Kennedy, R.L., Malabu, U., Kazi, M., and Shashidhar, V. (2008) Management of obesity in the elderly: too much and too late? Journal of Nutrition, Health and Aging, 12 (9). pp. 608-621.

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Abstract

[Extract] The prevalence of obesity is increasing globally. This with the aging population structure accounts for the increased prevalence of chronic diseases associated with obesity. For example, the number of people with diabetes in the world is projected to reach 300 million before 2025. Through childhood, adolescence, and adult life, obesity prevalence increases with age. However, the elderly (aged 60 plus), have a lower prevalence and in the extreme elderly (aged 80 plus), it is only a third of that in middle life. Obesity in the elderly presents a distinct problem. As at younger ages, it is associated with chronic diseases, and with functional and cognitive decline. However, the prevalence of being underweight is also a high and is itself a marker for poor health and functional decline. The ideal body weight and composition for elderly populations has yet to be defined. Weight management should be a target for certain elderly individuals whose health is at risk. However, in the elderly is important to maintain an optimal body composition as well as weight. Elderly individuals with weight-related diseases such as type 2 diabetes represent an obvious target for weight management. It is, in practice, difficult to identify elderly patients who would benefit from weight management programmes. The various components of the metabolic syndrome (MS) become more common with aging. Drugs to decrease cardiovascular risk and to treat diabetes and the other chronic diseases of aging have improved in recent years. The elderly are frequently prescribed complex drug regimens with which they often comply poorly, derive little benefit, and experience a high risk of adverse reactions and drug interactions. Although it is clear that obesity should be treated in high-risk elderly patients, pharmacotherapy and surgery do not have an evidence base specific to the elderly. There is emerging evidence to guide us with dietary and exercise therapy (1, 2). This review attempts to define the situations in which management of obesity is indicated, and to summarise what is known, and what is emerging, about the various treatment options.

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