Medihub - Medical Information - Geriatric and healthcare of the elderly

Obesity in the elderly

Introduction

There is a lack of good definitions of overweight and obesity for the elderly and it might not be appropriate to apply the standards for younger adults to them. Obesity does not qualify as a risk factor in acute care setting, provided obesity related disease is excluded.

Overweight should not be treated in geriatric patients with acute medical problems. The correlation between BMI and survival ceased after 79 years old. As such, we need to use common sense and good clinical judgement for each individual patient.

Weight loss is advisable when:

(1) there is extreme obesity

(2) Obesity is contributing to diabetes, arthritis of weight-bearing joints, or other problems.

Tips to maintaining a healthy weight in the elderly

- A high BMI of >28 in elderly women was associated with 2x risk of disability - defined as difficulty in mild activities like walking a quarter of a mile.

- The actual regimen for weight reduction should be individualised for each patient. A good guideline to keep in mind is that a deficit of 500 kcal per day from the recommended intake levels will produce a loss of 0.5 kg per week. Sedentary older individuals will need to lose weight at a slower rate.

- Referral to a qualified dietician will be very helpful in sorting out the details of the required diet.

- Moderate levels of exercise may also be helpful in increasing energy expenditure. Examples of such exercise are a daily walk, stationary cycling and regular swimming. Strenuous exercise is not appropriate.

- For the mildly to moderately overweight elderly person who is in good health, there is no evidence to support the need for weight reduction. Weight loss in obese women was associated with increased risk for disabilities. This weight loss might be involuntary and caused by illness.

Reference:

Launer IJ. BMI- weight change and risk of mobility disability in middle aged and older women. JAMA 1994; 271: 1093-8.