Is Obesity Bad for Older Persons? A Systematic Review of the Pros and Cons of Weight Reduction in Later Life

Geriatric Research Education and Clinical Center, Durham VA Medical Center, Durham, NC, USA.
Journal of the American Medical Directors Association (Impact Factor: 4.94). 06/2008; 9(5):302-12. DOI: 10.1016/j.jamda.2008.01.006
Source: PubMed


The purpose of this review was to describe the characteristics of late-life obesity, including prevalence, pathophysiology, and influences on morbidity and mortality. A second objective was to systematically review the empiric evidence on the effects of intentional weight loss interventions in older individuals.
We summarized the characteristics and known impact of late-life obesity and conducted a systematic review of the outcomes of weight loss interventions in obese older subjects. The inclusion criteria for the review were the following: randomized controlled trial; subjects aged 60 years or older; baseline BMI 27 or higher; weight loss versus baseline 3% or more or 2 kg; and trial duration 6 months or longer.
The search strategy yielded 16 articles on weight loss interventions that were examined in detail. Overall, these interventions led to significant benefits for those with osteoarthritis, coronary heart disease, and type 2 diabetes mellitus (DM-2), while having slightly negative effects on bone mineral density and lean body mass.
Longitudinal trials examining mortality and body weight suggest that maintaining weight is beneficial in older persons who become obese after age 65; in contrast, intervention trials show clinically important benefits of weight reduction with regard to osteoarthritis, physical function, and possibly DM-2 and coronary heart disease. Given these findings, we recommend that decisions about whether or not to institute a weight loss intervention for obese older persons be carefully considered on an individualized basis with special attention to the weight history and the medical conditions of each individual.

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    • "In addition, obesity plays an important role in non-fatal physical disability in older adults [3]. Weight loss leads to metabolic and functional benefits [4]. However , a potential drawback of weight loss in older adults is the accompanying loss of skeletal muscle mass [5]. "
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    ABSTRACT: Currently there is no consensus on protein requirements for obese older adults during weight loss. Here we explore the potential use of a new method for assessment of protein requirements based on changes in appendicular muscle mass during weight loss. 60 obese older adults were subjected to 13 wk weight loss program, including hypocaloric diet and resistance training. Assessment of appendicular muscle mass was performed by DXA at baseline and after 13 wk challenge period, and the difference calculated as muscle mass change. Protein intake (g/kg body weight and g/kg fat free mass (FFM)) at 13wks was used as marker of protein intake during 13 wk period. 30 subjects received 10 times weekly 20 g protein supplement throughout the 13 week hypocaloric phase which is included in the calculation of total protein intake. Receiver operating characteristic (ROC) curve analysis was used to explore the optimal cutoff point for protein intake (g/kg) versus increase in appendicular muscle mass of more than 250 g over 13 wks (y/n). Subsequently, logistic regression analysis was performed for protein intake cutoff and muscle mass accretion, adjusted for sex, age, baseline BMI, and training compliance. ROC curve analysis provided a protein intake level per day of 1.2 g/kg bw and 1.9 g/kg FFM as cutoff point. Presence of muscle mass accretion during 13 wk challenge period was significantly higher with protein intake higher than 1.2 g/kg bw (OR 5.4, 95%CI 1.4-20.6, p = 0.013) or higher than 1.9 g/kg FFM (OR 8.1, 95%CI 2.1-31.9, p = 0.003). Subjects with a protein intake higher than 1.2 g/kg had significantly more often muscle mass accretion, compared to subjects with less protein intake (10/14 (72%) vs 15/46 (33%), p = 0.010). For 1.9 g/kg FFM this was 70% vs 28% (p = 0.002). This exploratory study provided a level of at least 1.2 g/kg body weight or 1.9 g/kg fat free mass as optimal daily protein intake for obese older adults under these challenged conditions of weight loss, based on muscle mass accretion during the challenge. Dutch Trial Register under number NTR2751. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
    Clinical Nutrition 03/2015; DOI:10.1016/j.clnu.2015.02.016 · 4.48 Impact Factor
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    • "Evidence regarding the most effective means for achieving weight loss in older persons is controversial, with modest positive outcomes reported for interventions involving diet, physical exercise, and a combined approach (see [38, 39]). For example, a high saturated fat and no-starch diet yielded weight loss without adverse effects on lipids in persons aged 53–73 after 6 weeks [40]. "
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    ABSTRACT: Studies of obesity and its relationship with mortality risk in older persons have yielded conflicting results. We aimed to examine the age-related associations between obesity and mortality in older persons. Data were drawn from the Cross-Sectional and Longitudinal Aging Study (CALAS), a national survey of a random sample of older Jewish persons in Israel conducted during 1989-1992. Analyses included 1369 self-respondent participants aged 75-94 from the Cross-Sectional and Longitudinal Aging Study (CALAS). Mortality data at 20-year followup were recorded from the Israeli National Population Registry. Obesity was significantly predictive of higher mortality for persons aged 75-84, but from age 85 onwards, obesity had a protective effect on mortality albeit at a nonsignificant level. Being underweight was consistently predictive of mortality. Findings suggest that the common emphasis on avoiding obesity may not apply to those advancing towards old-old age, at least as far as mortality is concerned.
    Journal of aging research 09/2011; 2011(12):765071. DOI:10.4061/2011/765071
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    ABSTRACT: It is difficult to define what is meant by the term obesity in elderly persons (EPs), as aging is associated with increased body fat and reduced lean body mass. The body mass index (BMI) is thus difficult to interpret, particularly as height also decreases with age. Thus, the percentage of body fat in an EP is around the same level as the threshold at which a young adult would be considered obese (25% for men and 35% for women in the over 60s). Moreover, it would seem important to consider body fat distribution and fat-free mass are situated, rather than just the BMI; in this way, three clinical forms of obesity can be described: abdominal obesity (or central obesity), age-related lipodystrophy and sarcopenia, which all need careful assessment in terms of prognosis. The various complications of obesity are presented, as obesity can cause numerous functional disorders and is a risk factor for metabolic and cardiovascular disease as well as for cancer and cognitive decline. Nevertheless, excess adipose tissue can protect against osteoporosis and wasting disease. L’obésité est difficile à définir chez la personne âgée (PA), car le vieillissement s’accompagne d’une augmentation de la masse grasse et d’une diminution de la masse maigre. L’indice de masse corporelle (IMC) est donc d’interprétation délicate et ce d’autant plus que la taille diminue avec L’âge. Ainsi, le pourcentage de masse grasse de la PA en bonne santé est-il, en moyenne, voisin du seuil qui est habituellement choisi pour définir L’obésité chez L’adulte jeune (25 % pour les hommes et 35 % pour les femmes, dans la tranche d’âge de plus de 60 ans). De plus, il paraît pertinent de considérer la répartition du tissu adipeux (TA) et la masse maigre plutôt que le seul IMC; on décrit ainsi trois formes cliniques, L’obésité abdominale (ou viscérale), L’adiposité lipodystrophique liée à L’âge et L’obésité sarcopénique qui méritent une attention particulière quant à leur pronostic. Les différentes complications de L’obésité sont présentées, L’obésité étant la cause de multiples déficits fonctionnels et un facteur de risque pour les maladies métaboliques et cardiovasculaires mais aussi pour le cancer et le déclin cognitif. Néanmoins, L’excès de TA peut avoir un effet protecteur vis-à-vis de L’ostéoporose et dans les situations d’agression.
    Obésité 12/2009; 4(3):166-175. DOI:10.1007/s11690-009-0184-2
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