Obesity and the Elderly

Abstract

The prevalence of obesity is rising progressively, even among older age groups. By the year 2030 to 2035 over 20% of the adult US population and over 25% of the Europeans will be aged 65 years or older. The predicted prevalence of obesity in Americans, 60 years and older was 37% in 2010. The predicted prevalence of obesity in Europe in 2015 varies between 20% and 30% dependent on the model used. This means 20.9 million obese 60 years or older people in the United States in 2010 and 32 million obese elders in 2015 in EU. Although cutoff values of body mass index, waist circumference, and percentages of fat mass have not been defined for the elderly, it is clear from several meta-analyses that mortality and morbidity associated with overweight and obesity only increases at a body mass index >30 kg/m(2). Thus, treatment should only be offered to patients who are obese rather than overweight and who have functional impairments, metabolic complications, or obesity-related diseases, that can benefit from weight loss. The weight loss therapy should minimize muscle and bone loss and vigilance as regards the development of sarcopenic obesity--a combination of an unhealthy excess of body fat with a detrimental loss of muscle and fat-free mass including bone--is important. Lifestyle intervention should be the first step and consists of a diet with a 500 kcal energy deficit and an adequate intake of protein of high biological quality, together with calcium and vitamin D, behavioral therapy, and multicomponent exercise. Multicomponent exercise includes flexibility training, balance training, aerobic exercise, and resistance training. The adherence rate in most studies is around 75%. Knowledge of constraints and modulators of physical inactivity should be of help to engage the elderly in physical activity. The role of pharmacotherapy and bariatric surgery in the elderly is largely unknown as in most studies people aged 65 years and older were excluded.

Obesity and related consequences to ageing

“…Nonsubcutaneous fat accumulation is known to be strongly associated with insulin resistance and dyslipidemia (Kuk et al 2009). Currently, the utility of BMI as a predictor of type 2 diabetes mellitus is questioned, essentially because many abdominally obese older individuals have normal BMI, whereas highly muscled athletes can have an abnormal BMI (Kuk et al 2009;Jiang et al 2015;Mathus-Vliegen 2012). Despite stable BMI or body weight, ageing is associated with an increase in percent body fat by approximately 1 % per decade (Kuk et al 2009).…”

Subclinical Compromise in Cardiac Strain Relates to Lower Cognitive Performances in Older Adults

“…In a prior study, worse GLS was associated with increased cerebral small vessel disease among older adults without prevalent cardiovascular disease (CVD) 6. However, cardiac strain has not been thoroughly evaluated in relation to cognition among aging adults who endure decades of vascular risk factor exposure 11, 12…”

Conceptos básicos sobre obesidad sarcopénica en el adulto mayor

“…Los puntos de corte ya han sido caracterizados en algunas poblaciones. (1,2,(4)(5)(6)(7) El segundo componente, la obesidad La obesidad, entendida como presencia de tejido adiposo en exceso, se ha definido a partir de los criterios antropométricos de índice de masa corporal (IMC) y circunferencia abdominal (CA). No obstante, en el caso del adulto mayor, los criterios diagnósticos no han sido tan claramente validados dado los factores de posible confusión a la hora de estimarlos.…”

“…(14) Aunque enla literatura se tiene que tanto la obesidad como la sarcopenia son factores predictores independientes de la limitación funcional en el adulto mayor; las implicaciones en el paciente obeso y sarcopénico tienden a ser mayores, esto porque se ha documentado una mayor limitación -efecto sinérgico-cuando ambos factores coexisten. (2,7,15) …”

“…Se reporta incidencia de sarcopenia entre el 4% y 12 % y la obesidad sarcopénica podría rondar entre el 4% y 9%. (7) Sin embargo otras revisiones sugieren datos muy divergentes, por ejemplo en una revisión sistemática se recopila información de prevalencia de obesidad sarcopénica que va de un 2.75 hasta un 20 %. (6) Otros estudios reportan prevalencias de hasta un 50% (16) …”