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Villareal DT, Apovian CM, Kushner RF, Klein S. Obesity in older adults: technical review and position statement of the American College for Nutrition and NAASO, The Obesity Society. Am J Clin Nutr 82, 923-934
Abstract
Obesity causes serious medical complications and impairs quality of life. Moreover, in older persons, obesity can exacerbate the age-related decline in physical function and lead to frailty. However, appropriate treatment for obesity in older persons is controversial because of the reduction in relative health risks associated with increasing body mass index and the concern that weight loss could have potential harmful effects in the older population. This joint position statement from the American Society for Nutrition and NAASO, The Obesity Society reviews the clinical issues related to obesity in older persons and provides health professionals with appropriate weight-management guidelines for obese older patients. The current data show that weight-loss therapy improves physical function, quality of life, and the medical complications associated with obesity in older persons. Therefore, weight-loss therapy that minimizes muscle and bone losses is recommended for older persons who are obese and who have functional impairments or medical complications that can benefit from weight loss.
... Primary OA is an age-related disorder characterized by degradation of the articular cartilage and the substantial loss of matrix [12]. The symptoms and signs gradually develop after the fifth decade [13], and approximately 68% of females and 58% of males older than 65 years of age have OA [14]. There are several contributing factors to the development of OA, such as cartilage matrix degradation and intraarticular cell senescence [15,16], extraarticular loss of SMM [17], and deterioration of proprioception [18]. ...
... There are several contributing factors to the development of OA, such as cartilage matrix degradation and intraarticular cell senescence [15,16], extraarticular loss of SMM [17], and deterioration of proprioception [18]. In addition to age, obesity is associated with an increased risk of knee OA, especially in older subjects [14,19]. The American College of Rheumatology (ACR) criteria for OA of the knee consists of age, joint symptoms, the lack of inflammatory conditions, and positive radiography of the knee [20]. ...
... BMI, the ratio between weight and height, representing body fat, is the most commonly used measure of obesity, and in cross-sectional studies in large populations, BMI values have indicated that the incidence of obesity is increasing in older people. However, after reaching its peak at 50 to 60 years of age, it tends to decline in both sexes [14,29]. ...
Background:
This study was conducted to analyze the effects of low skeletal muscle mass index (SMI) and obesity on aging-related osteoarthritis (OA) in the Korean population.
Methods:
A total of 16,601 participants who underwent a dual-energy X-ray absorptiometry and 3,976 subjects with knee X-rays according to the modified Kellgren-Lawrence (KL) system were enrolled. Knees of ≥KL grade 2 were classified as radiologic OA. The severity of joint space narrowing (JSN) was classified by X-rays as normal, mild-to-moderate, and severe JSN in radiologic OA. The subjects were grouped as normal SMI (SMI of ≥-1 standard deviation [SD] of the mean), low SMI class I (SMI of ≥-2 SDs and <-1 SD), and low SMI class II (SMI of <-2 SDs). Obesity was defined as a body mass index (BMI) of ≥27.5 kg/m2.
Results:
The modified KL grade and JSN severity were negatively correlated with the SMI and positively correlated with BMI and age. The SMI was negatively correlated with age. JSN severity was significantly associated with a low SMI class compared to a normal SMI, which was more prominent in low SMI class II than class I. Obesity was significantly associated with more severe JSN, only for obesity with a low SMI class. Furthermore, patients with a low SMI class, regardless of obesity, were prone to having more severe JSN.
Conclusion:
This study suggested that a low SMI class was associated with aging and that an age-related low SMI was more critically related to the severity of JSN in OA.
... The results of the current study disagree with these findings support evidence by Hart et al. [31] and Villareal et al. [32] that persons who are obese are at an increased risk for developing these life-threatening conditions. In addition, the health risks associated with obesity are more severe than in persons who are overweight, thus the overweight participants may not have felt their weight was a health risk which may be cause of their increased perception of very good or excellent health [31] [32]. ...
... The results of the current study disagree with these findings support evidence by Hart et al. [31] and Villareal et al. [32] that persons who are obese are at an increased risk for developing these life-threatening conditions. In addition, the health risks associated with obesity are more severe than in persons who are overweight, thus the overweight participants may not have felt their weight was a health risk which may be cause of their increased perception of very good or excellent health [31] [32]. ...
Background: Overweight and obesity are among the most frequently encountered multi-factorial disorders in most populations of the world. In addition, to its health impacts, overweight/obesity leads to many health problems which reflect on the university students' physical, psychological, social and environmental aspects of their quality of life. The study aimed to evaluate the effect of an educational program on improving the quality of life of overweight/obese university students in the Gaza Strip. Materials and Methods: quasi-experimental nonequivalent pretest-posttest control group design utilized in this study 74 and 69 students in the intervention and control group respectively. The study was conducted at the Islamic University of Gaza and data were collected in two stages before and after five months from the application of the educational program, using an interviewing questionnaire and World Health Organization Quality of life-BREF instrument; pre-post test and body mass index were calculated. Results: The study results revealed that overall students' knowledge for the posttest was significantly higher than pretest (p-value ≤ 0.05). Overall, the mean score of quality of life after the program was significantly (p-value = 0.001) greater than before and greater than the control group for all domains. Conclusion: The study concluded that the health educational intervention program had positive effects on knowledge, practices and attitudes regarding overweight/obesity by improving university students' mean score of quality of life.
... 7 Ageing is typically associated with changes in body composition, such as decreased muscle mass and redistribution of total and regional fat. [8][9][10] Underweight older adults with minimal reserve capacity are at risk of adverse health outcomes, 5 11 and unintentional weight loss is commonly acknowledged as a significant frailty indicator. 5 However, a growing body of evidence also suggests a positive association between obesity among older adults and the risk of frailty. ...
... 10 12-16 Obesity aggravates the agerelated decline in muscle strength, aerobic capacity and physical functionality, thus worsening health and well-being. 10 11 14 17 18 It is also closely associated with metabolic disorders, Open access inflammageing and oxidative stress, all of which have been suggested to contribute to the risk of frailty. 14 19 Anthropometric measures, including body mass index (BMI) and waist circumference (WC), are simple, costeffective tools that reflect an individual's body composition and nutritional status. ...
Objective This study investigated the association between obesity, assessed using body mass index (BMI) and waist circumference (WC), and pre-frailty/frailty among older adults over 21 years of follow-up.
Design Prospective cohort study.
Setting Population-based study among community-dwelling adults in Tromsø municipality, Norway.
Participants 2340 women and 2169 men aged ≥45 years attending the Tromsø study in 1994–1995 (Tromsø4) and 2015–2016 (Tromsø7), with additional BMI and WC measurements in 2001 (Tromsø5) and 2007–2008 (Tromsø6).
Primary outcome measure Physical frailty was defined as the presence of three or more and pre-frailty as the presence of one to two of the five frailty components suggested by Fried et al: low grip strength, slow walking speed, exhaustion, unintentional weight loss and low physical activity.
Results Participants with baseline obesity (adjusted OR 2.41, 95% CI 1.93 to 3.02), assessed by BMI, were more likely to be pre-frail/frail than those with normal BMI. Participants with high (OR 2.14, 95% CI 1.59 to 2.87) or moderately high (OR 1.57, 95% CI 1.21 to 2.03) baseline WC were more likely to be pre-frail/frail than those with normal WC. Those at baseline with normal BMI but moderately high/high WC or overweight with normal WC had no significantly increased odds for pre-frailty/frailty. However, those with both obesity and moderately high/high WC had increased odds of pre-frailty/frailty. Higher odds of pre-frailty/frailty were observed among those in ‘overweight to obesity’ or ‘increasing obesity’ trajectories than those with stable normal BMI. Compared with participants in a stable normal WC trajectory, those with high WC throughout follow-up were more likely to be pre-frail/frail.
Conclusion Both general and abdominal obesity, especially over time during adulthood, is associated with an increased risk of pre-frailty/frailty in later years. Thus maintaining normal BMI and WC throughout adult life is important.
... Prior research that relied on BMI to explore the association between obesity and depression among older individuals had a limitation in overlooking the age-related decline in muscle mass and strength. This decline is commonly concomitant with an augmentation in fat mass, primarily in the abdominal region, potentially resulting in an underestimation of obesity prevalence in the elderly (Hughes et al. 2002), Additionally, age-related reductions in height resulting from vertebral compression and kyphosis may lead to an overestimation of obesity levels in older individuals (Villareal et al. 2005). ...
Background
There is a lack of research examining the association between obesity and depressive symptoms in relation to mental health. This study aimed to examine the correlation between Body Roundness Index (BRI) and depressive symptoms in elderly Chinese individuals.
Methods
The study sample consisted of 11,842 individuals aged 65 years or older from the 2018 Chinese Longitudinal Health Longevity Survey (CLHLS) database. A multivariate logistic regression analysis was used to investigate how BRI affects the likelihood of experiencing depressive symptoms, with restricted cubic spline (RCS) curves illustrating this impact. BRI values were calculated using a predefined formula for each participant, and depressive status was assessed using the Center for Epidemiologic Studies Depression Scale (CES‐D‐10).
Results
The mean age of the participants was 83.1 ± 10.9 years. A non‐linear relationship was identified between the BRI score and the risk of depressive symptoms. The analysis showed that for BRI scores below 5.17, there was a significant 9% increase in the risk of depressive symptoms for every 1‐point decrease in BRI score. Conversely, when the BRI was 5.17 or higher, a decrease in the BRI score did not lead to a significant increase in the risk of depressive symptoms.
Conclusion
The study demonstrated a significant association between BRI and depressive symptoms in elderly Chinese individuals. Furthermore, it was noted that older adults classified as overweight and mildly obese had a lower likelihood of experiencing depressive symptoms and demonstrated improved mental health.
... These benefits may result from enhanced satiety, increased thermogenesis, and/or the provision of additional essential amino acids (EAAs) for MPS [33,37,38]. Consequently, professional nutrition and obesity societies recommend higher protein intake as part of effective weight loss strategies to optimize body composition and support long-term weight loss maintenance [39], as described in greater detail below. ...
Obesity is a public health crisis, with prevalence rates tripling over the past 60 y. Although lifestyle modifications, such as diet and physical activity, remain the first-line treatments, recent anti-obesity medications (AOMs) have been shown to achieve greater reductions in body weight and fat mass. However, AOMs also reduce fat-free mass, including skeletal muscle, which has been demonstrated to account for 20% to 50% of total weight loss. This can equate to ∼6 kg or 10% of total lean mass after 12–18 mo, a loss comparable to a decade of human aging. Despite questions surrounding the clinical relevance of weight loss-induced muscle loss, the importance of adopting lifestyle behaviors such as eating a protein-rich diet and incorporating regular resistance training to support skeletal muscle health, long-term weight loss maintenance, and overall well-being among AOM users should be encouraged. Herein, we provide a rationale for the clinical significance of minimizing weight-loss-induced lean mass loss and emphasize the integration of diet and physical activity into AOM clinical care. Owing to a lack of published findings on diet and physical activity supporting skeletal muscle health with AOMs, specifically, we lean on findings from large-scale clinical weight loss and diet and exercise trials to draw evidence-based recommendations for strategies to protect skeletal muscle. We conclude by identifying gaps in the literature and emphasizing the need for future experimental research to optimize skeletal muscle and whole-body health through a balance of pharmacotherapy and healthy habits.
... The observed decline in fat free mass was greater in the least fit compared with the more fit older adult 7 . The decrease in fat free mass with aging is particularly an issue as it relates to a reduction in bone mineral density and declines in physical function 16 . Low bone mineral density is a major predictor of bone fractures 17 and physical frailty is associated with a low relative proportion of body weight as fat free mass, as well as poor muscle quality 18 . ...
There is a rising prevalence of both obesity (defined as a body mass index of > 30.0 kg/m2) and the number of individuals over the age of 60 years. Currently ~40% of older adults are obese and the number of individuals over the age of 65 is expected to reach 82 million by 2050. Obesity is also estimated to affect 50% of older adults in next few decades. This combination makes this a very concerning health issue. While intentional weight loss benefits young- to middle- aged adults, this is not so clear with older adults. Due to the loss of fat free mass, including skeletal muscle and bone mineral density, there is an increased risk of impaired physical function, fractures, and even mortality in this older cohort. Complicating whether to advise older adults to attempt to lose weight or not is the fact that about 1 in 5 individuals rescind and gain back most if not all of lost weight. This weight regain is mostly as fat and it is deposited into ectopic fat depots, potentially making cardiometabolic risk worse. Caloric restriction using a variety of diet patterns and macronutrient distributions can be successful, at least in the short-term. Additionally, combining resistance and aerobic exercise training with caloric restriction seems to provide the best results with regards to protecting loss of skeletal muscle and bone mineral density. Finally, time restricted eating is a novel approach for combating the detrimental effects of obesity and aging.
... Diet-induced weight loss is accompanied by a decline in lean mass, which is estimated at approximately 25% of the body mass lost. 6 This loss of lean mass during dietary intervention is associated with weight regain, 7 and individuals often experience weight fluctuations or weight loss cycling, which increases the risk for muscle wasting and weakness. 8 Loss of muscle mass during weight loss can also increase mortality risk and risk of disability. ...
Introduction
Lifestyle interventions combining caloric restriction with resistance exercise have the potential to preserve lean mass during weight loss. Additional protein intake can further improve lean mass. However, it is unclear whether these effects are sustained after completion of the intervention. This study aimed to evaluate the long‐term effect of a 3‐month lifestyle intervention, with or without supplementation of a protein drink, to preserve lean mass in older adults with obesity and type 2 diabetes at 6 months post‐intervention.
Methods
Adults (n = 123) aged ≥55 years with obesity and type 2 diabetes were enrolled in a 3‐month intensive lifestyle intervention including a hypocaloric diet, resistance exercise and high‐intensity interval training. Participants were randomized to either receive a leucine and vitamin D‐enriched protein drink or an isocaloric control drink. The 3‐month intervention was followed by a 6‐month phase without intervention. At baseline, 3 and 9 months (follow‐up) body composition, physical functioning, physical activity and quality of life were assessed. Statistical analyses were performed using linear mixed models.
Results
Body weight loss was largely sustained at follow‐up (−2.1 kg compared to baseline, 95% CI [−2.8, −1.5]) and comprised a sustained loss of fat mass (−2.6 kg, 95% CI [−3.2, −2.0]) with a simultaneous gain of lean mass (+0.7 kg, 95% CI [+0.2, +1.2]). Improvements in 400 m walk speed (+0.05 m/s, 95% CI [+0.03, +0.08]) and chair stand test time (−1.5 s, 95% CI [−1.9, −1.1]) were sustained at follow‐up. There were no differences in these changes between the protein supplementation group and the control group at follow‐up.
Conclusions
Older adults with obesity and type 2 diabetes preserved their lean mass, their loss of fat mass and their improvements in physical functioning at 6 months post‐intervention. Protein supplementation during intervention did not affect outcomes at follow‐up.
... Measurement cut-offs for sarcopenia and obesity from various studies[34][35][36][37][38] ...
Sarcopenic obesity (SO) is a chronic condition and an emerging health challenge, in view of the growing elderly population and the obesity epidemic. Due to a lack of awareness among treating doctors and the non-specific nauture of the associated symptoms, SO remains grossly underdiagnosed. There is no consensus yet on a standard definition or diagnostic criteria for SO, which limits the estimation of the global prevalence of this condition. It has been linked to numerous metabolic derangements, cardiovascular disease (CVD) and mortality. The treatment of SO is multimodal and requires expertise across multiple specialties. While dietary modifications and exercise regimens have shown a potential therapeutic benefit, there is currently no proven pharmacological management for SO. However, numerous drugs and the role of bariatric surgery are still under trial, and have great scope for further research. This article covers the available literature regarding the definition, diagnostic criteria, and prevalence of SO, with available evidence linking it to CVD, metabolic disease and mortality, and an overview of current directives on management.
... Measurement cut-offs for sarcopenia and obesity from various studies[34][35][36][37][38] ...
Sarcopenic obesity (SO) is a chronic condition and an emerging health challenge, in view of the growing elderly population and the obesity epidemic. Due to a lack of awareness among treating doctors and the non-specific nauture of the associated symptoms, SO remains grossly underdiagnosed. There is no consensus yet on a standard definition or diagnostic criteria for SO, which limits the estimation of the global prevalence of this condition. It has been linked to numerous metabolic derangements, cardiovascular disease (CVD) and mortality. The treatment of SO is multimodal and requires expertise across multiple specialties. While dietary modifications and exercise regimens have shown a potential therapeutic benefit, there is currently no proven pharmacological management for SO. However, numerous drugs and the role of bariatric surgery are still under trial, and have great scope for further research. This article covers the available literature regarding the definition, diagnostic criteria, and prevalence of SO, with available evidence linking it to CVD, metabolic disease and mortality, and an overview of current directives on management.
... The World Health Organization (WHO) defines overweight and obesity as abnormal or excessive fat accumulation that increases the risk of cardiometabolic disease and certain types of cancer (1). The association between BMI and all-cause mortality for BMI over 25 kg/m 2 (overweight), and over 30 kg/m 2 (obese), is well documented (2) and BMI has been widely used and accepted as a simple method to classify cardiometabolic risk by weight status (3). Despite being a practical tool for evaluating obesity and predicting chronic disease and mortality in a large population (4), the use of BMI to identify excess fat at the individual level has reasonable specificity but poor sensitivity, with approximately half the individuals with excessive body fat percentage (BF%), misclassified as non-obese (5,6). ...
Objective
To evaluate the prevalence of excessive adiposity among normal-weight individuals, and their cardiometabolic risk.
Methods
This cross-sectional study included 3,001 participants (ages 20–95, 52% men, BMI 28.0 ± 5.5 kg/m²) who completed an anthropometric evaluation, dual x-ray absorptiometry (DXA) scan to measure body composition, and cardiometabolic blood markers. Excess adiposity was defined as ≥25% for men and ≥ 35% for women.
Results
Of the entire study participants, 967 were in normal BMI (18.5–24.9 kg/m²) with a wide body fat distribution (4–49%). Of them, 26% of men and 38% of women were classified with excess adiposity. As compared to normal-weight lean participants, normal-weight obese men and women had higher triglycerides (76.5 ± 37.3 vs. 101.2 ± 50.3 mg/dL, p = 0.004 and 84 ± 44.2 vs. 101.4 ± 91.1 mg/dL, p = 0.030; respectively) and elevated low-density lipoprotein cholesterol (103.3 ± 31.7 vs. 119.6 ± 45.5 mg/dL, p = 0.011) and total cholesterol (171.5 ± 40.3 vs. 190.2 ± 39 mg/dL, p = 0.007) for men only. Among NWO, abdominal circumference was prevalent in 60% of the females with NWO (≥88 cm), but only in 4% of males (≥102 cm).
Conclusion
Higher adiposity, even within normal weight, increases cardiometabolic risk, and abdominal waist circumference misclassified obesity in normal-weight individuals. This study highlights the need for a body composition evaluation to determine cardiometabolic risk for adults with normal body weight.
... However, they should be designed on an individual basis. Weight loss induced only by caloric restriction results in fat tissue and fat-free mass loss (38). Physical activity should be simultaneously sustained for absolute or, in some instances, relative SMM increase. ...
Background
Based on cross-sectional studies, there is a link between body composition parameters and steatosis in non-alcoholic fatty liver disease (NAFLD). However, whether long-term changes in different body composition parameters will result in NAFLD resolution is unclear. Therefore, we aimed to summarize the literature on longitudinal studies evaluating the association between NAFLD resolution and body composition change.
Methods
Based on the recommendations of the Cochrane Handbook, we performed a systematic search on September 26th, 2021, in three databases: Embase, MEDLINE (via PubMed), and Cochrane Central Register of Controlled Trials (CENTRAL). Eligible studies reported on patients with NAFLD (liver fat >5%) and examined the correlation between body composition improvement and decrease in steatosis. We did not have pre-defined body composition or steatosis measurement criteria. Next, we calculated pooled correlation coefficient (r) with a 95% confidence interval (CI). Furthermore, we narratively summarized articles with other statistical methods.
Results
We included 15 studies in our narrative review and five in our quantitative synthesis. Based on two studies with 85 patients, we found a pooled correlation coefficient of r = 0.49 (CI: 0.22–0.69, Spearman's correlation) between the change of visceral adipose tissue and liver steatosis. Similarly, based on three studies with 175 patients, the correlation was r = 0.33 (CI: 0.19–0.46, Pearson's correlation). On the other hand, based on two studies with 163 patients, the correlation between subcutaneous adipose tissue change and liver steatosis change was r = 0.42 (CI: 0.29–0.54, Pearson's correlation). Furthermore, based on the studies in the narrative synthesis, body composition improvement was associated with steatosis resolution.
Conclusions
Based on the included studies, body composition improvement may be associated with a decrease in liver fat content in NAFLD.
Systematic review registration
Identifier: CRD42021278584.
... Obesity was previously thought to be a protective factor against bone loss due to the higher bone mineral rate found in obese bodies (Villareal et al., 2005). However, conflicting views on the impact of obesity on bone health have emerged with studies on bone microarchitecture, and the latest evidence suggests that obesity is detrimental to bone metabolism (Rinonapoli et al., 2021). ...
Gut microbiota has been reported to participate in bone metabolism. However, no article has quantitatively and qualitatively analyzed this crossing field. The present study aims to analyze the current international research trends and demonstrate possible hotspots in the recent decade through bibliometrics. We screened out 938 articles meeting the standards from 2001 to 2021 in the Web of Science Core Collection database. Bibliometric analyses were performed and visualized using Excel, Citespace, and VOSviewer. Generally, the annual number of published literatures in this field shows an escalating trend. The United States has the largest number of publications, accounting for 30.4% of the total. Michigan State University and Sichuan University have the largest number of publications, while Michigan State University has the highest average number of citations at 60.00. Nutrients published 49 articles, ranking first, while the Journal of Bone and Mineral Research had the highest average number of citations at 13.36. Narayanan Parameswaran from Michigan State University, Roberto Pacifici from Emory University, and Christopher Hernandez from Cornell University were the three professors who made the largest contribution to this field. Frequency analysis showed that inflammation (148), obesity (86), and probiotics (81) are keywords with the highest focus. Moreover, keywords cluster analysis and keywords burst analysis showed that “inflammation”, “obesity”, and “probiotics” were the most researched topics in the field of gut microbiota and bone metabolism. Scientific publications related to gut microbiota and bone metabolism have continuously risen from 2001 to 2021. The underlying mechanism has been widely studied in the past few years, and factors affecting the alterations of the gut microbiota, as well as probiotic treatment, are emerging as new research trends.
... Aging is the dominant risk factor for most chronic diseases, many of which are linked to tissue-specific metabolic perturbations 1,2 . Age-related declines in metabolic homeostasis are further exacerbated by obesity 3,4 , which has increased dramatically in older adults in recent decades 5,6 . Moreover, obesity is now recognized to exacerbate aging mechanisms and induce phenotypes more commonly observed with advancing age [7][8][9][10][11][12][13] . ...
Metabolic dysfunction underlies several chronic diseases. Dietary interventions can reverse metabolic declines and slow aging but remaining compliant is difficult. 17α-estradiol (17α-E2) treatment improves metabolic parameters and slows aging in male mice without inducing significant feminization. We recently reported that estrogen receptor α is required for the majority of 17α-E2-mediated benefits in male mice, but that 17α-E2 also attenuates fibrogenesis in liver, which is regulated by estrogen receptor β (ERβ)-expressing hepatic stellate cells (HSC). The current studies sought to determine if 17α-E2-mediated benefits on systemic and hepatic metabolism are ERβ-dependent. We found that 17α-E2 treatment reversed obesity and related systemic metabolic sequela in both male and female mice, but this was partially blocked in female, but not male, ERβKO mice. ERβ ablation in male mice attenuated 17α-E2-mediated benefits on hepatic stearoyl-coenyzme A desaturase 1 (SCD1) and transforming growth factor β1 (TGF-β1) production, which play critical roles in HSC activation and liver fibrosis. We also found that 17α-E2 treatment suppresses SCD1 production in cultured hepatocytes and hepatic stellate cells, indicating that 17α-E2 directly signals in both cell-types to suppress drivers of steatosis and fibrosis. We conclude that ERβ partially controls 17α-E2-mediated benefits on systemic metabolic regulation in female, but not male, mice, and that 17α-E2 likely signals through ERβ in HSCs to attenuate pro-fibrotic mechanisms.
... Similarly, in this study, along with increased age, higher wealth index was found to be positively associated with overweight and obesity. Another plausible explanation could be the changes in body composition with increased age, particularly those associated with decline in fat-free mass and subsequent rise in fat mass which begins to occur when an individual crosses 30 years of age [55,59]. Increase in age has also been identified as an essential risk factor for both overweight or obesity and other NCDs [53]. ...
This study aimed to examine the trends in the prevalence of overweight and obesity and to determine the associated socioeconomic and household environmental factors among women in Nepal. Using nationally representative data from the 1996, 2001, 2006, 2011, and 2016 cross-sectional Nepal Demographic and Health Surveys (NDHSs) (n = 33,507), the prevalence of overweight–obesity (body mass index (BMI) ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) among women aged 15–49 years were examined. From the latest NDHS 2016, non-pregnant women with recorded anthropometric measurements (n = 6165) were included in the final analyses. Multivariate logistic regression models were used to determine the socioeconomic and household environmental factors associated with BMI ≥ 25 and BMI ≥ 30. Between 1996 and 2016, the prevalence of overweight–obesity increased from 1.8% to 19.7%, while the prevalence of obesity increased from 0.2% to 4.1%. Age, marital status, wealth index, province of residence, type of cooking fuel, and household possessions—refrigerator and bicycle were significantly associated with having overweight–obesity and obesity. Similarly, educational status, religion, type of toilet facility, and household possessions—television and mobile phone were significantly associated with having overweight–obesity. Given the alarming increase in the prevalence of overweight and obesity among Nepalese women, there is an urgent need for interventions addressing these critical socioeconomic and household environmental factors.
... Obesity in older adults is associated with loss of functional independence and diminished well-being, as well as with an increased risk of presenting with the cardiometabolic syndrome, a combination of metabolic abnormalities predictive of cardiovascular disease and mortality. 42,43 Still, obesity does not preclude the possibility to have a preserved muscle mass in old age, and obese patients could thus optimally respond to exercise interventions, although sarcopenic obesity can be a challenge when tailoring exercise interventions. There is evidence that the combination of weight loss and exercise provides greater improvements in physical function than either intervention alone, 44 although the evidence in hospitalized older adults is more limited. ...
Background
Different multimorbidity patterns present with different prognoses, but it is unknown to what extent they may influence the effectiveness of an individualized multicomponent exercise program offered to hospitalized older adults.
Methods
This study is a secondary analysis of a randomized controlled trial conducted in the Department of Geriatric Medicine of a tertiary hospital. In addition to the standard care, an exercise-training multicomponent program was delivered to the intervention group during the acute hospitalization period. Multimorbidity patterns were determined through fuzzy c-means cluster analysis, over 38 chronic diseases. Functional, cognitive and affective outcomes were considered.
Results
Three hundred and six patients were included in the analyses (154 control; 152 intervention), with a mean age of 87.2 years, and 58.5% being female. Four patterns of multimorbidity were identified: heart valves and prostate diseases (26.8%); metabolic diseases and colitis (20.6%); psychiatric, cardiovascular and autoimmune diseases (16%); and an unspecific pattern (36.6%). The Short Physical Performance Battery (SPPB) test improved across all patterns, but the intervention was most effective for patients in the metabolic/colitis pattern (2.48-point difference between intervention/control groups, 95% CI 1.60-3.35). Regarding the Barthel Index and the Mini Mental State Examination (MMSE), the differences were significant for all multimorbidity patterns, except for the psychiatric/cardio/autoimmune pattern. Differences concerning quality of life were especially high for the p sychiatric/cardio/autoimmune pattern (16.9-point difference between intervention/control groups, 95% CI 4.04, 29.7).
Conclusions
Patients in all the analyzed multimorbidity patterns improved with this tailored program, but the improvement was highest for those in the metabolic pattern. Understanding how different chronic disease combinations are associated with specific functional and cognitive responses to a multicomponent exercise intervention may allow further tailoring such interventions to older patients’ clinical profile.
... Weight loss in older adults is associated with loss of muscle and bone mass [20]. Therefore, attempts to lose weight should incorporate exercise and optimal protein intake in order to prevent older adults from losing muscle and bone mass [90]. Any unintentional weight loss should lead to further nutritional and physical assessment, no matter the BMI. ...
... Worldwide, obesity is a leading risk factor for morbidity and mortality [7]. Thus, it is worth exploring genetic factors correlated with obesity to develop an intervention for this condition. ...
This study investigated the associations between relative telomere length (RTL) and resting metabolic rate (RMR), resting fat oxidation (RFO), and aerobic capacity and whether oxidative stress and inflammation are the underlying mechanisms in sedentary women. We also aimed to determine whether the correlations depend on age and obesity. Sixty-eight normal weight and 66 obese women participated in this study. After adjustment for age, energy expenditure, energy intake, and education level, the RTL of all participants was negatively correlated with absolute RMR (RMRAB) and serum high-sensitivity C-reactive protein (hsCRP) concentration, and positively correlated with maximum oxygen consumption (V˙O2max) (all p < 0.05). After additional adjustment for adiposity indices and fat-free mass (FFM), RTL was positively correlated with plasma vitamin C concentration (p < 0.05). Furthermore, after adjustment for fasting blood glucose concentration, RTL was negatively correlated with age and positively correlated with V˙O2max (mL/kg FFM/min). We found that normal weight women had longer RTL than obese women (p < 0.001). We suggest that RTL is negatively correlated with RMRAB and positively correlated with aerobic capacity, possibly via antioxidant and anti-inflammatory mechanisms. Furthermore, age and obesity influenced the associations. We provide useful information for the management of promotion strategies for health-related physical fitness in women.
... The increased prevalence of obesity is a major health concern. Aging significantly increases the risks of obesity and obesity-induced co-morbidities such as type-2 diabetes mellitus (T2DM), non-alcoholic fatty liver disease/steatohepatitis (NAFLD/NASH), cardiovascular disease and certain types of cancer [1][2][3][4]. Excess fat accumulation exacerbates frailty in older persons. Conversely, metabolic dysfunction accelerates aging, as young people with obesity and T2DM often exhibit features of accelerated aging [5]. ...
(1) Background: We previously demonstrated that disruption of IP6K1 improves metabolism, protecting mice from high-fat diet-induced obesity, insulin resistance, and non-alcoholic fatty liver disease and steatohepatitis. Age-induced metabolic dysfunction is a major risk factor for metabolic diseases. The involvement of IP6K1 in this process is unknown. (2) Methods: Here, we compared body and fat mass, insulin sensitivity, energy expenditure and serum-, adipose tissue- and liver-metabolic parameters of chow-fed, aged, wild type (aWT) and whole body Ip6k1 knockout (aKO) mice. (3) Results: IP6K1 was upregulated in the adipose tissue and liver of aWT mice compared to young WT mice. Moreover, Ip6k1 deletion blocked age-induced increase in body- and fat-weight and insulin resistance in mice. aKO mice oxidized carbohydrates more efficiently. The knockouts displayed reduced levels of serum insulin, triglycerides, and non-esterified fatty acids. Ip6k1 deletion partly protected age-induced decline of the thermogenic uncoupling protein UCP1 in inguinal white adipose tissue. Targets inhibited by IP6K1 activity such as the insulin sensitivity- and energy expenditure-inducing protein kinases, protein kinase B (PKB/Akt) and AMP-activated protein kinase (AMPK), were activated in the adipose tissue and liver of aKO mice. (4) Conclusions: Ip6k1 deletion maintains healthy metabolism in aging and thus, targeting this kinase may delay the development of age-induced metabolic dysfunction.
Despite adverse metabolic and functional consequences of obesity (BMI ≥30 kg/m ² ), clinical recommendations for weight loss (WL) in older adults (65+ years) with obesity remain controversial. Reluctance stems partly from epidemiologic data demonstrating musculoskeletal tissue loss with WL and increased risk of disability and osteoporotic fracture. Randomized controlled trials in older adults complement and extend knowledge in this area showing: (1) lifestyle‐based WL interventions often yield clinically meaningful (~8%–10%) WL in older adults; (2) lean mass loss is significant, although fat mass loss is preferential and physical performance is often improved, particularly when combined with aerobic and resistance training (RT); (3) bone loss is also significant, with some evidence that RT can attenuate WL‐associated bone loss; and (4) fat mass regain after intervention cessation is common, yet physical performance gains appear to be maintained. Best practices for treating older adults with obesity include comprehensive assessment of baseline musculoskeletal health; patient‐centered goal setting; moderate (i.e., −500 kcal/day) caloric restriction ensuring protein (1–1.2 g/kg/day), calcium (1000–1200 mg/day), and vitamin D (800–1000 IU/day) needs are met; incorporation of RT (≥2 days/week) and moderate‐intensity weight‐bearing aerobic training (≥150 min/week); and delivery of care by a multidisciplinary team.
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Zusammenfassung
Mit der zunehmenden Prävalenz von Adipositas bei älteren Menschen gewinnen maßgeschneiderte therapeutische Strategien an Bedeutung. Aktuelle Leitlinien empfehlen multimodale Ansätze für das Gewichtsmanagement bei Erwachsenen, enthalten jedoch keine spezifischen Empfehlungen für ältere Menschen. Altersbedingte Veränderungen der Körperzusammensetzung, geriatrische Syndrome und Multimorbidität sind bei Therapieentscheidungen zu berücksichtigen. Eine Gewichtsreduktion kann den altersbedingten Verlust von Muskel- und Knochenmasse verstärken und das Risiko ungünstiger Folgen erhöhen. Daher sind Therapiekonzepte notwendig, die den Verlust von Fettmasse, den Erhalt von Muskel- und Knochenmasse sowie die Verbesserung des funktionellen Status anstreben.
Dieser Artikel gibt einen Überblick über die multimodale Adipositastherapie im Alter und fasst klinische Studien zusammen, die solche Interventionen bei älteren Menschen mit spezifischen Komorbiditäten durchgeführt haben. Multimodale Interventionen, die moderate Kalorienrestriktion, kombiniertes Kraft- und Ausdauertraining sowie verhaltenstherapeutische Strategien umfassen, haben sich als sicher und effektiv erwiesen. Allerdings wurden Komorbiditäten und geriatrische Syndrome in den Studien selten berücksichtigt. Zudem gibt es wenige Studien, die spezielle Krankheitsbilder oder Syndrome wie Herzinsuffizienz, Arthrose oder Gebrechlichkeit als Einschlusskriterium adressieren, was die Übertragbarkeit der Ansätze einschränkt.
Aims
We assessed changes in body composition following tirzepatide treatment in a substudy of participants with obesity or overweight from the SURMOUNT‐1 trial, overall and post hoc in clinically relevant subgroups.
Materials and Methods
Substudy participants ( n = 160 of the 2539 in SURMOUNT‐1) underwent dual‐energy X‐ray absorptiometry (DXA) at baseline and Week 72. Body composition parameters were evaluated by analysis of covariance, logistic regression or Fisher's exact test. Post hoc subgroup analyses were conducted by sex (female or male), age (<50, 50 to <65, or ≥65 years) and total body weight reduction tertiles (≤15.3 kg, >15.3 to ≤25.9 kg, or >25.9 kg).
Results
The 160 participants (pooled tirzepatide doses n = 124, placebo n = 36) with baseline and end of study DXA data were 73% female and had a mean weight of 102.5 kg and body mass index of 38.0 kg/m ² . The change in body weight, fat mass and lean mass from baseline to Week 72 was −21.3%, −33.9% and −10.9% with tirzepatide and −5.3%, −8.2% and −2.6% with placebo, respectively ( p < 0.001 for all comparisons). Of the body weight lost, approximately 75% was fat mass and 25% was lean mass for both tirzepatide and placebo. These proportions remained consistent across most subgroup analyses.
Conclusions
In participants with obesity or overweight from the SURMOUNT‐1 trial, tirzepatide treatment significantly reduced body weight, fat mass and lean mass compared with placebo, while in post hoc analyses, the proportion of body weight lost as fat or lean mass was relatively consistent including in clinically relevant subgroups.
Objective: To identify the scientific evidence available on nutritional conducts to prevent the aggravation and treat institutionalized elderly people with sarcopenia. Methods: Integrative review conducted in the databases: LILACS, PUBMED, EBSCO and SciELO, from the descriptors: Diet Therapy; Elderly; Long-Stay Institution for the Elderly; Sarcopenia. The PICO strategy was used to develop the guiding question. Articles that answered the guiding question "what is the available evidence on nutritional management for institutionalized elderly people with sarcopenia to prevent the worsening and treatment of the disease" were included. Literature review: Six articles that responded to the theme were included in the integrative review. It was found that oral supplements plus high quality protein, vitamin D, Medium Chain Triglycerides (MCTs), beta-hydroxy-beta-methylbutyric acid (HMB) and leucine were nutritional interventions used to prevent the aggravation and treat sarcopenia in institutionalized elderly people. The practice of physical exercises was considered as an alternative intervention combined with nutritional conducts in order to improve results. Conclusion: Nutritional interventions of oral supplementation of high quality protein, vitamin D, TCMs, HMB and leucine may be beneficial to prevent the onset of sarcopenia and to treat institutionalized elderly people with sarcopenia.
Introduction: Aging population and growing obesity prevalence are two major public health issues. Bariatric surgery has been shown to be both safe and effective, but its role in the treatment of the elderly remains controversial.
Objectives: To evaluate the efficacy and safety of laparoscopic bariatric surgery in patients over 70 years of age.
Methods: A systematic review and assessment of the literature was performed in November-December 2023. Inclusion criteria gathered studies of elderly (age ≥70 years old) who underwent laparoscopic bariatric surgery. The data extraction focused on weight loss, obesity-related diseases, and complications.
Results: Fourteen retrospective studies were included, involving 3923 septuagenarians (female, 69.70%). One year after the surgery, the mean excess weight loss was 54.66%. At last follow-up, the improvement in obesity-related diseases was regarded as 50% diagnosed with diabetes, 36% with hypertension, 50% with reflux, 36% with sleep apnea, and 25% with hyperlipidemia. The overall postoperative major morbidity and mortality were about 2% and 1%, respectively.
Conclusions: This systematic review suggests that laparoscopic bariatric surgery is an effective and safe treatment for patients over 70 years of age.
Obesity is found to be a significant risk factor for type 2 diabetes mellitus (T2DM), attributed to lipotoxicity‐induced β‐cell dysfunction. However, the specific mechanism involved in the process remains incompletely unclarified. The current study demonstrated lipotoxicity resulted in the activation of ER stress, which increased the protein level of TXNIP, thereby inducing senescence‐assiciated dysfunction in MIN6 cells under high fat environment. And we also found sesamol, a natural functional component extracted from sesame, was able to alleviate senescence‐associated β‐cell dysfunction induced by lipotoxicity by inhibiting ER stress and TXNIP. Our findings provided novel insights into senescence‐related T2DM and propose innovative therapeutic approaches for utilizing sesamol in the treatment of T2DM in the obese elderly population.
Excess adiposity is at the root of type 2 diabetes (T2D). Glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) have emerged as first‐line treatments for T2D based on significant weight loss results. The composition of weight loss using most diets consists of <25% fat‐free mass (FFM) loss, with the remainder from fat stores. Higher amounts of weight loss (achieved with metabolic bariatric surgery) result in greater reductions in FFM. Our aim was to assess the impact that GLP‐1RA‐based treatments have on FFM. We analysed studies that reported changes in FFM with the following agents: exenatide, liraglutide, semaglutide, and the dual incretin receptor agonist tirzepatide. We performed an analysis of various weight loss interventions to provide a reference for expected changes in FFM. We evaluated studies using dual‐energy X‐ray absorptiometry (DXA) for measuring FFM (a crude surrogate for skeletal muscle). In evaluating the composition of weight loss, the percentage lost as fat‐free mass (%FFML) was equal to ΔFFM/total weight change. The %FFML using GLP‐1RA‐based agents was between 20% and 40%. In the 28 clinical trials evaluated, the proportion of FFM loss was highly variable, but the majority reported %FFML exceeding 25%. Our review was limited to small substudies and the use of DXA, which does not measure skeletal muscle mass directly. Since FFM contains a variable amount of muscle (approximately 55%), this indirect measure may explain the heterogeneity in the data. Assessing quantity and quality of skeletal muscle using advanced imaging (magnetic resonance imaging) with functional testing will help fill the gaps in our current understanding.
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) ranges from hepatic steatosis to nonalcoholic steatohepatitis and may lead to liver cirrhosis. This study aimed to assess the feasibility of numerical grading MASLD using noncontrast computed tomography (NCCT). Methods: In a retrospective study of 166 patients diagnosed with MASLD between June 2020 and January 2024, MASLD was graded by ultrasonography, and liver density was measured on NCCT. The MASLD grades and NCCT densities were compared. Results: The MASLD grades were distributed as follows: grade 0 (n = 79, 47.6%), grade 2 (n = 48, 28.9%), grade 1 (n = 25, 15.1%), and grade 3 (n = 14, 8.4%). The mean liver density was 57.75 Hounsfield units (HU) ± 6.18 (range: 48.9-78.2), 51.1 HU ± 4.7 (range: 41.4-59.7), 39.3 ± 6.4 (range: 21.4-48.9), and 22.87 ± 7.5 (range: 12-36.4) in the grade 0, grade 1, grade 2, and grade 3 patients, respectively. An analysis of variance test showed significant variance in the distribution of mean liver density in the different MASLD grades (p < 0.001). Conclusions: After ultrasonography diagnosis of MASLD, NCCT offers an objective, numerical, and calculable method for MASLD grading that is available for radiologists, radiologic technologists, and interested physicians away from experience dependence. NCCT determined that grade 2 had a specific density from 36.4 to 41.4 HU that significantly overlapped with grade 1 (41.4-48.9) HU and with grade 3 (21.4-36.4 HU). Grade 1 showed a significant overlap with the normal liver (48.9-59.7 HU).
The prevalence of obesity in older adults (people aged >60 years) is increasing in line with the demographic shift in global populations. Despite knowledge of obesity-related complications in younger adults (increased risk of type 2 diabetes, liver and cardiovascular disease and malignancy), these considerations may be outweighed, in older adults, by concerns regarding weight-loss induced reduction in skeletal muscle and bone mass, and the awareness of the ‘obesity paradox’. Obesity in the elderly contributes to various obesity-related complications from cardiometabolic disease and cancer, to functional decline, worsening cognition, and quality of life, that will have already suffered an age-related decline. Lifestyle interventions remain the cornerstone of obesity management in older adults, with emphasis on resistance training for muscle strength and bone mineral density preservation. However, in older adults with obesity refractory to lifestyle strategies, pharmacotherapy, using anti-obesity medicines (AOMs), can be a useful adjunct. Recent evidence suggests that intentional weight loss in older adults with overweight and obesity is effective and safe, hence a diminishing reluctance to use AOMs in this more vulnerable population. Despite nine AOMs being currently approved for the treatment of obesity, limited clinical trial evidence in older adults predominantly focuses on incretin therapy with glucagon-like peptide-1 receptor agonists (liraglutide, semaglutide, and tirzepatide). AOMs enhance weight loss and reduce cardiometabolic events, while maintaining muscle mass. Future randomised controlled trials should specifically evaluate the effectiveness of novel AOMs for long-term weight management in older adults with obesity, carefully considering the impact on body composition and functional ability, as well as health economics.
Background
Whether testosterone replacement therapy (TRT) conveys additional cardiometabolic benefit to an intensive lifestyle therapy (LT) in older men with obesity and hypogonadism remains unclear.
Objective
To determine whether TRT augments the effect of LT on metabolic outcomes in older men with obesity and hypogonadism.
Design
Secondary analysis of a randomized, double-blind, placebo-controlled trial.
Setting
Veterans Affairs Medical Center
Participants
83 older (age ≥ 65 years) men with obesity (BMI ≥ 30 kg/m2) and persistently low AM testosterone (< 10.4 nmol/L) associated with frailty.
Interventions
LT (weight management and exercise training) plus either testosterone (LT+TRT) or placebo (LT+Pbo) for six months.
Outcome measures
Primary outcome was change in glycated hemoglobin (HbA1c). Secondary outcomes included changes in other glucometabolic and lipid profile components, liver enzymes, inflammatory markers, adipokines; subcutaneous, visceral, intramuscular, and hepatic fat; blood pressure, and metabolic syndrome score.
Results
HbA1c decreased similarly in LT+TRT and LT+Pbo groups (-0.5% vs. -0.6%, respectively; p= 0.35). While TRT showed no synergistic effect with LT on ameliorating secondary outcomes, it eliminated the augmentative effect of LT on high-density lipoprotein cholesterol concentration (5.4 ± 1.0 mg/dL in LT+Pbo group vs. 0.2 ± 1.1 mg/dL in LT+TRT group, p= 0.01) and adiponectin levels (-408 ± 489 ng/mL in TRT+LT group vs 1832 ± 468 ng/mL in LT+Pbo group, p= 0.02).
Conclusion
In older men with obesity and hypogonadism, adding TRT for six months to LT does not result in further improved cardiometabolic profiles, and could potentially blunt some of the metabolic benefits induced by LT.
Background: Based on cross-sectional studies, there is a link between body composition parameters and steatosis in non-alcoholic fatty liver disease (NAFLD). However, whether long-term changes in different body composition parameters will result in NAFLD resolution is unclear. Therefore, we aimed to summarize the literature on longitudinal studies evaluating the association between NAFLD resolution and body composition change.
Methods: Based on the recommendations of the Cochrane Handbook, we performed a systematic search on September 26th, 2021, in four databases: Embase, MEDLINE (via PubMed), and Cochrane Central Register of Controlled Trials (CENTRAL). Eligible studies reported on patients with NAFLD (liver fat >5%) and examined the correlation between body composition improvement and a decrease in steatosis. We did not have pre-defined body composition or steatosis measurement criteria. Next, we calculated pooled correlation coefficient (r) with a 95% confidence interval (CI).
Results: We identified 15 eligible studies, of which 5 five studies were included in our quantitative synthesis. Based on two studies with 85 patients, we found a pooled correlation coefficient of r=0.49 (CI: 0.22-0.69, Spearman’s correlation) between the change of visceral adipose tissue and liver steatosis. Similarly, based on three studies with 175 patients, the correlation was r=0.33 (CI: 0.19-0.46, Pearson’s correlation). On the other hand, based on two studies with 163 patients, the correlation between subcutaneous adipose tissue change and liver steatosis change was r=0.42 (CI: 0.29-0.54, Pearson’s correlation).
Conclusion: Based on the included studies, body composition improvement is associated with a decrease in liver fat content in NAFLD.
Background:
Traditionally, weight loss (WL) trials utilize dual energy X-ray absorptiometry (DXA) to measure lean mass. This method assumes lean mass, as the sum of all non-bone and non-fat tissue, is a reasonable proxy for muscle mass. In contrast, the D3 -creatine (D3 Cr) dilution method directly measures whole body skeletal muscle mass, although this method has yet to be applied in the context of a geriatric WL trial. The purpose of this project was to (1) describe estimates of change and variability in D3 Cr muscle mass in older adults participating in an intentional WL intervention and (2) relate its change to other measures of body composition as well as muscle function and strength.
Methods:
The INVEST in Bone Health trial (NCT04076618), used as a scaffold for this ancillary pilot project, is a three-armed, 12-month randomized, controlled trial designed to determine the effects of resistance training or weighted vest use during intentional WL on a battery of musculoskeletal health outcomes among 150 older adults living with obesity. A convenience sample of 24 participants (n = 8/arm) are included in this analysis. At baseline and 6 months, participants were weighed, ingested a 30 mg D3 Cr tracer dose, provided a fasted urine sample 3-6 days post-dosage, underwent DXA (total body fat and lean masses, appendicular lean mass) and computed tomography (mid-thigh and trunk muscle/intermuscular fat areas) scans, and performed 400-m walk, stair climb, knee extensor strength, and grip strength tests.
Results:
Participants were older (68.0 ± 4.4 years), mostly White (75.0%), predominantly female (66.7%), and living with obesity (body mass index: 33.8 ± 2.7 kg/m2 ). Six month total body WL was -10.3 (95% confidence interval, CI: -12.7, -7.9) kg. All DXA and computed tomography-derived body composition measures were significantly decreased from baseline, yet D3 Cr muscle mass did not change [+0.5 (95% CI: -2.0, 3.0) kg]. Of muscle function and strength measures, only grip strength significantly changed [+2.5 (95% CI: 1.0, 4.0) kg] from baseline.
Conclusions:
Among 24 older adults, significant WL with or without weighted vest use or resistance training over a 6-month period was associated with significant declines in all bioimaging metrics, while D3 Cr muscle mass and muscle function and strength were preserved. Treatment assignment for the trial remains blinded; therefore, full interpretation of these findings is limited. Future work in this area will assess change in D3 Cr muscle mass by parent trial treatment group assignment in all study participants.
Background
Previous research has linked sarcopenic obesity (SO) to cognitive function; however, the relationship between cognitive performance and SO Alzheimer's disease (AD) patients remains unclear. This study aimed to investigate their relationship in AD patients.
Methods
One hundred and twenty mild to moderate AD patients and 56 normal controls were recruited. According to sarcopenia or obesity status, AD patients were classified into subgroups: normal, obesity, sarcopenia, and SO. Body composition, demographics, and sarcopenia parameters were assessed. Cognitive performance was evaluated using neuropsychological scales.
Results
Among the 176 participants, the prevalence of SO in the moderate AD group was higher than in the normal control group. The moderate AD group had the lowest appendicular skeletal muscle mass index (ASMI) and the highest percentage of body fat (PBF). Hypertension and diabetes were more prevalent in the SO group than in the normal group among the subgroups. The sarcopenia and SO groups exhibited worse global cognitive function compared to the normal and obesity groups. Partial correlation analysis revealed that ASMI, PBF, and visceral fat area were associated with multiple cognitive domains scores. In logistic regression analysis, after adjusting for confounders, obesity was not found to be associated with AD. However, sarcopenia (odds ratio (OR) = 5.35, 95% CI: 1.27–22.46) and SO (OR = 5.84, 95% CI: 1.26–27.11) were identified as independent risk factors for AD.
Conclusions
SO was associated with cognitive dysfunction in AD patients. Moreover, the impact of SO on cognitive decline was greater than that of sarcopenia. Early identification and intervention for SO may have a positive effect on the occurrence and progression of AD.
Metabolic dysfunction underlies several chronic diseases. Dietary interventions can reverse metabolic declines and slow aging but remaining compliant is difficult. 17α-estradiol (17α-E2) treatment improves metabolic parameters and slows aging in male mice without inducing significant feminization. We recently reported that estrogen receptor α is required for the majority of 17α-E2-mediated benefits in male mice, but that 17α-E2 also attenuates fibrogenesis in liver, which is regulated by estrogen receptor β (ERβ)-expressing hepatic stellate cells (HSC). The current studies sought to determine if 17α-E2-mediated benefits on systemic and hepatic metabolism are ERβ-dependent. We found that 17α-E2 treatment reversed obesity and related systemic metabolic sequela in both male and female mice, but this was partially blocked in female, but not male, ERβKO mice. ERβ ablation in male mice attenuated 17α-E2-mediated benefits on hepatic stearoyl-coenyzme A desaturase 1 (SCD1) and transforming growth factor β1 (TGF-β1) production, which play critical roles in HSC activation and liver fibrosis. We also found that 17α-E2 treatment suppresses SCD1 production in cultured hepatocytes and hepatic stellate cells, indicating that 17α-E2 directly signals in both cell-types to suppress drivers of steatosis and fibrosis. We conclude that ERβ partially controls 17α-E2-mediated benefits on systemic metabolic regulation in female, but not male, mice, and that 17α-E2 likely signals through ERβ in HSCs to attenuate pro-fibrotic mechanisms.
With the rise in obesity across age groups, it has been a hindrance to engaging in physical activity and mobility in older adults. Daily calorie restriction (CR) up to 25% has been the cornerstone of obesity management even though the safety in older adults remains incompletely understood. Although some adults can follow CR with clinically significant weight loss and improved health metrics, CR faces 2 obstacles-many fail to adopt CR and even among those who can adopt it short term, long-term compliance can be difficult. Furthermore, there is a continuing debate about the net benefits of CR-induced weight loss in older adults because of the concern that CR may worsen sarcopenia, osteopenia, and frailty. The science of circadian rhythm and its plasticity toward the timing of nutrition offer promise to alleviate some challenges of CR. The new concept of Time-Restricted Feeding/Eating (TRF for animal studies and TRE for human studies) can be an actionable approach to sustaining the circadian regulation of physiology, metabolism, and behavior. TRE can often (not always) lead to CR. Hence, the combined effect of TRE through circadian optimization and CR can potentially reduce weight and improve cardiometabolic and functional health while lessening the detrimental effects of CR. However, the science and efficacy of TRE as a sustainable lifestyle in humans are in its infancy, whereas animal studies have offered many desirable outcomes and underlying mechanisms. In this article, we will discuss the scope and opportunities to combine CR, exercise, and TRE to improve functional capacity among older adults with obesity.
Background:
Visceral obesity is associated with high cardiovascular events risk in type 2 diabetes mellitus (T2DM). Whether normal-weight visceral obesity will pose a higher atherosclerotic cardiovascular disease (ASCVD) risk than body mass index (BMI)-defined overweight or obese counterparts with or without visceral obesity remains unclear. We aimed to explore the relationship between general obesity and visceral obesity and 10-year ASCVD risk in patients with T2DM.
Methods:
Patients with T2DM (6997) who satisfied the requirements for inclusion were enrolled. Patients were considered to have normal weight when 18.5 kg/m2 ≤ BMI < 24 kg/m2; overweight when 24 kg/m2 ≤ BMI < 28 kg/m2; and obesity when BMI ≥ 28 kg/m2. Visceral obesity was defined as a visceral fat area (VFA) ≥ 100 cm2. Patients were separated into six groups based on BMI and VFA. The odd ratios (OR) for a high 10-year ASCVD risk for different combinations of BMI and VFA were analysed using stepwise logistic regression. Receiver operating characteristic (ROC) curves for diagnosing the high 10-year ASCVD risk were constructed, and areas under the ROC curves were estimated. Potential non-linear relationships between VFA levels and high 10-year ASCVD risk were examined using restricted cubic splines (knot = 4). Multilinear regression was used to identify factors affecting VFA in patients with T2DM.
Results:
In patients with T2DM, subjects with normal-weight visceral obesity had the highest 10-year ASCVD risk among the six groups, which had more than a 2-fold or 3-fold higher OR than those who were overweight or obese according to BMI but did not have visceral obesity (all P < 0.05). The VFA threshold for high 10-year ASCVD risk was 90 cm2. Multilinear regression showed significant differences in the effect of age, hypertension, drinking, fasting serum insulin, fasting plasma glucose, 2 h postprandial C-peptide, triglyceride, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol on VFA in patients with T2DM (all P < 0.05).
Conclusions:
T2DM patients with normal-weight visceral obesity had a higher 10-year ASCVD risk than BMI-defined overweight or obese counterparts with or without visceral obesity, which should initiate standardised management for ASCVD primary prevention.
Context
The Pritikin Program, which provides intensive lifestyle therapy has been shown to improve cardiometabolic outcomes when provided as a residential program.
Objective
The purpose of the present study was to conduct a short-term, randomized, controlled trial to evaluate the feasibility and clinical efficacy of treatment with the Pritikin Program in an outpatient worksite setting.
Methods
Cardiometabolic outcomes were evaluated in people with overweight/obesity and ≥2 metabolic abnormalities (high triglycerides, low HDL-cholesterol, high blood pressure, HbA1c > 5.7%), before and after they were randomized to 6-weeks of standard care (n = 26) or intensive lifestyle therapy, based on the Pritikin Program (n = 28). Participants in the lifestyle intervention group were provided all food as packed-out meals and participated in group nutrition, behavioral education, cooking classes and exercise sessions 3 times per week at a worksite location.
Results
Compared with standard care, intensive lifestyle therapy decreased body weight (-5.0% vs -0.5%), HbA1c (-15.5% vs +2.3%), plasma total cholesterol (-9.8% vs +7.7%), LDL-cholesterol (-10.3% vs +9.3%), and triglyceride (-21.7% vs +3.0%) concentrations, and systolic blood pressure (-7.0% vs 0%) (all P-values <0.02), and increased exercise tolerance (time to exhaustion walking on a treadmill by +23.7% vs +4.5%; P < 0.001).
Conclusions
This study demonstrates the feasibility and clinical effectiveness of short-term, intensive outpatient lifestyle therapy in people with overweight/obesity and increased risk of coronary heart disease when all food is provided and the intervention is conducted at a convenient worksite setting.
Resumo Introdução Alterações na composição corporal do idoso podem ser rapidamente identificadas por profissionais de saúde na Atenção Básica, reduzindo o impacto sobre a saúde, o estado nutricional e a capacidade funcional. Objetivo Identificar relações entre massa e força muscular com o estado nutricional e a capacidade funcional em idosos da comunidade. Método Estudo transversal, envolvendo 323 idosos. A avaliação da composição corporal foi realizada por absorciometria (DEXA) e antropometria. A capacidade funcional foi avaliada pelas Atividades Instrumentais de Vida Diária, pela velocidade da marcha (VM) e Time Up and Go (TUG). Resultados Nesta amostra, o índice de massa magra (IMM) se mostrou associado aos indicadores do estado nutricional (IMC, CP e CC), além de ter apresentado importante correlação com a força de preensão palmar (FPP). A FPP esteve relacionada à VM e ao TUG. A análise de regressão identificou associação entre o IMC e o IMM (p<0,001), bem como entre a VM e a FPP (p=0,003). Conclusão A FPP se apresentou como importante indicador da capacidade funcional e se mostrou correlacionada com o IMM. Consequentemente, o IMM está associado aos indicadores do estado nutricional. Logo, na impossibilidade de avaliação do IMM, recomendamos a avaliação da FPP, CP e IMC como preditores de comprometimento do estado nutricional e da incapacidade funcional do idoso.
Adipose tissue (AT) inflammation is strongly associated with obesity-induced insulin resistance. When subjected to metabolic stress, adipocytes become inflamed and secrete a plethora of cytokines and chemokines, which recruit circulating immune cells to AT. Although sirtuin 6 (Sirt6) is known to control genomic stabilization, aging, and cellular metabolism, it is now understood to also play a pivotal role in the regulation of AT inflammation. Sirt6 protein levels are reduced in the AT of obese humans and animals and increased by weight loss. In this review, we summarize the potential mechanism of AT inflammation caused by impaired action of Sirt6 from the immune cells' point of view. We first describe the properties and functions of immune cells in obese AT, with an emphasis on discrete macrophage subpopulations which are central to AT inflammation. We then highlight data that links Sirt6 to functional phenotypes of AT inflammation. Importantly, we discuss in detail the effects of Sirt6 deficiency in adipocytes, macrophages, and eosinophils on insulin resistance or AT browning. In our closing perspectives, we discuss emerging issues in this field that require further investigation.
The measurement of anthropometric indices can be used to promote early prevention of Diabetes mellitus (DM) in the Filipino population. This study aims to compare the recommended anthropometric measurements namely body mass index (BMI), waist circumference, waist-to-height ratio (WHR), skin fold thickness, and mid-upper arm circumference (MUAC) of two groups, those with diabetes and those without (control), to predict the health risk status of the Filipino adult population. The results suggest that the parameters such as BMI, waist circumference, and WHR in females proved to be the most accurate to predict the diabetes risk among Filipino females. On the other hand, using the logistic regression model, the BMI, MUAC, and waist circumference indices collectively were found to have significant bearings with regard to the risk of acquiring DM. The Asian cutoff values of 18.5-24.9 kg/m2 for BMI, and < 90cm and < 80cm for waist circumference of male and female respectively, as recommended according to Taiwanese standards, are also said to apply to the Filipino population. This study is perhaps the first study in the Philippines that has relied on actual data gathering instead of using meta-analysis as done in earlier studies. In the wake of higher mortality in the diabetic COVID 19 positive patients, the gathering of baseline data of potential DM patients will help the government/stakeholders to efficiently strategize public health policies related to future preparedness for such pandemics.
Objectives:
To determine the effect of diet, exercise, and diet-exercise in combination on measures of biological age.
Design:
Secondary analysis of a 1-year randomized, controlled trial.
Setting:
University-based Medical Center.
Participants:
One-hundred-seven older (age≥65 yrs.) adults with obesity (BMI≥30 kg/m2) were randomized and 93 completed the study. Analyses used intention-to-treat.
Interventions:
Participants were randomized to a control group, a weight-management (diet) group, an exercise group, or a weight-management-plus-exercise (diet-exercise) group.
Main outcome measures:
We calculated Klemera-Doubal Method (KDM) biological age, Homeostatic Dysregulation (HD) score, and Health Aging Index (HAI) score at baseline, and changes at 6- and 12-months.
Results:
Diet and diet-exercise decreased KDM biological age more than exercise and control (-2.4±0.4, -2.2±0.3, -0.2±0.4, and 0.2±0.5, respectively, P<0.05 for the between group-differences). Diet and diet-exercise also decreased HD score more than exercise and control (-1.0±0.3, -1.1±0.3, 0.1±0.3, and 0.3±0.3 respectively, P<0.05). Moreover, diet-exercise decreased HAI score more than exercise, diet, or control (-1.1±0.2, -0.5±0.2, -0.5±0.2, and 0.0±0.2, respectively, P<0.05).
Conclusions:
These findings suggest that diet and diet-exercise are both effective methods of improving biological age, and that biological age may be a valuable method of assessing geroprotective interventions in older humans.
Background: Some investigations show that obesity is associated with increase in bone mass due to excessive mechanical exertion. However, these data are contradictory as loss of mineral density of bone tissue and, respectively, the risk of fractures in this population group is higher. The aim of the research was to investigate impact of drug therapy with zoledronic acid on nanostructure of bones in rats with limited mobility and high-calorie diet.
Methods: Rats (n = 56) were distributed into three groups: control (n = 18) – standard vivarium conditions, І experimental group (n = 18) – rats, which were on a high-calorie diet with limited mobility (HCD+LM), ІІ experimental group (n = 18) – HCD+LM+zoledronic acid. Zoledronic acid was injected at the dose 0.025 mg/kg intramuscularly every four weeks for six months. X-ray structure analysis, scanning electron microscopy and atomic absorption spectrometry were used for investigation of ultrastructure and quantitative assessment of mineral component loss in the femoral neck.
Results: Obesity and limited mobility reduced the level of the mineral component in the femoral neck (−31.5%) compared with control. It is significant that zoledronic acid did not permit decrease in mineral component of the bone throughout the entire experiment compared with group I (+41.8%), and all parameters were higher than in control group (+15%).
Conclusions: Obesity and limited mobility negatively affect mineral bone mass. Zoledronic acid induces increase in the mineral component as a result of remodeling inhibition under conditions of obesity and limited mobility modeling.
Background
Studies have shown neighborhood walkability is associated with obesity. To advance this research, study designs involving longer follow-up, broader geographic regions, appropriate neighborhood characterization, assessment of exposure length and severity, and consideration of stayers and movers are needed. Using a cohort spanning the conterminous United States, this study examines the longitudinal relationship between a network buffer-derived, duration-weighted neighborhood walkability measure and two adiposity-related outcomes.
Methods
This study included 12,846 Black/African American and White adults in the REasons for Geographic And Racial Differences in Stroke study. Body mass index (BMI) and waist circumference (WC) were assessed at baseline and up to 13.3 years later (M (SD) = 9.4 (1.0) years). BMI and WC were dichotomized. Walk Score® was duration-weighted based on time at each address and categorized as Very Car-Dependent, Car-Dependent, Somewhat Walkable, Very Walkable, and Walker’s Paradise. Unadjusted and adjusted logistic regression models tested each neighborhood walkability-adiposity association. Adjusted models controlled for demographics, health factors, neighborhood socioeconomic status, follow-up time, and either baseline BMI or baseline WC. Adjusted models also tested for interactions. Post-estimation Wald tests examined whether categorical variables had coefficients jointly equal to zero. Orthogonal polynomial contrasts tested for a linear trend in the neighborhood walkability-adiposity relationships.
Results
The odds of being overweight/obese at follow-up were lower for residents with duration-weighted Walk Score® values in the Walker’s Paradise range and residents with values in the Very Walkable range compared to residents with values in the Very Car-Dependent range. Residents with duration-weighted Walk Score® values classified as Very Walkable had significantly lower odds of having a moderate-to-high risk WC at follow-up relative to those in the Very Car-Dependent range. For both outcomes, the effects were small but meaningful. The negative linear trend was significant for BMI but not WC.
Conclusion
People with cumulative neighborhood walkability scores in the Walker’s Paradise range were less likely to be overweight/obese independent of other factors, while people with scores in the Very Walkable range were less likely to be overweight/obese and less likely to have a moderate-to-high risk WC. Addressing neighborhood walkability is one approach to combating obesity.
Clinical studies show that hypogonadism in the aging male is associated with obesity and osteoporosis. Experimental studies are mostly conducted on relatively young adult animals and the induced hypogonadism lasts for a relatively short time. The present study aimed to describe the effect of long-term hypogonadism beginning in puberty on body composition, morphometry, and bone mineral density in aged male rats. Morphometric measurements and dual-energy X-ray absorptiometry were conducted at the age of 30 months on control and gonadectomized males. Long-term hypogonadism did not affect body weight, but led to a higher fat mass (by 26 %), lower lean mass (by 44 %), shorter body length (by 9 %), and anogenital distance (by 26 %), as well as to lower tail circumference (by 15 %) in comparison to control males. Lower bone mineral density (by 13 %) and bone mineral content (by 15 %) were observed in gonadectomized males. Results showing sarcopenic obesity and osteoporosis in this model of long-term hypogonadism might mimic the situation in aging males better than the widely used short-term hypogonadism induced in young animals. The morphometric analysis could potentially be a useful tool to study normal weight obesity without the need for specific equipment.
Nutritional problems are common in older people. In particular, malnutrition is very frequent and associated with several negative health outcomes. Therefore, the screening of malnutrition through validated tools is mandatory in this population. Weight loss is another common condition in older people and may indicate reversible or not reversible causes: the early diagnosis of weight loss is mandatory for starting the correct diagnostic pathways. The first treatment of weight loss is to treat the cause, if possible. Then, the use of dietary recommendations and nutritional supplementations is of importance. In this chapter, we will discuss how nutritional status should be assessed in older adults, the management of malnutrition, the most common treatments of weight loss, obesity in older individuals, and the role of general practitioners (GPs) in nutritional issues affecting older people.
A key public health issue is the health of the increasing global ageing population. Such a population shift will necessitate changes and improvements to healthcare systems and individual lifestyle behaviours to ensure that adults who are living longer are doing so in good health. Just as in any other age group, adequate nutrition is paramount to ensure optimal physical and mental functioning for older adults. However, the ability to achieve adequate nutritional status will be affected by a range of factors; for example chronic illnesses can have a direct impact on nutritional status, while suffering from poor mental health can affect appetite. This chapter aims to describe the ageing population and nutritional requirements of older adults, present the evidence linking nutrition and chronic disease risk and then summarise the factors that affect dietary intake, nutritional status and malnutrition risk of older adults, including medical, physical, psychological, social and economic factors, which can have both direct and indirect impact on dietary intake.
Obesity is a global problem across all age groups in the USA during the past 30 years; the proportion of older adults who are obese has doubled. As in the younger age group, genetic, environmental, social, as well as several other factors, are the etiological factors. In the USA, according to the National Institute of Health (NIH), poverty and lower levels of education are linked to obesity because it is cheaper to consume tons of high-calorie, processed food than fresh fruits and vegetables. According to the World Health Organization (WHO), a BMI of >30 is a marker of obesity. BMI above 25 is considered overweight, whereas a BMI over 30 is considered obese. Morbid obesity is defined as a BMI above 35 with comorbidity (diabetes, hypertension, or obstructive sleep apnea) or over 40 without comorbidity. The body composition of an obese older individual is different from their younger counterparts. Hormonal regulatory alterations predispose the old to increases in fat mass. There is redistribution of adipose tissue throughout the body with an increase in intra-abdominal fat with less subcutaneous fat. Aging results in decline in the growth hormone (GH), insulin-like growth factor 1 (IGF-1), testosterone, and estrogen. The decrease in GH results in a decline in lean muscle mass. Sarcopenia may coexist with obesity and may cause frailty and associated complications. Obesity is a risk factor for type 2 DM, coronary artery disease, respiratory problems, dermatological problems, osteoarthritis, and above all many forms of cancer (pancreas, breast, colon, esophageal, endometrial, kidney, thyroid, liver, and gallbladder cancer). Management of obesity in older adults is a complex one and has to be done with the help of a qualified geriatrician, nutritionist, and physical therapist. Surgical procedures are options for a few selected older adults.
Background:
Older adults living in nursing homes have an increased risk of adverse outcomes. However, the role of body composition in vital health and quality of life parameters such as functional capacity and cognitive function is less studied in this group of older adults compared to community-dwelling counterparts.
Objective:
The aim of the present study was to examine the association of body composition with functional capacity and cognitive function in nursing home residents.
Methods:
Fifty-three older adults (82.8±7.3 years) were enrolled in this study and they underwent body composition evaluation, functional capacity and cognitive function measurements.
Results:
The results showed a high prevalence of obesity accompanied by functional capacity limitations and cognitive impairment in older adults living in nursing homes. Partial correlations, controlling for age, showed that body fat percentage was positively correlated with sit-to-stand-5 (r=0.310, p=0.025) and timed-up-and-go (r=0.331, p=0.017), and negatively correlated with handgrip strength test results (r=-0.431, p<0.001), whereas greater lean body mass was associated with better sit-to-stand-5 (r=-0.410, p=0.003), handgrip strength (r=0.624, p<0.001) and cognitive function performance (r=0.302, p=0.037).
Conclusions:
These important associations reinforce the need to develop effective healthy lifestyle interventions targeting both lean mass and body fat to combat functional and cognitive decline in nursing home residents.
Sarcopenia is an age-related muscle mass and strength loss, which, if accompanied by higher percentages of adipose tissue, constitutes a state known as sarcopenic obesity. Accumulating evidence suggests that at a global level, sarcopenic obesity among adults, especially the elderly, is increasing. Nevertheless, comparisons between epidemiologic studies remain a challenge because of the lack of a universally accepted definition. What is known so far is that the coexistence of sarcopenia and obesity seems to amplify functional decline, cardiometabolic multi-morbidity, and mortality. Sarcopenic obesity is a developing field that highlights the evolving and still under investigated cross talk between muscle and adipose tissue physiology. In this chapter, we intend to shed light on what is already known in the emerging field of sarcopenic obesity and highlight some gaps that can be addressed to increase our limited understanding of this clinically important pathology.
There is growing evidence that excess body weight increases the risk of cancer at several sites, including kidney, endometrium, colon, prostate, gallbladder and breast in post‐menopausal women. The proportion of all cancers attributable to overweight has, however, never been systematically estimated. We reviewed the epidemiological literature and quantitatively summarised, by meta‐analysis, the relationship between excess weight and the risk of developing cancer at the 6 sites listed above. Estimates were then combined with sex‐specific estimates of the prevalence of overweight [body mass index (BMI) 25–29 kg/m²] and obesity (BMI ≥30 kg/m²) in each country in the European Union to obtain the proportion of cancers attributable to excess weight. Overall, excess body mass accounts for 5% of all cancers in the European Union, 3% in men and 6% in women, corresponding to 27,000 male and 45,000 female cancer cases yearly. The attributable proportion varied, in men, between 2.1% for Greece and 4.9% for Germany and, in women, between 3.9% for Denmark and 8.8% for Spain. The highest attributable proportions were obtained for cancers of the endometrium (39%), kidney (25% in both sexes) and gallbladder (25% in men and 24% in women). The largest number of attributable cases was for colon cancer (21,500 annual cases), followed by endometrium (14,000 cases) and breast (12,800 cases). Some 36,000 cases could be avoided by halving the prevalence of overweight and obese people in Europe. © 2001 Wiley‐Liss, Inc.
This study examined the effects of dietary weight loss and exercise on the health-related quality of life (HRQL) of overweight and obese, older adults with knee osteoarthritis. A total of 316 older men and women with documented evidence of knee osteoarthritis were randomly assigned to 1 of 4 18-month interventions: dietary weight loss, exercise, dietary weight loss and exercise, or healthy lifestyle control. Measures included the SF-36 Health Survey and satisfaction with body function and appearance. Results revealed that the combined diet and exercise intervention had the most consistent, positive effect on HRQL compared with the control group; however, findings were restricted to measures of physical health or psychological outcomes that are related to the physical self.
Context The prevalence of obesity and overweight increased in the United States
between 1978 and 1991. More recent reports have suggested continued increases
but are based on self-reported data.Objective To examine trends and prevalences of overweight (body mass index [BMI]
≥25) and obesity (BMI ≥30), using measured height and weight data.Design, Setting, and Participants Survey of 4115 adult men and women conducted in 1999 and 2000 as part
of the National Health and Nutrition Examination Survey (NHANES), a nationally
representative sample of the US population.Main Outcome Measure Age-adjusted prevalence of overweight, obesity, and extreme obesity
compared with prior surveys, and sex-, age-, and race/ethnicity–specific
estimates.Results The age-adjusted prevalence of obesity was 30.5% in 1999-2000 compared
with 22.9% in NHANES III (1988-1994; P<.001).
The prevalence of overweight also increased during this period from 55.9%
to 64.5% (P<.001). Extreme obesity (BMI ≥40)
also increased significantly in the population, from 2.9% to 4.7% (P = .002). Although not all changes were statistically significant,
increases occurred for both men and women in all age groups and for non-Hispanic
whites, non-Hispanic blacks, and Mexican Americans. Racial/ethnic groups did
not differ significantly in the prevalence of obesity or overweight for men.
Among women, obesity and overweight prevalences were highest among non-Hispanic
black women. More than half of non-Hispanic black women aged 40 years or older
were obese and more than 80% were overweight.Conclusions The increases in the prevalences of obesity and overweight previously
observed continued in 1999-2000. The potential health benefits from reduction
in overweight and obesity are of considerable public health importance.
Advanced age is considered a relative contraindication to primary bariatric surgery at some institutions. As life expectancy is steadily increasing and quality of life is improving in our elderly population, we may need to reconsider the health benefits that obese elderly patients can obtain from bariatric surgery. Therefore, we examine the operative outcomes, weight loss, reduction of comorbidities, and medication requirements in patients older than 60 years compared with those younger than 60 years undergoing laparoscopic Roux-en-Y gastric bypass.
The null hypothesis tested in this study is that patients older than 60 years who undergo laparoscopic Roux-en-Y gastric bypass experience a medical benefit not significantly different from that experienced by younger patients in terms of the number of medications and comorbid conditions.
The number of preoperative and postoperative comorbid conditions and the medications required for those conditions were compared between consecutive patients older than 60 years and those younger than 60 years who underwent Roux-en-Y laparoscopic gastric bypass. Early operative outcomes were also assessed.
Analysis of 110 patients younger than 60 years compared with 20 patients older than 60 years revealed no difference in complication rate or length of hospital stay. Younger patients lost more weight and had a significantly greater reduction in body mass index. Younger patients also demonstrated more complete resolution of comorbid conditions, although this difference was not significant. Older patients, who had more comorbid conditions requiring more medication at the time of surgery, experienced a greater medication reduction during follow-up, although this was not statistically significant.
Patients of advanced age can safely undergo laparoscopic Roux-en-Y gastric bypass. Younger patients can be expected to demonstrate greater weight loss and experience more complete resolution of their comorbid conditions. Older patients demonstrated greater overall reduction in medication requirements. Therefore, patients older than 60 years can be considered good candidates for obesity surgery and can be expected to enjoy substantial health benefits similar to those experienced by younger patients.
Orlistat, a gastrointestinal lipase inhibitor that reduces dietary fat absorption by approximately 30%, may promote weight loss and reduce cardiovascular risk factors.
To test the hypothesis that orlistat combined with dietary intervention is more effective than placebo plus diet for weight loss and maintenance over 2 years.
Randomized, double-blind, placebo-controlled study conducted from October 1992 to October 1995.
Obese adults (body mass index [weight in kilograms divided by the square of height in meters], 30-43 kg/m2) evaluated at 18 US research centers.
Subjects received placebo plus a controlled-energy diet during a 4-week lead-in. On study day 1, the diet was continued and subjects were randomized to receive placebo 3 times a day or orlistat, 120 mg 3 times a day, for 52 weeks. After 52 weeks, subjects began a weight-maintenance diet, and the placebo group (n = 133) continued to receive placebo and orlistat-treated subjects were rerandomized to receive placebo 3 times a day (n = 138), orlistat, 60 mg (n = 152) or 120 mg (n = 153) 3 times a day, for an additional 52 weeks.
Body weight change and changes in blood pressure and serum lipid, glucose, and insulin levels.
A total of 1187 subjects entered the protocol, and 892 were randomly assigned on day 1 to double-blind treatment. For intent-to-treat analysis, 223 placebo-treated subjects and 657 orlistat-treated subjects were evaluated. During the first year orlistat-treated subjects lost more weight (mean +/- SEM, 8.76+/-0.37 kg) than placebo-treated subjects (5.81+/-0.67 kg) (P<.001). Subjects treated with orlistat, 120 mg 3 times a day, during year 1 and year 2 regained less weight during year 2 (3.2+/-0.45 kg; 35.2% regain) than those who received orlistat, 60 mg (4.26+/-0.57 kg; 51.3% regain), or placebo (5.63+/-0.42 kg; 63.4% regain) in year 2 (P<.001). Treatment with orlistat, 120 mg 3 times a day, was associated with improvements in fasting low-density lipoprotein cholesterol and insulin levels.
Two-year treatment with orlistat plus diet significantly promotes weight loss, lessens weight regain, and improves some obesity-related disease risk factors.
Context Recent reports show that obesity and diabetes have increased in the
United States in the past decade.Objective To estimate the prevalence of obesity, diabetes, and use of weight control
strategies among US adults in 2000.Design, Setting, and Participants The Behavioral Risk Factor Surveillance System, a random-digit telephone
survey conducted in all states in 2000, with 184 450 adults aged 18 years
or older.Main Outcome Measures Body mass index (BMI), calculated from self-reported weight and height;
self-reported diabetes; prevalence of weight loss or maintenance attempts;
and weight control strategies used.Results In 2000, the prevalence of obesity (BMI ≥30 kg/m2) was
19.8%, the prevalence of diabetes was 7.3%, and the prevalence of both combined
was 2.9%. Mississippi had the highest rates of obesity (24.3%) and of diabetes
(8.8%); Colorado had the lowest rate of obesity (13.8%); and Alaska had the
lowest rate of diabetes (4.4%). Twenty-seven percent of US adults did not
engage in any physical activity, and another 28.2% were not regularly active.
Only 24.4% of US adults consumed fruits and vegetables 5 or more times daily.
Among obese participants who had had a routine checkup during the past year,
42.8% had been advised by a health care professional to lose weight. Among
participants trying to lose or maintain weight, 17.5% were following recommendations
to eat fewer calories and increase physical activity to more than 150 min/wk.Conclusions The prevalence of obesity and diabetes continues to increase among US
adults. Interventions are needed to improve physical activity and diet in
communities nationwide.
Background
Recent clinical guidelines on the health risks of obesity use body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) and waist circumference, but the waist-hip ratio may provide independent information.
Methods
To assess the joint and relative associations of BMI, waist circumference, and waist-hip ratio with multiple disease end points, we conducted a prospective cohort study of 31,702 Iowa women, aged 55 to 69 years and free of cancer, heart disease, and diabetes, assembled by random sampling and mail survey in 1986. Study end points were total and cause-specific mortality and incidence of site-specific cancers and self-reported diabetes, hypertension, and hip fracture over 11 to 12 years.
Results
The waist-hip ratio was the best anthropometric predictor of total mortality, with the multivariable-adjusted relative risk for quintile 5 vs 1 of 1.2 (95% confidence interval, 1.1-1.4), compared with 0.91 (95% confidence interval, 0.8-1.0) for BMI and 1.1 (95% confidence interval, 1.0-1.3) for waist circumference. The waist-hip ratio was also associated positively with mortality from coronary heart disease, other cardiovascular diseases, cancer, and other causes. The waist-hip ratio was associated less consistently than BMI or waist circumference with cancer incidence. All anthropometric indexes were associated with incidence of diabetes and hypertension. For example, women simultaneously in the highest quintiles of BMI and waist-hip ratio had a relative risk of diabetes of 29 (95% confidence interval, 18-46) vs women in the lowest combined quintiles.
Conclusion
The waist-hip ratio offers additional prognostic information beyond BMI and waist circumference.
Background:
Although changes in body weight with aging are common, little is known about the effects of weight change on health in old age.Objectives:
To study the effects of weight loss and weight gain from age 50 years to old age on the risk of hip fracture among postmenopausal white women aged 67 years and older and to determine if the level of weight at age 50 years modifies this risk.Methods:
The association between weight change and the risk of hip fracture was studied in 3683 communitydwelling white women aged 67 years and older from three sites of the Established Populations for Epidemiologic Studies of the Elderly.Results:
Extreme weight loss (10% or more) beginning at age 50 years was associated in a proportional hazards model with increased risk of hip fracture (relative risk [RR], 2.9; 95% confidence interval [CI], 2.0-4.1). This risk was greatest among women in the lowest (RR, 2.3; CI, 1.1-4.8) and middle (RR, 2.8; CI, 1.5-5.3) tertiles of body mass index at age 50 years. Among the thinnest women, even more modest weight loss (5% to <10%) was associated with increased risk of hip fracture (RR, 2.3; CI, 1.0-5.2). Weight gain of 10% or more beginning at age 50 years provided borderline protection against the risk of hip fracture (RR, 0.7; CI, 0.4-1.0). The RRs for weight gain of 10% or more were protective only among women in the middle and high tertiles of body mass index at age 50 years and were not significant (middle tertile RR, 0.8; CI, 0.3-1.8; high tertile RR, 0.6; CI, 0.2-1.9).Conclusions:
Weight history is an important determinant of the risk of hip fracture. Weight loss beginning at age 50 years increases the risk of hip fracture in older white women, especially among those who are thin at ahip50 years; weight gain of 10% or more decreases the risk of bip fracture. Physicians should include weight history in their assessment of postmenopausal older women for risk of hip fracture.(Arch Intern Med. 1996;156:989-994)
Study Objective: To determine whether clinically available data on risk factors are adequate to identify perimenopausal women with either low or high bone mass.
Design: Cross-sectional observational study of a cohort of perimenopausal women (mean age, 50. 8 years).
Setting: Community volunteers in a university hospital.
Subjects: One hundred twenty-four white volunteers established as perimenopausal by history and serum concentrations of estrogens and follicle-stimulating hormone.
Measurements and Main Results: Models were constructed to predict bone mass in the radius, lumbar spine, and hip using risk factors (age, height, weight, calcium and caffeine intake, alcohol and tobacco use, and urinary markers of bone turnover). Although highly significant predictive models were developed for all skeletal sites, none of the models correctly identified more than 70% of women with low bone mass at any site. However, for the radius, a model was constructed that never overestimated bone mass by more than 0.10 g/cm. A small subgroup (7%) with short stature, low body weight, low calcium intake, and who were heavy smokers always had low radial bone mass. Using these models, about 30% of our population could be assessed without bone mass measurements. Predictions for the spine and femur were less efficient, suggesting that direct measurements are required if therapy decisions are to be based on bone mass at these sites.
Conclusions: Risk factors for osteoporosis are of limited use in identifying women with low bone mass around the time of menopause. Measurements of bone mass are probably necessary if the risk for osteoporosis is to be the basis for deciding on estrogen replacement therapy.
OBJECTIVE: To identify modifiable predictors of functional decline among community‐residing older women and to derive and validate a clinical prediction tool for functional decline based only on modifiable predictors.
DESIGN: A prospective cohort study.
SETTING: Four geographic areas of the United States.
PARTICIPANTS: Community‐residing women older than age 65 recruited from population‐based listings between 1986 and 1988 (n = 6632).
MEASUREMENTS: Modifiable predictors were considered to be those that a clinician seeing an older patient for the first time could reasonably expect to change over a 4‐year period: benzodiazepine use, depression, low exercise level, low social functioning, body‐mass index, poor visual acuity, low bone mineral density, slow gait, and weak grip. Known predictors of functional decline unlikely to be amenable to intervention included age, education, medical comorbidity, cognitive function, smoking history, and presence of previous spine fracture. All variables were measured at baseline; only modifiable predictors were candidates for the prediction tool. Functional decline was defined as loss of ability over the 4—year interval to perform one or more of five vigorous or eight basic daily activities.
RESULTS: Slow gait, short‐acting benzodiazepine use, depression, low exercise level, and obesity were significant modifiable predictors of functional decline in both vigorous and basic activities. Weak grip predicted functional decline in vigorous activities, whereas long‐acting benzodiazepine use and poor visual acuity predicted functional decline in basic activities. A prediction rule based on these eight modifiable predictors classified women in the derivation set into three risk groups for decline in vigorous activities (12%, 25%, and 39% risk) and two risk groups for decline in basic activities (2% and 10% risk). In the validation set, the probabilities of functional decline were nearly identical.
CONCLUSIONS: A substantial portion of the variation of functional decline can be attributed to risk factors amenable to intervention over the short term. Using eight modifiable predictors that can be identified in a single office visit, clinicians can identify older women at risk for functional decline. J Am Geriatr Soc 48: 170–178, 2000.
Background:
We undertook a randomised controlled trial to assess the efficacy and tolerance of orlistat, a gastrointestinal lipase inhibitor, in promoting weight loss and preventing weight regain in obese patients over a 2-year period.
Methods:
743 patients (body-mass index 28-47 kg/m2), recruited at 15 European centres, entered a 4-week, single-blind, placebo lead-in period on a slightly hypocaloric diet (600 kcal/day deficit). 688 patients who completed the lead-in were assigned double-blind treatment with orlistat 120 mg (three times a day) or placebo for 1 year in conjunction with the hypocaloric diet. In a second 52-week double-blind period patients were reassigned orlistat or placebo with a weight maintenance (eucaloric) diet.
Findings:
From the start of lead-in to the end of year 1, the orlistat group lost, on average, more bodyweight than the placebo group (10.2% [10.3 kg] vs 6.1% [6.1 kg]; LSM difference 3.9 kg [p < 0.001] from randomisation to the end of year 1). During year 2, patients who continued with orlistat regained, on average, half as much weight as those patients switched to placebo (p < 0.001). Patients switched from placebo to orlistat lost an additional 0.9 kg during year 2, compared with a mean regain of 2.5 kg in patients who continued on placebo (p < 0.001). Total cholesterol, low-density lipoprotein (LDL) cholesterol, LDL/high-density lipoprotein ratio, and concentrations of glucose and insulin decreased more in the orlistat group than in the placebo group. Gastrointestinal adverse events were more common in the orlistat group. Other adverse symptoms occurred at a similar frequency during both treatments.
Interpretation:
Orlistat taken with an appropriate diet promotes clinically significant weight loss and reduces weight regain in obese patients over a 2-year period. The use of orlistat beyond 2 years needs careful monitoring with respect to efficacy and adverse events.
Chronic diseases and disabilities increase with age, affecting more than 60% of those over 75 y, and limiting activities in about half of them. Therefore, total energy expenditure (TEE) and its components are assessed separately in health and disease. An analysis of 568 doubly labelled water measurements in 'healthy' subjects (184 measurements in subjects over 65 years) suggests that there is a decrease of 0.69 and 0.43 MJ/day/decade respectively in men (standard weight 75 kg) and women (standard weight 67 kg). Physical activity (PA) accounted for 46% of the decrease in TEE, basal metabolic rate (BMR) for 44% of the decrease and thermogenesis (T) for the remaining 10%. TEE was found to be 10.79+/-2.09 and 8.62+/-1.49 MJ/day in 150 men and 100 women aged over 60 y, respectively. Of the total variance in TEE, measured with doubly labelled water over a 2 week period, 69% was considered to be due to differences between individuals, and 31% to differences within individuals. The variance due to PA plus T was threefold greater than that due to BMR. Physiological factors were far more important than methodological factors in influencing measurements of TEE, BMR and PA+T. An analysis of 136 measurements of TEE (doubly labelled water and bicarbonate-urea methods) in free-living elderly patients suffering from a variety of diseases suggests a frequent decrease in TEE, which may occur despite an increase in BMR. This is largely due to a reduction is PA (eg up to approximately 50% reduction), but in some cases it is also due to a reduction in BMR (loss of body weight). More comprehensive information is required about TEE and its components, partly because of a probable selection bias in recruitment of subjects participating in specific tracer studies, and partly because of the variable effects of different diseases and factors that operate at different times in the course of the same disease.
Objective: The Diabetes Prevention Program (DPP) showed that intensive lifestyle intervention reduced the risk of diabetes by 58%. This paper examines demographic, psychosocial, and behavioral factors related to achieving weight loss and physical activity goals in the DPP lifestyle participants. Research Methods and Procedures: Lifestyle participants (n = 1079; mean age = 50.6, BMI = 33.9, 68% female, and 46% from minority groups) had goals of 7% weight loss and 150 min/wk of physical activity. Goal achievement was assessed at the end of the 16-session core curriculum (approximately week 24) and the final intervention visit (mean = 3.2 years) as a function of demographic, psychosocial, and behavioral variables. Results: Forty-nine percent met the weight loss goal and 74% met the activity goal initially, while 37% and 67%, respectively, met these goals long-term. Men and those with lower initial BMI were more likely to meet activity but not weight loss goals. Hispanic, Asian, and Native Americans were more likely to meet the long-term activity goals, and whites were more likely to meet the initial weight loss goal. In multivariate analyses, meeting the long-term weight loss goal and both activity goals increased with age, while psychosocial and depression measures were unrelated to goal achievement. Dietary self-monitoring was positively related to meeting both weight loss and activity goals, and meeting the activity goal was positively related to meeting the weight loss goal. Participants who met initial goals were 1.5 to 3.0 times more likely to meet these goals long-term. Discussion: Success at meeting the weight loss and activity goals increased with age. Initial success predicted long-term success. Self-monitoring and meeting activity goals were related to achieving and sustaining weight loss.
Overweight and obesity represent a rapidly growing threat to the health of populations in an increasing number of countries. Indeed they are now so common that they are replacing more traditional problems such as undernutrition and infectious diseases as the most significant causes of ill-health. Obesity comorbidities include coronary heart disease, hypertension and stroke, certain types of cancer, non-insulin-dependent diabetes mellitus, gallbladder disease, dyslipidaemia, osteoarthritis and gout, and pulmonary diseases, including sleep apnoea. In addition, the obese suffer from social bias, prejudice and discrimination, on the part not only of the general public but also of health professionals, and this may make them reluctant to seek medical assistance. WHO therefore convened a Consultation on obesity to review current epidemiological information, contributing factors and associated consequences, and this report presents its conclusions and recommendations. In particular, the Consultation considered the system for classifying overweight and obesity based on the body mass index, and concluded that a coherent system is now available and should be adopted internationally. The Consultation also concluded that the fundamental causes of the obesity epidemic are sedentary lifestyles and high-fat energy-dense diets, both resulting from the profound changes taking place in society and the behavioural patterns of communities as a consequence of increased urbanization and industrialization and the disappearance of traditional lifestyles. A reduction in fat intake to around 20-25% of energy is necessary to minimize energy imbalance and weight gain in sedentary individuals. While there is strong evidence that certain genes have an influence on body mass and body fat, most do not qualify as necessary genes, i.e. genes that cause obesity whenever two copies of the defective allele are present; it is likely to be many years before the results of genetic research can be applied to the problem. Methods for the treatment of obesity are described, including dietary management, physical activity and exercise, and antiobesity drugs, with gastrointestinal surgery being reserved for extreme cases.
Background
The metabolic syndrome is an important cluster of coronary heart disease risk factors with common insulin resistance. The extent to which the metabolic syndrome is associated with demographic and potentially modifiable lifestyle factors in the US population is unknown.Methods
Metabolic syndrome–associated factors and prevalence, as defined by Adult Treatment Panel III criteria, were evaluated in a representative US sample of 3305 black, 3477 Mexican American, and 5581 white men and nonpregnant or lactating women aged 20 years and older who participated in the cross-sectional Third National Health and Nutrition Examination Survey.Results
The metabolic syndrome was present in 22.8% and 22.6% of US men and women, respectively (P = .86). The age-specific prevalence was highest in Mexican Americans and lowest in blacks of both sexes. Ethnic differences persisted even after adjusting for age, body mass index, and socioeconomic status. The metabolic syndrome was present in 4.6%, 22.4%, and 59.6% of normal-weight, overweight, and obese men, respectively, and a similar distribution was observed in women. Older age, postmenopausal status, Mexican American ethnicity, higher body mass index, current smoking, low household income, high carbohydrate intake, no alcohol consumption, and physical inactivity were associated with increased odds of the metabolic syndrome.Conclusions
The metabolic syndrome is present in more than 20% of the US adult population; varies substantially by ethnicity even after adjusting for body mass index, age, socioeconomic status, and other predictor variables; and is associated with several potentially modifiable lifestyle factors. Identification and clinical management of this high-risk group is an important aspect of coronary heart disease prevention.
Osteoarthritis (OA) is the most common of the arthropathies. The prevalence increases significantly with age, with as many as 68% of women and 58% of men aged 65 years or older having radiological evidence of disease. With an aging population, OA will represent an increasingly significant healthcare burden.
The current treatment of patients with OA is purely symptomatic. As yet, there is no evidence that treatment changes the course of the disease. The current optimal treatment involves a combined approach which includes modification of risk factors, particularly obesity, and nonpharmacological treatments such as physiotherapy. If drugs are required in the treatment of OA, full dose regular paracetamol (acetaminophen) should be the first line of analgesic therapy. There is little evidence that the current over-reliance on long term treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) is justified. If NSAIDs are used, it is necessary to regularly review their use and to be aware of their potential toxicity, particularly in the older age group.
Objective: To summarize published studies analyzing the effects of long-term change in body weight on all-cause mortality and have not been reported elsewhere in these proceedings. Data Sources: Thirteen reports from 11 diverse population studies, 7 from the United States and 4 from Europe. Study Selection: All studies included a weight change period of 4 or more years, followed by a mortality assessment period of 8 or more years. All weight changes occurred in persons 17 years or older
Objective.
—As disability is highly prevalent among older women, is costly, and affects the quality of life, preventable causes of disability must be identified. In this study, we investigated the relationship between the body mass index (BMI), weight change, and the onset of disability in older women.Design.
—Prospective cohort study.Setting.
—The nationally representative US epidemiologic follow-up study of the National Health and Nutrition Examination Survey (NHANES) I (1971 through 1987).Patients.
—White women classified as young-old (mean age 60 years at baseline, mean age 65 years at follow-up) and old-old (mean age 76 years at baseline, mean age 80 years at follow-up).Main Outcome Measures.
—The relative odds for the onset of mobility disability associated with tertiles of past BMI (measured 8 to 16 years prior to disability ascertainment) and current BMI (measured 2 to 5 years prior to disability ascertainment) and with weight change between the two weight measurements.Results.
—In both cohorts, women in the high past BMI group (>27 in the young-old and >28.1 in the old-old cohort) had a twofold increase in the risk for disability compared with women in the low past BMI group. High current BMI was as strongly related as past BMI to risk of disability in the young-old women; it was not as strong a predictor in old-old women. In the old-old group only, women who experienced a weight loss of more than 5% had a twofold increase in risk of disability compared with weight-stable women. These results were adjusted for age, smoking, education, and study time and were not importantly modified with the addition into the models of single or multiple health conditions.Conclusions.
—These prospective data suggest that high BMI is a strong predictor of long-term risk for mobility disability in older women and that this risk persists even to very old age. However, the paradoxical increase in risk associated with weight loss in the old-old women requires further study. Programs to prevent overweight may have potential for decreasing disability in women.(JAMA. 1994;271:1093-1098)
Objective.
—To examine trends in overweight prevalence and body mass index of the US adult population.Design.
—Nationally representative cross-sectional surveys with an in-person interview and a medical examination, including measurement of height and weight.Setting/Participants.
—Between 6000 and 13000 adults aged 20 through 74 years examined in each of four separate national surveys during 1960 to 1962 (the first National Health Examination Survey [NHES I]), 1971 to 1974 (the first National Health and Nutrition Examination Survey [NHANES I]), 1976 to 1980 (NHANESII), and 1988 to 1991 (NHANES III phase 1).Results.
—In the period 1988 to 1991,33.4% of US adults 20 years of age or older were estimated to be overweight. Comparisons of the 1988 to 1991 overweight prevalence estimates with data from earlier surveys indicate dramatic increases in all race/sex groups. Overweight prevalence increased 8% between the 1976 to 1980 and 1988 to 1991 surveys. During this period, for adult men and women aged 20 through 74 years, mean body mass index increased from 25.3 to 26.3; mean body weight increased 3.6 kg.Conclusions.
—These nationally representative data document a substantial increase in overweight among US adults and support the findings of other investigations that show notable increases in overweight during the past decade. These observations suggest that the Healthy People 2000 objective of reducing the prevalence of overweight US adults to no more than 20% may not be met by the year 2000. Understanding the reasons underlying the increase in the prevalence of overweight in the United States and elucidating the potential consequences in terms of morbidity and mortality present a challenge to our understanding of the etiology, treatment, and prevention of overweight.(JAMA. 1994;272:205-211)
DEPRESSION in the aging and the aged is a major public health problem. It causes suffering to many who go undiagnosed, and it burdens families and institutions providing care for the elderly by disabling those who might otherwise be able-bodied. What makes depression in the elderly so insidious is that neither the victim nor the health care provider may recognize its symptoms in the context of the multiple physical problems of many elderly people. Depressed mood, the typical signature of depression, may be less prominent than other depressive symptoms such as loss of appetite, sleeplessness, anergia, and loss of interest in, and enjoyment of, the normal pursuits of life. There is a wide spectrum of depressive symptoms as well as types of available therapies.
Because of the many physical illnesses and social and economic problems of the elderly, individual health care providers often conclude that depression is a normal consequence
Objective: To evaluate the relation between weight variability and death in high;risk, middle-aged men participating in the Multiple Risk Factor Intervention Trial (MRFIT). Design: Cohort study with 3.8 years of follow-up. Setting: Multicenter, collaborative, primary prevention trial conducted at 22 clinical centers in the United States. Participants: Men (n=10 529) who were 35 to 57 years old at baseline and who were in the upper 10% to 15% of risk for coronary heart disease because of smoking, high blood pressure, and elevated cholesterol level. Participants were seen at least annually for 6 to 7 years for medical evaluations in study clinical centers
T ODAY, OBESITY HAS REACHED EN-demic proportions 1 and the widespread lack of clinical suc-cess 2 calls for effective treat-ment of this chronic disorder. Thera-peutic intervention prevents the serious and cost-intensive sequelae of this con-dition. 3 The reluctance of the medical profession to treat obesity 4 is fortu-nately no longer justified because short-term weight reduction achieved by in-terventions, such as dieting, exercise, and behavior modification programs, can lead to long-term weight loss through the use of effective medicines. 5-8 These drugs are designed to be used as an adjunct to non-medical therapy. 9-11 Obesity can be seen as the underlying condition predispos-ing persons to cardiovascular risk fac-tors. Thus, symptomatic treatment of these risk factors can now be replaced by a causal therapy that addresses obesity itself. The main objective of this phar-macotherapeutic approach is to achieve long-term weight loss, 12 and there is evi-dence that even moderate weight loss of 5% to 10% results in reduced morbid-ity 13 and mortality. 14 Sibutramine hydrochloride enhances satiety, primarily by blocking the reup-take of 2 neurotransmitters, noradrena-line and serotonin. It is also postulated that sibutramine increases the meta-bolic rate by enhancing peripheral nor-adrenaline function via 3-adrenocep-tors leading to an increase in energy expenditure. 15 So far, approximately 8000 patients have taken sibutramine in clini-cal studies. Its effectiveness in reducing weight and achieving weight mainte-nance already has been shown in sev-eral randomized, double-blind stud-ies. 16,17 The aim of this randomized study was to show equivalent weight reduc-tion in an obese population using 2 thera- Context Treatment of obesity requires long-term therapy, which can be hampered by difficulties in achieving patient compliance. The effectiveness of sibutramine hy-drochloride in treating obesity has been shown in randomized controlled trials. Objective To compare the effectiveness of 2 distinct sibutramine regimens with each other and with placebo for weight reduction among obese persons. Design Randomized, double-blind, parallel-group placebo-controlled trial from April 1997 to September 1998. Setting One hundred eight private practices and 3 outpatient departments of uni-versity hospitals in Germany. Patients A total of 1102 obese adults (body mass index, 30-40 kg/m 2) entered the 4-week open-label run-in period with 15 mg/d of sibutramine, 1001 of whom had weight loss of at least 2% or 2 kg were randomized into the 44-week randomized treatment period. Interventions Patients were randomly assigned to receive 15 mg/d of sibutramine continuously throughout weeks 1-48 (n = 405); 15 mg/d of sibutramine intermit-tently during weeks 1-12, 19-30, and 37-48, with placebo during all other weeks (n = 395); or placebo for weeks 5-48 (n = 201).
About 97 million adults in the United States are overweight or obese. Obesity and overweight substantially increase the risk of morbidity from hypertension; dyslipidemia; type 2 diabetes; coronary heart disease; stroke; gallbladder disease; osteoarthritis; sleep apnea and respiratory problems; and endometrial, breast, prostate, and colon cancers. Higher body weights are also associated with increases in all-cause mortality. The aim of this guideline is to provide useful advice on how to achieve weight reduction and maintenance of a lower body weight. It is also important to note that prevention of further weight gain can be a goal for some patients. Obesity is a chronic disease, and both the patient and the practitioner need to understand that successful treatment requires a life-long effort. Assessment of Weight and Body Fat Two measures important for assessing overweight and total body fat content are; determining body mass index (BMI) and measuring waist circumference. 1. Body Mass Index: The BMI, which describes relative weight for height, is significantly correlated with total body fat content. The BMI should be used to assess overweight and obesity and to monitor changes in body weight. Measurements of body weight alone can be used to determine efficacy of weight loss therapy. BMI is calculated as weight (kg)/height squared (m 2). To estimate BMI using pounds and inches, use: [weight (pounds)/height (inches) 2 ] x 703. Weight classifications by BMI, selected for use in this report, are shown in the table below. • Pregnant women who, on the basis of their pre-pregnant weight, would be classified as obese may encounter certain obstetrical risks. However, the inappropriateness of weight reduction during pregnancy is well recognized (Thomas, 1995). Hence, this guideline specifically excludes pregnant women. Source (adapted from): Preventing and Managing the Global Epidemic of Obesity. Report of the World Health Organization Consultation of Obesity. WHO, Geneva, June 1997.
▪ Surgeons, gastroenterologists, endocrinologists, psychiatrists, nutritionists, and other health care professionals, as well as members of the public convened to address nonsurgical treatments for severe obesity, surgical treatments for severe obesity, and criteria for selection, the efficacy, and risks of surgical treatments for severe obesity, and the need for future research on and epidemiologic evaluation of these therapies.
The National Institutes of Health Consensus Development Panel recommended that patients seeking therapy for severe obesity for the first time should be considered for treatment in a nonsurgical program that integrates a dietary regimen, appropriate exercise, behavior modification, and psychological support; that gastric restrictive or bypass procedures could be considered for well-informed and motivated patients in whom the operative risks were acceptable; that patients who are candidates for surgical procedures should be selected carefully after evaluation by a multidisciplinary team with medical, surgical, psychiatric, and nutritional expertise; that surgery be done by a surgeon who has substantial experience in the particular procedure and who works in a clinical setting with adequate support for all aspects of management and assessment; and that patients undergo lifelong medical surveillance after surgery.
Context:
The increasing prevalence of obesity is a major public health concern, since obesity is associated with several chronic diseases.
Objective:
To monitor trends in state-specific data and to examine changes in the prevalence of obesity among adults.
Design:
Cross-sectional random-digit telephone survey (Behavioral Risk Factor Surveillance System) of noninstitutionalized adults aged 18 years or older conducted by the Centers for Disease Control and Prevention and state health departments from 1991 to 1998.
Setting:
States that participated in the Behavioral Risk Factor Surveillance System.
Main outcome measures:
Body mass index calculated from self-reported weight and height.
Results:
The prevalence of obesity (defined as a body mass index > or =30 kg/m2) increased from 12.0% in 1991 to 17.9% in 1998. A steady increase was observed in all states; in both sexes; across age groups, races, educational levels; and occurred regardless of smoking status. The greatest magnitude of increase was found in the following groups: 18- to 29-year-olds (7.1% to 12.1%), those with some college education (10.6% to 17.8%), and those of Hispanic ethnicity (11.6% to 20.8%). The magnitude of the increased prevalence varied by region (ranging from 31.9% for mid Atlantic to 67.2% for South Atlantic, the area with the greatest increases) and by state (ranging from 11.3% for Delaware to 101.8% for Georgia, the state with the greatest increases).
Conclusions:
Obesity continues to increase rapidly in the United States. To alter this trend, strategies and programs for weight maintenance as well as weight reduction must become a higher public health priority.
The conversion of Δ4 to E1 in vitro by human female fat tissue was investigated. In patients with endometrial carcinoma an average conversion of 0.1% was found. The values ranged from 0.03 to 0.19%. In the other patients this conversion was only 0.027 % with a range of 0.01 to 0.06 %. The significance of these results is discussed.
Several epidemiologic investigations have suggested that weight loss is associated with increased mortality risk but have not examined whether the weight loss was intentional or unintentional. The authors examined whether the association between weight loss and mortality differs by whether the weight loss was intentional or unintentional as part of the Iowa Women's Health Study, a prospective cohort study of health risk factors in postmenopausal women. Women aged 55-69 years completed questions about intentional and unintentional weight losses since age 18 years via mail survey in 1992 and were followed through 1995. One or more intentional weight loss episodes of 20 or more pounds (> or =9.1 kg) during adulthood was not significantly associated with higher total or cardiovascular disease mortality risk compared with never losing > or =20 pounds. One or more unintentional weight loss episodes of 20 or more pounds was associated with a 26-57% higher total mortality risk and a 51-114% higher cardiovascular disease mortality risk, compared with never losing 20 or more pounds. Associations between unintentional weight loss and increased mortality risk were confined mostly to women with prevalent disease, hypertension, or diabetes. Patterns of association did not vary by overweight status. These findings suggest that the association between weight loss and increased mortality risk observed in epidemiologic studies may be due to unintentional weight loss that reflects existing disease and not due to intentional weight loss.
Background:
The effect of change in weight in later years on risk of osteoporotic fractures is uncertain. Prior studies have assessed the relationship between weight change and risk of hip fracture only and have not examined whether the association between weight loss and increased risk of hip fracture is because of voluntary or involuntary weight loss.