Weight Management in Older Adults

Abstract

As the number of older adults increases rapidly, the national epidemic of obesity is also affecting our aging population. This is particularly concerning given the numerous health risks and increased costs associated with this condition. Weight management is extremely important for older adults given the risks associated with abdominal adiposity, which is a typical fat redistribution during aging, and the prevalence of comorbid conditions in this age group. However, approaches to weight loss must be considered critically given the dangers of sarcopenia (a condition that occurs when muscle mass and quality is lost), the increase risk of hip fracture with weight loss, and the association between reduced mortality and increased BMI in older adults. This overview highlights the challenges and implications of measuring adiposity in older adults, the dangers and benefits of weight loss in this population, and provides an overview of the new Medicare Obesity Benefit. In addition we provide a summary of outcomes from successful weight loss interventions for older adults and discuss implications for advancing clinical practice.

Metabolic, Molecular, and Behavioral Effects of Western Diet in Serotonin Transporter-Deficient Mice: Rescue by Heterozygosity?

“…The aged mice displayed a prolonged increase in intake in the amount of calories after the switch to the highly caloric WD, which lasted for at least one week instead of 3 days in young mice (Strekalova , 2015). This is in accordance with the well-described agerelated dysregulation of consummatory behavior and metabolic processes (Gill et al, 2015) in the WD model. The aged Sert −/− mice fed a WD displayed greater changes in most of the diet-induced abnormalities that were found in the WT controls, including impairment of glucose tolerance, behavioral despair, suppressed novelty exploration and hippocampus-dependent performance, impulsivity in the O-maze, and brain over-expression of Tlr4.…”

Effects of once-weekly semaglutide vs once-daily canagliflozin on body composition in type 2 diabetes: a substudy of the SUSTAIN 8 randomised controlled clinical trial

“…e The in-trial analysis included all available post-baseline data. Missing data were multiple imputed induced weight loss is associated with corresponding changes in both body fat and fat-free mass, including muscle [33]. In individuals with type 2 diabetes, it is preferable to reduce fat without significant loss of lean mass [32], although this can occur during weight loss in those who are obese [34].…”

ESPEN guideline on clinical nutrition and hydration in geriatrics

“…Due to changes in body composition during aging and a reduction of body height, the validity of the BMI as a measure of overweight and obesity is reduced in older people [248e250]. Moreover, there is increasing evidence that in terms of mortality, cardiovascular and metabolic risk and even in terms of function, the distribution of body fat may be more important than the amount per se [249,250]. To date no consensus on how to assess obesity-related health risk in older adults has been reached and the role of BMI, overweight and obesity remains highly controversial.…”

“…On the other hand, as weight loss in older persons may have harmful effects due to the loss of lean mass (see commentary to recommendation 54), the decision for or against weight reduction shall always be taken at the individual level. It should be based on a careful weighing of possible risks and benefits of the intervention considering functional resources, metabolic risk, comorbidities, patients' perspective and priorities, and estimated effects on his or her quality of life [249,250]. If decision is made against weight reduction, it is advisable to aim at weight stability and avoidance of further aggravation of obesity [16].…”