Abstract
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.
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Vuittonet, C.L., Sbharwal, A., Pitchumoni, C.S. (2020). Obesity in Older Adults: Pathophysiology and Clinical Implications. In: Pitchumoni, C., Dharmarajan, T. (eds) Geriatric Gastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-319-90761-1_98-1
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