Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society

Villareal, Dennis T; Apovian, Caroline M; Kushner, Robert F; Klein, Samuel

doi:10.1093/ajcn/82.5.923

Cited by 880Nutrition and Health in AgingBody Composition Measurement TechniquesObesity, Physical Activity, Diet

Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society

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Villareal, Dennis T, Apovian, Caroline M, Kushner, Robert F, Klein, Samuel·2005·The American Journal of Clinical Nutrition

DOI 10.1093/ajcn/82.5.923

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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 the 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.

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With ageing, fat preferentially accumulates viscerally and ectopically rather than as abdominal subcutaneous fat.
“With ageing, fat preferentially accumulates both viscerally and ectopically rather than as abdominal subcutaneous fat.”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [186]
The 'Changes in body weight and body composition with aging' section says intraabdominal fat increases more, in relative terms, than subcutaneous fat. It also reports increases in intramuscular and intrahepatic fat, but does not say those ectopic depots increase preferentially over abdominal subcutaneous fat; the 'Definition of obesity' section says abdominal subcutaneous fat also increases with aging. Page numbers were not available in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Rapid intra-abdominal fat accumulation is worsened by physical inactivity, hormonal changes, reduced responsiveness to thyroid hormone and leptin resistance.
“Rapid accumulation of intra-abdominal fat is exacerbated by physical inactivity, hormonal changes, reduced responsiveness to thyroid hormone and leptin resistance186.”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [186]
The Pathogenesis section links declining physical activity and age-related hormonal changes, including reduced thyroid-hormone responsiveness and leptin resistance, to increasing body fat. The Changes in Body Weight and Body Composition with Aging section reports a greater relative increase in intra-abdominal fat. The paper does not specifically establish that each listed factor worsens intra-abdominal fat accumulation, and it describes the overall increase in body fat as gradual, not rapid. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Intentional weight loss in older adults improves morbidity and physical function.
“intentional weight loss in older adults improves morbidity and physical function186”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [186]
The Physical function and quality of life section reports improved physical function in obese older adults when moderate weight loss was combined with exercise. The Medical complications section reports improvements in obesity-related metabolic abnormalities, but says most studies of these effects were conducted in middle-aged adults; it does not establish improved morbidity in older adults. The claim also omits the exercise component of the physical-function finding. (LLM, conf=0.86)
Experimental — accuracy not yet measured
It has been recommended that fried and high-fat foods be avoided to decrease gastrointestinal side effects associated with AOMs.
“It has been recommended that fried and high-fat foods be avoided to decrease gastrointestinal side effects associated with AOMs [71,72].”
From Nutritional considerations with antiobesity medications (2024) · cites this paper as [71]
The Pharmacotherapy section reports gastrointestinal side effects from orlistat, an anti-obesity medication, and explains that it increases stool fat. It does not recommend avoiding fried or high-fat foods to reduce those side effects. (LLM, conf=0.82)
Experimental — accuracy not yet measured
Obesity is defined as unhealthy excess body fat that increases the risk of medical illness and mortality.
“Obesity is defined as an unhealthy excess body fat that increases the risk of medical illness and mortality186.”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [186]

To date, the American Association of Clinical Endocrinologists, the Endocrine Society and the Obesity Society have not recommended testosterone supplementation as a treatment for sarcopenia or obesity.
“To date, the American Association of Clinical Endocrinologists187, the Endocrine Society425 and the Obesity Society186 have not recommended testosterone supplementation as a treatment for sarcopenia or obesity.”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [186]
The Treatment options and Pharmacotherapy sections discuss obesity treatments, and the Future Research Directions section discusses sarcopenic obesity. None states whether the Obesity Society recommends testosterone supplementation for sarcopenia or obesity. A treatment list that omits testosterone does not establish the claimed non-recommendation. (LLM, conf=0.72)
Experimental — accuracy not yet measured
Various scientific societies such as the Obesity Society or the American Association of Clinical Endocrinologists do not recommend the administration of testosterone in the management of obesity and/or sarcopenia.
“Currently, various scientific societies such as the Obesity Society or the American Association of Clinical Endocrinologists, do not recommend the administration of testosterone in the management of obesity and/or sarcopenia (89, 90).”
From Sarcopenic obesity: epidemiology, pathophysiology, cardiovascular disease, mortality, and management (2023) · cites this paper as [89]
An estimated 30-40% of weight lost during GLP-1 RA therapy may derive from fat-free mass.
“an estimated 30–40% of weight lost may derive from fat-free mass, which is of particular concern for older adults and individuals with sarcopenic obesity [4, 5].”
From Bridging the nutrition guidance gap for GLP-1 receptor agonist therapy assisted weight loss: Lessons from bariatric surgery (2026) · cites this paper as [5]

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Obesity in Older Adults – A Growing Problem
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Authors: Villareal, D. T., Apovian, C. M., Kushner, R. F., & Klein, S.
Affiliations: Boston University (US)
Corresponding author: Klein, Samuel
ORCID: Villareal, Dennis T
Apovian, Caroline M
Klein, Samuel
Venue: The American Journal of Clinical Nutrition
Publisher: Elsevier BV
Published: 2005-11
Volume: 82
Issue: 5
Pages: 923-934
ISSN: 0002-9165 (ISSN-L)
DOI: 10.1093/ajcn/82.5.923
OpenAlex: W1890921467
Cited by: 880
References: 210
Citations by year: 2026: 38 · 2025: 29 · 2024: 34 · 2023: 38 · 2022: 52 · 2021: 58 · 2020: 44 · 2019: 33 · 2018: 40 · 2017: 43 · 2016: 51 · 2015: 62 · 2014: 56 · 2013: 60 · 2012: 44
FWCI: 14.38
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 6333 d)
Locations: American Journal of Clinical Nutrition (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (DK56341)
National Institute of Diabetes and Digestive and Kidney Diseases (DK56341, P30DK056341)
Topics: Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords: obesity in older adults, weight loss treatment, physical function, frailty, quality of life, body mass index
MeSH terms: Aged, Aging, Body Composition, Female, Humans, Male, Middle Aged, Obesity, Quality of Life, United States, Weight Loss, Exercise, Bone Density

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Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society

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