How Controversial is Weight Management in The Elderly?

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.

Whistler, BC

Han TS, Tajar A, & Lean ME (2011). Obesity and weight management in the elderly. British medical bulletin PMID: 21325341