Obesity in the elderly

Obesity refers to an unhealthy excess of body fat, which increases the risk of medical illness and premature mortality.

The percent of older adults with obesity is increasing.

Aging and obesity contribute to the increased use of health care services.

Life expectancy at birth in developed countries is over 70 years, and estimates indicates that there are 605 million people who are older than 65 years.

Estimated the number of US older adults with obesity is 40.2 million.

In the elderly obesity contributes to the early onset of chronic morbidities and functional impairment, and leads to premature mortality.

Body mass index (BMI) is a method of classifying medical risk by weight status.

BMI is calculated as body weight (in kg) divided by the square of height (in m).

BMI provide a measure of the relation between height and weight and correlates results with percentage of body fat in young and middle-aged adults.

As the BMI increases, the likelihood of being affected by obesity increases as well.

The major drawback of BMI is that it does not differentiate between body fat and fat free mass and so, changes in body composition tend to underestimate fatness, whereas the loss of height would tend to overestimate fatness at any given BMI.

BMI is inversely related to measured physical performance in older persons, with a 3-unit increase in BMI is associated with a 1-point decrease in physical performance test scores.

Aging and obesity share numerous causative mechanisms mostly linked to dysfunctional adipose tissue, such as metabolic dysfunction, multi organ damage, endocrine disruption, impaired immune function, and chronic inflammation.

Excess body fat mass and a BMI of ≥30 in older individuals are associated with physical dysfunction and are predictive of a decline in functional status and future disability.

When we grow older, we tend to lose our muscle mass, and It gets replaced with fat.

Key reason for some individuals who become overweight or obese as they age is the decrease of their caloric needs and physical activity.

In addition to decreased activity, reduced growth hormone and testosterone levels, poor nutrition, medications, hypothyroid disorders, and lower metabolic rates are additional factors that can cause weight gain and contribute to obesity in older adults.

Hormonal changes can enhance the accumulation of fat, the reduction of fat free mass and energy balance.

As we grow old, we often get shorter, due to osteoporosis and spinal vertebral issues that take away inches in older age.

In such cases BMI will be falsely higher.

Determining waist circumference is a valuable measurement that may give physicians guidance in weight matters.

In the elderly population, weight classification may not always be accurate.

In the majority of organs and body systems function is negatively affected by obesity.

Obesity has more functional implications associated with it compared to lean in the older population.

Obesity exacerbates age-related decline in physical function, activities of daily living, and mobility.

Increased life expectancy is associated with the increase in the number of noncommunicable diseases—obesity, coronary heart disease, hypertension, type 2 diabetes mellitus (T2DM), osteoarthritis, cataracts, urinary incontinence, and certain cancers.

Most commonly, diabetes, hypertension, high cholesterol, heart disease and certain cancers are encountered in patients affected by obesity.

Metabolic syndrome and Type II Diabetes is the strongest disease associated with overweight and obesity.

The rise in abdominal fat mass in both men and women aged 70–79 years indicates the presence of metabolic syndrome.

As we age, physical disability is also a major problem due to the effect of weight on joints.

At a younger age, overweight and obesity are clearly associated with a shorter lifespan, but at older age the best protective weight might be higher in the older population.

It is suspected that it the elderly population affected by obesity is represented by people that are resistant to the negative effects of obesity.

Obesity also affects cognition, and such functions deteriorate with age and more rapidly in the population affected by obesity.

Obesity, particularly abdominal obesity, is associated with pulmonary function impairments, obesity-hypoventilation syndrome, and obstructive sleep apnea.

Obesity is linked to a lesser quality of life.

The elderly have less muscle and more fat as a result of normal aging and often deconditioning.

A moderate weight-loss of 5-10 percent results in significant health benefits.

Even a weight loss of 3 percent in older adults significantly improves inflammation, blood pressure, cholesterol and blood sugar.

Supervised weight-loss should be considered in older adults who are obese.

Lifestyle changes are advised to include diet and exercise.

Calorie restriction and attention to diet composition and an adequate amount of protein in the diet is recommended.

Resistance training with muscle-strengthening exercises, flexibility and balance exercises are recommended.

Weight-loss medication choices are more limited in older adults.

Weight loss can lead to additional lean muscle loss and decreased physical strength.

In older adults who are obese or overweight, weight loss must be done safely and methodically and be accompanied by physical activity.

The older obese population is at a higher risk for falls and frailty.

When muscle loss from aging, is coupled that with muscle loss from weight loss, it can significantly affect functional status and bone density.

As muscle mass decreases, fat mass increases over time, and there is a progressive decline in fat-free mass (FFM) after the age of 20–30 years.

Aging is associated with a decrease in all major components of total energy expenditure (TEE).

As physical activity decreases with increasing age, it is estimated that decreased physical activity accounts for about one-half of the decrease in total energy expenditure that occurs with aging.

A decrease in total energy expenditure is an important contributor to the gradual increase in body fat with advancing age.

The relation between energy intake and expenditure is an important determinant of body fat mass.

Fat mass reaches maximum levels at 60–70 years of age.

Both fat free mass and fat mass decrease during old age (>70 years).

Redistribution of body fat and fat free mass is associated with aging.

With aging there is a greater relative increase in intra-abdominal fat, and because of the loss of skeletal muscle there is greater decrease in peripheral than in central fat free mass.

Older adults with a higher percentage of fat mass have an increased risks of disability, mobility limitations, and decreased physical function.

Women are at a greater risk for above difficulties than men as they have higher fat mass.

Insulin resistance among the elderly is associated with increased intramuscular and intrahepatic fat.

Since weight loss typically leads to losing both fat and muscle personalized diet plans are required.

Weight-resistant exercises to minimize muscle loss is required.

Older adults occasionally suffer with loss of taste or difficulty chewing that can hinder the amount of protein they consume, particularly if they get most of their protein from meat.

Protein is critical for maintaining the immune system and rebuilding muscle mass.

Therefore, the increase in total fat mass that occurs with aging must be attributable to an increase in energy intake, a decrease in energy expenditure, or both.

Older heavier men have the greatest increase in the respiratory disturbance index.

Increased weight on the chest wall decreases respiratory compliance, increases the work of breathing, and restricts ventilation.

After tobacco overweight and obesity are the most important known avoidable causes of cancer.

Obesity is associated with an increased risk of several types of cancer: breast, colon, gallbladder, pancreas, renal, bladder, uterine, cervical, and prostate.

Postmenopausal women with BMI ≥28 kg/m2 have a 26% increase in the risk of breast cancer compared with those with BMI <21 kg/m2.

Obesity contributes to the increase in prevalence of urinary incontinence in older persons, and the increase in urinary incontinence is directly associated with increased BMI.

Overweight and obesity are associated with an increased prevalence of cataracts and cataract surgery.

The focus of treatment should be on a reduction of intra-abdominal fat with diet restriction, and preservation of muscle mass and strength through physical activity.

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