Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: A guideline

Elisabeth M.H. Mathus-Vliegen, Arnaud Basdevant, Nick Finer, Vojtech Hainer, Hans Hauner, Dragan Micic, Maximo Maislos, Gabriela Roman, Yves Schutz, Constantine Tsigos, Hermann Toplak, Volkan Yumuk, Barbara Zahorska-Markiewicz

    Research output: Contribution to journalReview articlepeer-review

    152 Scopus citations

    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/m2. 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.

    Original languageEnglish
    Pages (from-to)460-483
    Number of pages24
    JournalObesity Facts
    Volume5
    Issue number3
    DOIs
    StatePublished - 1 Jun 2012

    Keywords

    • Ageing
    • Bariatric surgery
    • Diet
    • Epidemiology
    • Exercise
    • Life-style interventions
    • Obesity
    • Pharmacotherapy
    • Sarcopenia
    • Sarcopenic obesity

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