Obesity in Older Adults

Being overweight is a serious concern faced by people of all ages, leading to obesity. However, as we age, the attribute of obesity versus its impact on the human body differs from younger people to adults.

With the increase in the proportion of people above the age of 65 years increases the ubiquity of obese. The elderly population forms the basis of research and development of recommended treatments for those with the problems of obesity. It is identified that obesity elevates the mortality rate for those on the other end of the spectrum of Body Mass Index, followed by those who are underweight and appearing to be obese. 

The muscle mass reduces with growing age. Senior people become immobile or get sedentary. The muscle repository gets replaced with fats and although the BMI might not change, it increases the chances of becoming obese and associated ailments. The inaccuracy in BMI could also be related to the tendency of reduction in older people’s height due to osteoporosis or spinal related issues. This is logical as the body mass index is calculated over the variables - height and weight. If an individual gains weight due to old age and if the height reduces, due to above ailments, it could affect the overall calculations and one might be treated as overweight or obese. However, in reality, they are not. There is an ongoing contemplation on whether to use BMI as a standard for determining individuals’ eligibility as a an obese or not. However, until a more appropriate method of determination is found, BMI as an index will continue to be used. Few suggest using waist circumference as a variable to help dieticians determine the appropriateness of persons eligibility for being overweight.

The present article throws light on obesity in older adults, symptoms, causes and the health issues caused due to it. It also discusses about certain preventive tips for a healthier life in senior people. 

Statistics

According to recent statistics on obesity from the CDC, (Center for Disease Control and Prevention), roughly 93.3 million adults (39.8%) and 13.7 million children and teens (18.5%) in the American State are obese. Despite the rising percentages, there are plenty of ways to prevent obesity in both kids and adults.

Key facts

• The obesity condition is three times more prevalent than it was in 1975
• Thirty nine percent of people aged eighteen years and over were having excess weight and thirteen percent were obese
• In 2016, it was estimated that more than 1.9 billion adults, 18 years and older, were overweight. Of these individuals, over 650 million were obese.
• Most of the world's population live in countries where overweight and obesity kills more people than underweight
• In 2019, around 38 million kids under the age of five were obese in 2019
• Over 340 million children and adolescents aged five-nineteen had excessive weight or were obese in 2016
• Obesity is preventable.

The obesity condition is associated with an increased number of deaths globally in comparison to the condition of underweight. Across the world, there is a massive population who are obese than underweight. Obesity is a growing problem in every region of the world except Asia and parts of sub-Saharan Africa and Asia. 

How does obesity affect older adults?

Several scientific research studies have proved and reported that the condition of obesity triggers and predisposes to many chronic health conditions and diseases. In fact, obesity negatively impacts almost all the functional systems and organs in the human body. Some health risks and diseases associated with obesity in older adults include – high blood sugar, high blood pressure, cardiovascular diseases, stroke, hypertension, and certain cancers. In older adults, obesity puts a lot of pressure on joints, bones and muscles that are already declining due to growing age. Another reason for growing weight in older people is physical disability. Experts describe this process as “the obesity paradox.” Due to obesity in older adults, they are not able to live their life with integrity and dignity.

Senior people suffering from health condition seem to live a longer life in comparison to when they have health disorders coupled with excess weight and obesity. According to several scientific studies, senior people with obesity can expect around six more years of remainder life with limitation in movement and physical activity and around five less years of remainder life without this restriction in comparison to those with normal weight.

Risks of obesity in older adults

There are a number of risks contributing to obesity

1. Biting more than one can chew. In other words, consuming more calories than required by the body.
2. Physical immobility due to some reasons.
3. Sedentary lifestyle as a result of professional lifestyle, even though the individual is able to move around easily.
4. All other factors, that could contribute to weight gain including family history of being obese, birth related factors that could include smoking or undernutrition, and socioeconomic factors like lack of education and household incomes.

Regular workout and keeping structured eating habits could help in managing the risks of obesity.

Causes of obesity in older people

Overweight can be associated with a complex set of problems associated with an individual including genetic structure and personal behavior. Behavior could include regular activities, lifestyle, eating habits and patterns, medications and exposure to other activities. Other factors may include dietary and physical activities, academics, skill sets, and promotion. Being obese is a serious issue as it is associated to an impoverished psychological health and decreased living conditions. It can also be the reason for spikes in death rates in many developed countries including the United States of America. This includes diabetes, cardiac diseases, stroke and many types of malignancy. 

Behavior

Healthy behavioral patterns may be associated with ongoing physical activities and healthy eating patterns. Maintaining a balance between calorie intake and burning them to an appropriate level is critical to avoiding weight gain. This dietary pattern and ongoing physical exercise help in preventing incurable diseases including type 2 diabetes and cardiac diseases. 

Community Environment

The decision-making factor of an individual or their family is determinant of their habitat and the community as a whole. Say for instance, a clean neighbourhood will always influence an individual to throw the trash in the bin, maintain a level of hygiene and indirectly keep a safe and clean habitat. Hence it is vital to create an amiable environment that is easy to transform into and engage with enthusiasm.

Genetics

Mutations due to genetics could be a gradual process and hence might have a minimal impact on being overweight. However, the way an individual would interact with their environment that advocates sedentary living and huge intake of high calorie food would impact development of the genetic structure of an individual.

Genetic influence on obesity

Our genetic structure communicates with the body to adjust to the changes in our environment. Variances in these genes could impact the dietary intake and eating habits. It is scarcely noticed that a clear pattern of a genetic structure is transformed within their offspring to cause a specific type of obesity. However, the main cause of most overweight issues are a resultant of a more complex genetic interaction and influence from external factors like environment and the surroundings.

Family history impact on obesity

Medical practitioners globally are always on the hunt to collect family history to analyze people with high risk due to overweight and associated ailments like diabetes, heart diseases, and some types of malignancy. The impact of family history in genetics is quite significant. The genetic structure cannot be alternated, however the way we carve our lifestyle and eating habits can influence obesity. Positive changes in the above factors can help improve the health of their family and the community, as a whole. 

Other factors due to drugs and diseases

Some ailments can advance to obesity and calorie gain. These include polycystic ovary syndrome and Cushing’s disease. Specific drugs and steroids, including antidepressants can also result in gaining weight. Immense research is conducted to understand the role of these miscellaneous factors that includes exposure to chemicals and the importance of microbiome.

Medical professionals can aid in educating about eating habits and historical data to determine whether ailments, medicines, behavioural factors, or psychological factors can contribute to overweight and devising solutions and alternatives to weight loss.

Does obesity increase with age? Why am I gaining weight as I age?

With growing age, the tendency to control and manage weight gain becomes difficult. The reason is that in senior people (between 40 – 60) the response of body to weight loss efforts does not remain the same. One to two pounds per year weight gain in older people becomes significant, in some cases and eventually results in obesity (a condition characterized by BMI -Body Mass Index of 30 or higher).

Apart from age, the condition of obesity in senior people is highly influenced by other factors as well like – level of exercises and physical work out, food habits and the genetic makeup. Some scientists explain it using peppy words like – genetics loads the gun and diet choice and lifestyle pulls the trigger.

Who is most at risk of becoming obese?

Obesity and excess weight gain are often accompanied by other serious health complications like high blood sugar, high blood pressure, heart disease, hypertension, malignant growths, and arthritis. People who live a sedentary life with limited movement, no physical workout, eat a lot of junk and processed foods etc. are at an increased risk of becoming obese. In addition, people who have obesity as a part of their genetic makeup and are on certain medications that trigger obesity are at an increased risk of this unpleasant health condition.

Rural populations with a higher risk of obesity in older adults include those who are: Age 60 and above. Low-income.

Health consequences of obesity in the elderly

Obesity is a common but increasing problem in the elderly. Several health implications and chronic diseases caused by obesity in older adults include;

Increased risk for heart disease

Obesity prevents transport of oxygen to veins and arteries of the heart and this increases risk of severe cardio-vascular health issues

Type 2 diabetes

cvv  Excess weight triggers modifications in body metabolism. The alterations result in adipose tissues (fat tissue) to produce fat molecules into the blood stream, which can significantly cause a negative effect on the insulin responsive cells and result in alleviated insulin sensitivity.

High blood pressure (hypertension)

Because of obesity, the heart has to perform and function a bit harder to transport blood to several tissues. This additional effort and harder task put lot of pressure and strain on the arteries. High blood pressure and thus hypertension is triggered when the arteries resist this blood flow, resulting in hypertension

Musculoskeletal disorders like osteoarthritis

Excess fat increases pressure and mechanical load on bones, muscles and cartilages and bone that “activates” those structures. A person with obesity is sixty percent more likely to develop osteoarthritis in comparison to someone of normal body weight.

Stroke

Obesity is responsible for ischemic stroke (stroke due to lack of blood flow) in many older men and women.  

Gallbladder disease

Being overweight or having a condition like obesity may predispose you more likely to develop gallstones. Gallstones is a serious condition that should be treated to avoid complications.

High LDL (low-density lipoprotein) cholesterol, low HDL (high-density lipoprotein) cholesterol, or high levels of triglycerides (Dyslipidemia)

High LDL, cholesterol, triglycerides, and low HDL are not good for the heart. In fact, these all could lead to an increase risk for heart diseases and stroke.

Certain types of cancer 

Obesity is linked with an increased risk of several types of malignant growths – colon cancer, bladder cancer, uterine cancer, cervical cancer, breast cancer, renal cancer, pancreatic cancer, gallbladder cancer and prostate cancers.

Urinary incontinence

Increased Body Mass Index is closely associated with urinary incontinence

Cataracts and cataract surgery

several studies have reported that obesity in older adults increase the risk of cataracts.

Sleep apnea

In older people who suffer from excess weight and obesity, fats get accumulated around the upper respiratory tract thereby narrowing the airways. As a result, the muscle activity gets impacted badly, resulting in hypoxic (a very low level of oxygen) and apneic (a temporary suspension of breathing) episodes, ultimately causing sleep apnea.

Atherosclerosis (where fatty deposits narrow down the arteries)

Obesity results in deposition of fat around the arteries which makes them narrow and this increases risk of a condition called as atherosclerosis.

Asthma

Obesity increases fat around the abdomen and the chest which might cause constriction in the lungs and makes it difficult to breathe comfortably. According to ALA - American Lung Association, obesity and excess weight produces too much inflammatory items that alter and impair lung function and result in breathing issues or asthma.

Metabolic syndrome

This health issue is associated with excess weight and obesity and inactivity. This syndrome is also associated with a medical condition termed as - insulin resistance.

Pulmonary abnormalities

Obesity-hypoventilation syndrome, and obstructive sleep apnea. Excess weight on the chest wall reduces respiratory compliance, makes it harder to breathe and causes restriction of the ventilation.

Economic and Societal Consequences

Obesity related health issues have a significant negative effect on the health care system. Direct health costs including treatment includes medical costs may include diagnostic, prognosis, prevention and treatment services. Indirect health and medical costs are associated with illness and mortality and include lost productivity. The index or the characteristics used to measure productivity include workers being away and not present at work because of obesity associated medical issues, reduced productivity while at work, and restricted ability to move and premature death.

How to prevent obesity in the elderly / addressing obesity in older adults

Fortunately, a healthy lifestyle, physical workout and healthy food choices are helpful in maintaining a healthy weight. There are several prevention tips that are helpful in addressing obesity in older adults.

Planned Weight-loss

In adults, there is fat but less muscle. This is normal in elderly people as it is a part of normal aging process and deconditioning. Modest calorie restriction has been recommended by health experts and doctors as the optimal method of alleviating fat mass and preserving muscle mass. Reduction in polypharmacy is a valuable target for weight management in senior people

Aerobic exercise

• At least 5 days per week for moderate intensity physical activity (5-6 on a scale of 0-10 for level of physical exertion)
• At least 30 minutes daily of moderate intensity Physical Activity > 10 minutes each for a total of at least 150 minutes per week.
• Exercise can include any modality that does not impose excessive orthopaedic stress with walking being the most common activity
• Stationary cycling and aquatic exercises are beneficial for those with limited tolerance for weight-bearing activity.

Flexibility exercise

To maintain the flexibility necessary for regular physical activity and daily life, senior people need to perform activities that maintain or increase flexibility at least two days each week for at least 10 minutes each day

Muscle strength / Endurance exercise

• At least 2 days per week
• Light intensity (40% - 50% of 1-repetition max) for older adults beginning a resistance training programme slowly progressing to moderate intensity (60% to 70% of 1 – repetition max.)
• Exercises should involve progressive weight training or weight – bearing calisthenics (either standing or seated) that include 8-10 exercises involving 8-10 major muscle groups and at least 1 set of 8-10 repetitions per exercise

Other considerations

• Physical activity sessions should begin with a warm-up and end with an appropriate cool down
• Intensity and duration of exercise should be light at the beginning of deconditioned individuals, or those with chronic conditions or functional limitations
• Progression of exercise should be individualized
• Initial strength training sessions using weight lifting machines should be supervised
• Obese or older weight adults may benefit to a progression of >250 minutes per week of moderate intensity exercise.
• Apart from physical activity, older people who have the tendency to gain excessive weight should binge on more good fat and less of bad or unhealthy fat. Healthy fats like polyunsaturated fats (fats present in plant and animal foods), improves cholesterol (hyperlipidemia) levels and reduce obesity risk.
• Older people should avoid processed and sugary foods as these foods are ultra-processed and can encourage overeating and an increased risk of obesity.
• To control weight gain and obesity condition, older people should tale 5- 9 servings of fruits and veggies. This helps keeps calories in control and alleviate the risk of overeating.
• Senior people should plenty of dietary fibre as it plays a significant role in weight management.
• Low-glycemic index foods keep blood sugar levels steadier. This helps in weight management and controlling obesity.
• Older people should keep their loved ones (their immediate family) involved in their journey. Family can accompany during walks, help in making healthy food choices and even help to encourage a healthy lifestyle.
• A weight training regimen recommended by World Health Organization that involves all primary muscles at least 2 time every week.
• It is important to keep an eye on stress and mental comfort and health. Any kind of stress that could alter brain response and have an effect on eating ways and increases cravings and urge for high-calorie diet should be avoided. Eating uncontrollably can trigger obesity development and associated health issues.
• In addition, food budgeting and prepping meals ensures that ready-to-go healthy and balanced meals are available without any fuss.

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Final Takeaway

With age, senior people should take more care of their health, especially in terms of weight management. Obesity is a growing concern in older people. As a part of aging process, the ability of the body to manage weight declines and this triggers several health issues. However, a healthy lifestyle, little workout, healthy food choices and regular screening could be beneficial.