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

Abstract

The prevalence of obesity is rising progressively, even among older age groups. By the year 2030–2035 over 20% of the adult US population and over 25% of the Europeans will be aged 65 years and 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+ people in the USA in 2010 and 32 million obese elders in 2015 in the EU. Although cut-off values of BMI, waist circumference and percentages of fat mass have not been defined for the elderly (nor for the elderly of different ethnicity), it is clear from several meta-analyses that mortality and morbidity associated with overweight and obesity only increases at a BMI above 30 kg/m<sup>2</sup>. Thus, treatment should only be offered to patients who are obese rather than overweight and who also have functional impairments, metabolic complications or obesity-related diseases, that can benefit from weight loss. The weight loss therapy should aim to minimize muscle and bone loss but also 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 in the elderly, who are vulnerable to this outcome. Life-style intervention should be the first step and consists of a diet with a 500 kcal (2.1 MJ) energy deficit and an adequate intake of protein of high biological quality together with calcium and vitamin D, behavioural therapy and multi-component exercise. Multi-component 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 have been excluded.

Functional Assessment of Older Obese Patients Candidates for Bariatric Surgery

“…In this matter, the benefits of weight loss in the elderly include the improved functional capacity and ability of activities of daily living, and reduced musculoskeletal comorbidities (11) . In this series, half of the patients presented with some impairment of functionality, that increased with BMI (above 46,5 kg/m 2 for Lawton, above 49 kg/m 2 and above 51 kg/m 2 ).…”

“…The optimal weight loss should address improvement in obesity related co-morbidities (including functionality), an overall reduction in medication requirements, but minimizing the risks of massive weight loss. Data are not available to determine the optimal surgical procedure to achieve these goals (11) .…”

“…It is therefore important to assess co morbidity in these patients and their profile of functional dependence (8,12) , before choosing the best treatment for each of them (9) . In the other hand, massive weight loss in the elderly population is associated to the risk of loss of muscle mass (sarcopenia) if not combined to regular exercises, loss of mineral bone density, osteoporosis and increased risk of fractures (11) .…”

Obesity dilemma in the global burden of cardiovascular diseases

“…Treatment of obesity is connected with multiple health benefits, particularly the common risk factors as diabetes, chronic renal disease, hypertension and related to the decrease in total or cardiovascular mortality (17,29,30).…”

Longer time after bariatric surgery and sedentary leisure modify anthropometric parameters, body composition and sarcopenic obesity markers in women

“…This condition is known as "sarcopenic obesity" [1][2][3] . In addition to the impairment of functional capacity 4 , there are other health consequences related to sarcopenic obesity. One of these effects is an increased risk of developing type 2 diabetes mellitus 5 , increased levels of triglycerides, metabolic syndrome and cardiovascular disease [6][7][8] .…”