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Cited by 261Nutrition and Health in AgingObesity, Physical Activity, DietPharmacology and Obesity Treatment

Prevalence, Pathophysiology, Health Consequences and Treatment Options of Obesity in the Elderly: A Guideline

Mathus-Vliegen, Elisabeth M.H., Basdevant, Arnaud, Finer, Nick, Hainer, Vojtech, Hauner, Hans, Micic, Dragan, Maislos, Maximo, Roman, Gabriela +5 more·2012·Obesity Facts
DOI 10.1159/000341193
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Abstract

The prevalence of obesity is rising progressively, even among older age groups. By the year 2030–2035 over 20% of the adult US population and over 25% of the Europeans will be aged 65 years and older. The predicted prevalence of obesity in Americans, 60 years and older was 37% in 2010. The predicted prevalence of obesity in Europe in 2015 varies between 20 and 30% dependent on the model used. This means 20.9 million obese 60+ people in the USA in 2010 and 32 million obese elders in 2015 in the EU. Although cut-off values of BMI, waist circumference and percentages of fat mass have not been defined for the elderly (nor for the elderly of different ethnicity), it is clear from several meta-analyses that mortality and morbidity associated with overweight and obesity only increases at a BMI above 30 kg/m 2. Thus, treatment should only be offered to patients who are obese rather than overweight and who also have functional impairments, metabolic complications or obesity-related diseases, that can benefit from weight loss. The weight loss therapy should aim to minimize muscle and bone loss but also vigilance as regards the development of sarcopenic obesity – a combination of an unhealthy excess of body fat with a detrimental loss of muscle and fat-free mass including bone – is important in the elderly, who are vulnerable to this outcome. Life-style intervention should be the first step and consists of a diet with a 500 kcal (2.1 MJ) energy deficit and an adequate intake of protein of high biological quality together with calcium and vitamin D, behavioural therapy and multi-component exercise. Multi-component exercise includes flexibility training, balance training, aerobic exercise and resistance training. The adherence rate in most studies is around 75%. Knowledge of constraints and modulators of physical inactivity should be of help to engage the elderly in physical activity. The role of pharmacotherapy and bariatric surgery in the elderly is largely unknown as in most studies people aged 65 years and older have been excluded.

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  • Weight loss increases the risk of sarcopenia, frailty, functional decline, fractures, and malnutrition.

    “and consequently increases the risk of sarcopenia, frailty, functional decline, fractures, and malnutrition (276, 282, 283).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [276]

    In “Nutrition and Diet” (page not specified), the guideline says diet-induced weight loss could worsen age-related muscle loss and impair physical function. In “Who Should Lose Weight and What Are the Concerns?” (page not specified), it identifies sarcopenic obesity and hip fractures as potential adverse effects, but limits the fracture association to non-overweight elderly people. It does not say weight loss increases malnutrition risk, and it links frailty to sarcopenic obesity rather than directly to weight loss; the claim also states as certain what the guideline presents as a risk. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Weight loss, whether intentional or not, enhances the age-related loss of muscle mass.

    “Further, weight loss, whether intentional or not, enhances the age-related loss of muscle mass”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [276]

    The Nutrition and Diet section says diet-induced weight loss reduces fat-free mass and could exacerbate age-related muscle loss. The claim presents that possibility as certain and extends it to unintentional weight loss, which the cited passage does not address. The section Who Should Lose Weight and What Are the Concerns? likewise discusses muscle loss as a possible adverse effect of intentional weight loss. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Current expert recommendations regarding weight reduction in older people primarily refer to cases of obesity that are associated with comorbidities and obesity-related adverse health effects.

    “Current expert recommendations regarding weight reduction in older people primarily refer to cases of obesity that are associated with comorbidities and obesity-related adverse health effects (276)(277)(278)282).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [276]

  • In cases of obesity with comorbidities, positive effects of intended weight loss on orthopedic problems, cardiovascular and metabolic risk, insulin sensitivity, chronic inflammation, and functional limitations have been reported, partly in combination with physical exercise.

    “In these cases, positive effects of intended weight loss on orthopedic problems, cardiovascular and metabolic risk, insulin sensitivity, chronic inflammation, and functional limitations have been reported, partly in combination with physical exercise (11,274,276,278,285,286).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [276]

  • Experts generally agree that there is usually no need for overweight older people to lose weight.

    “Experts generally agree that there is usually no need for overweight older people to lose weight (274-278)”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [276]

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Authors
Mathus-Vliegen, E. M. H., Basdevant, A., Finer, N., Hainer, V., Hauner, H., Micic, D., Maislos, M., Roman, G., Schutz, Y., Tsigos, C., Toplak, H., Yumuk, V., & Zahorska-Markiewicz, B.
Affiliations
Amsterdam UMC Location University of Amsterdam (NL)
ORCID
Venue
Obesity Facts
Publisher
S. Karger AG
Published
2012
Volume
5
Issue
3
Pages
460-483
ISSN
  • 1662-4025 (ISSN-L)
  • 1662-4033
DOI
10.1159/000341193
OpenAlex
W2087540908
Cited by
261
References
128
Citations by year
2026: 5 · 2025: 11 · 2024: 14 · 2023: 13 · 2022: 19 · 2021: 18 · 2020: 17 · 2019: 18 · 2018: 22 · 2017: 19 · 2016: 25 · 2015: 32 · 2014: 24 · 2013: 23 · 2012: 1
FWCI
2.76
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Obesity Facts (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • IRIS (submittedVersion)
  • SERVAL (Université de Lausanne) (submittedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
Keywords
obesity in older adults, sarcopenic obesity, obesity prevalence, obesity pathophysiology, weight loss treatment, lifestyle intervention, energy deficit diet, protein intake, multicomponent exercise, physical activity adherence, physical inactivity, pharmacotherapy, bariatric surgery, functional disability, morbidity and mortality
MeSH terms
Behavior Therapy, Diet, Humans, Life Style, Obesity, Weight Loss, Health Behavior, Exercise, Practice Guidelines as Topic, Anti-Obesity Agents

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