How Controversial is Weight Management in The Elderly?
Monday, February 21, 2011
With the strong public focus on preventing and managing childhood obesity, it seems that we often forget that the population burden of obesity is actually in adults, including a substantial proportion of the elderly.
But whether or not obesity should be treated in the elderly is less clear.
It is therefore perhaps notable that TS Han and colleagues from the UK have just published a summary of the current data on obesity and weight management in the elderly in the British Medical Bulletin.
Their very comprehensive literature review reveals that a number of important clinical consequences of overweight and obesity are particularly problematic for elderly individuals, including type 2 diabetes mellitus, arthritis, urinary incontinence, sleep apnea and depression.
They also point out that BMI may be a less appropriate index in the elderly due to sarcopenia or loss of muscle mass.
As the authors point out:
“Reduction in muscle mass is an important determinant of physical function and metabolic rate and leads to the clinical hazards of obesity appearing at a lower BMI in older people.“
Many of the medical consequences of obesity in the elderly can be alleviated by modest, achievable weight loss (5-10 kg) with an evidence-based maintenance strategy, whereby a combination of exercise and modest calorie restriction appears particularly important for preserving muscle mass.
As the overweight and obese elderly are often on multiple medications for comorbidities, reduction in the number or doses of medications alone is a valuable target for weight management.
Age should not be considered an obstacle to weight management interventions using moderate calorie restriction and exercise, but risks from bariatric surgery most likely outweigh potential benefits in older patients.
However, as the authors point out, randomized controlled trials to determine health benefits and risks from long-term weight management in the obese elderly are lacking.
As always, I would first focus on improving diet and physical activity and certainly err on a more conservative management of weight unless the excess weight is clearly severely impacting health, mobility and quality of life.
Also, as the authors point out:
“Obesity, and specifically sarcopenic obesity, in the elderly is potentially preventable, should be tackled from younger ages, and also during major later life transitions such as retirement.“
I’d certainly like to hear from my readers about their own experiences with weight management in their older clients.
AMS
Whistler, BC
Han TS, Tajar A, & Lean ME (2011). Obesity and weight management in the elderly. British medical bulletin PMID: 21325341
Monday, February 21, 2011
Adults 65 and over make up about half of my clients. I always hope for a healthy appetite, regular eating habits and an interest and enjoyment in food, as a lack of these can indicate depression, a loss of a key component of quality of life and possibly even failure to thrive.
In general, goals related to weight are more common for those in the 65-75 range and less common for those in the 75-85+ range. Any changes in weight are recommended to be gradual, as rapid weight loss or gain is linked to increased mortality and can suggest an underlying condition such as cancer or fluid retention.
As the physical condition of people at a certain age can be dramatically different from one individual to another, personalized assessment is important with adults over 65. Mobility issues and ingrained eating habits can further emphasize the important of making any goals realistic and achievable for the individual. However there are benefits at any age to optimizing the nutrition of your diet and making some healthy changes such as choosing higher fibre foods. As an anecdote, most of the 90+ year olds I’ve worked with have described how good home cooking and enjoying food has been a big part of their lives.
Monday, February 21, 2011
Weight loss at any age fills a person with joy, hope and love of life. I am 72 years old and have just lost 70 pounds and i’m thrilled.
Monday, February 21, 2011
Arya, thanks a great blog. I am guessing that our patient population is about 25% over age 65, or maybe even age 70. Our weight management goals for the elderly are always conservative. Interestingly they do very well, with adherence and modest weight loss, and improved health, better than most of our patients, anecdotal, but Jennifer Kuk and I will look at this in our database specifically. I should remind all the MDs that the age cut off for bariatric surgery is a definite 65yo, and between 60 to 65, it is up to the discretion of the surgeon, so we can put them on the bariatric registry and let the surgeon decide.
I remember hearing a few things: we should try to keep the elderly between at BMI of 27 and 30 (is that validated?, I cannot find the reference, any else out there find it.) I think this refers to the supposed J curve for the elderly, but I feel this is normal for all populations. Too thin, increased mortality, too big increased mortality, the elderly don’t seem to be much different and I find that I will allow them aim for their health goals and not weight goals, and therefore the weight loss part of it is different based on their starting health, BMI etc. So the individualization of treatment is crucial. Better nutrition and decreasing sarcopenia with light resistance exercise is a great part of this regimen. Below is another short news bit, Carol Apovian makes some statements here. Again great blog Arya.
Sean Wharton, MD, FRCPC
Wharton Medical Clinic, Burlington/Hamilton, Ont. Canada
http://docnews.diabetesjournals.org/content/3/12/1.2.full