Should Obese Older Adults in Health Care Communities Be Encouraged to Lose Weight?
The obesity epidemic challenges health care professionals who care for older adults.
Our next great challenge in working with the nutritional needs of older adults in health care communities will be one that we have not worried about in many years: obesity. In the U.S., the prevalence of obesity in the general adult population is now at 67% (1); among adults over the age of 75 this rate was 26% for men and 27% for women in 2007-8. This may not sound alarming until you realize that this is an increase of 100% and 42% respectively since 1988-1994 (2). It is clear that in the coming years we'll see more obese residents enter health care facilities for both short-term rehabilitation and long-term stays.
Obesity and Disease Risk in Older Adults
Along with higher rates of obesity, older Americans are experiencing higher rates of obesity-related diseases. This includes coronary heart disease, type II diabetes, stroke, and several types of cancer. In addition, obese older adults report more limits to activity levels which can lead to further increases in obesity and contribute to metabolic syndrome and/or sarcopenic obesity - age related loss of skeletal muscle mass coupled with obesity which can lead to weakness, frailty and falls.
Benefits of Weight Loss for Obese Adults
At first glance, it is easy to think that weight loss should be the prescribed course of action for all obese older adults. After all, it has been shown that weight loss can help reduce the risk of chronic disease or - for those who already have chronic disease - help control those diseases that tend to be worsened by obesity. Plus, there is some evidence that weight reduction in obese people over the age of 65 has similar health benefits to those at younger ages, primarily related to the reduction of cardiovascular disease risk factors.
The National Health, Lung and Blood Institute summarizes the advantages of weight loss well in their review of the evidence-based research and recommendations (3). In general, weight loss is recommended to:
• Lower elevated blood pressure
• Lower elevated levels of total cholesterol, LDL-cholesterol and triglycerides
• Raise low levels of HDL-cholesterol
• Lower elevated blood glucose in obese persons with type 2 diabetes
Is Weight Loss Always the Best Course of Action?
While the benefits of weight loss for healthier older adults may include reduced risk of cardiovascular episodes, reduction in blood cholesterol, blood lipids and blood glucose levels, for more fragile older adults the health risks can outweigh the benefits. For obese older adults, a number of questions must be answered to determine if weight loss is appropriate:
• Will weight loss reduce risk factors for other complications?
• Will weight loss prolong life for the individual?
• What are the risks associated with obesity treatment? (3)
• Will a restricted diet reduce the individual's ability to consume adequate nutrients to maintain health?
For individuals who are appropriate for a planned weight loss program, the program must be carefully planned and supervised by trained health care professionals. Proper nutritional counseling and close monitoring of body weight and other nutritional parameters are essential.
For more fragile obese older adults health risks of weight loss include the potential for protein-energy malnutrition, vitamin/mineral deficiencies, and other complications that may follow (such as pressure ulcers, bone loss, weakness, and falls). For these patients a weight loss program may not be appropriate at all.
"A clinical decision to forgo obesity treatment in older adults should be guided by an evaluation of the potential benefits of weight reduction for day-to-day functioning and reduction of the risk of future cardiovascular events, as well as the patient's motivation for weight reduction. Care must be taken to ensure that any weight reduction program minimizes the likelihood of adverse effects on bone health or other aspects of nutritional status" (3).