) . In addition, a large body of evidence indicates that overweight and obesity (BMI ⩾ 25 kg/m 2 ) are associated with increased survival in patients with CVD and in particular those with heart failure, an unexpected finding termed the obesity paradox (6)(7)(8)(9)(10) .…”