Review
Is Obesity Bad for Older Persons? A Systematic Review of the Pros and Cons of Weight Reduction in Later Life

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Objectives

The purpose of this review was to describe the characteristics of late-life obesity, including prevalence, pathophysiology, and influences on morbidity and mortality. A second objective was to systematically review the empiric evidence on the effects of intentional weight loss interventions in older individuals.

Design

We summarized the characteristics and known impact of late-life obesity and conducted a systematic review of the outcomes of weight loss interventions in obese older subjects. The inclusion criteria for the review were the following: randomized controlled trial; subjects aged 60 years or older; baseline BMI 27 or higher; weight loss versus baseline 3% or more or 2 kg; and trial duration 6 months or longer.

Results

The search strategy yielded 16 articles on weight loss interventions that were examined in detail. Overall, these interventions led to significant benefits for those with osteoarthritis, coronary heart disease, and type 2 diabetes mellitus (DM-2), while having slightly negative effects on bone mineral density and lean body mass.

Conclusion

Longitudinal trials examining mortality and body weight suggest that maintaining weight is beneficial in older persons who become obese after age 65; in contrast, intervention trials show clinically important benefits of weight reduction with regard to osteoarthritis, physical function, and possibly DM-2 and coronary heart disease. Given these findings, we recommend that decisions about whether or not to institute a weight loss intervention for obese older persons be carefully considered on an individualized basis with special attention to the weight history and the medical conditions of each individual.

Section snippets

Definition and Prevalence of Obesity

Villareal et al3 offer a useful qualitative definition of obesity as “an unhealthy excess of body fat, which increases the risk of medical illness and premature mortality.” In practice and in research, however, the criteria most commonly used to measure the extent of excess adiposity is the body weight (mass), which is typically expressed as it relates to stature as the body mass index or BMI, the weight in kg divided by the squared height in meters (Formula: weight (kg)/[height (m)]2). While

Pathophysiology

Dietary energy intakes apparently do not increase with age and may even decline slightly in the later decades of life.8, 9 Thus age-associated decreases in energy requirements probably explain the gradual accumulation of body fat mass with age. Declines in resting metabolic rate and the thermic effect of food reduce basal energy needs. Energy expenditures in physical activity almost universally decrease with age, explaining a substantial portion of the decreased total energy expenditure in

Relationship of High BMI With Mortality After Age 65

There is strong evidence that in younger adults OB lessens life expectancy, a finding repeatedly confirmed in a number of well-known studies such as the Framingham Heart Study and NHANES II and III.10, 11 Just as well known is that the relative risk of death associated with high BMIs decreases with advancing age. This rather surprising discovery has been extensively explored. In the past decade alone, at least 17 medium to large epidemiological studies have been published on the relationship of

Effects of Obesity on Morbidity and Functional Status

Despite the seemingly paradoxical findings of the studies of BMI and late-life mortality, there is ample justification to anticipate that OB will have detrimental metabolic and functional effects on the health and quality of life of older persons. Excessive body mass is linked with enhanced risk of many serious comorbidities that increase with advancing age, including glucose intolerance, cardiovascular disease, hypertension, and some cancers, as well as functional decline, impaired quality of

What Are the Effects of Intentional Weight Loss in OB Older Adults?

The prevalence of OB in older adult cohorts is steadily increasing, potentially exacerbating the severity of age-related conditions like cardiovascular disease, DM-2, and arthritis. However, because of the potential benefits of OB noted previously in this review, there has been a hesitation to recommend weight reduction in OB older individuals. Findings from well-controlled interventional studies are needed to establish an evidence-based protocol for OB treatment in geriatric patients. In this

Methods for Systematic Review

The PubMed database was searched for English-language articles that contained each of 4 search domains: obesity (MeSH term or text word obese), weight loss (MeSH term), weight loss interventions (MeSH terms anti-obesity agents, bariatric surgery, exercise, or diet), and comorbidities (MeSH terms diabetes mellitus, osteoporosis, osteoarthritis, or cardiovascular diseases). These articles were then limited to randomized controlled trials. This resulted in a total of 268 articles, which were

Results of Systematic Review

The 16 articles identified as described actually represented only 5 distinct major trials; in some cases, several articles were written about different aspects of the same subjects within a given trial. The study characteristics of each of the trials are summarized in Table 2, and the outcomes are listed in Table 3.52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67 For ease of explanation, the trials are numbered 1 to 5 and the specific papers providing outcomes are listed in the

Clinical Implications of the Review Findings

Along with the statistical significance of the findings noted, we also want to consider the potential clinical importance of the outcomes observed in the weight loss trials we reviewed. In an effort to summarize the clinical implications of the trials, Table 4 lists them by the primary focus of the outcomes (eg, osteoarthritis, coronary heart disease), breaking the outcomes into 3 categories: metabolic, clinical, and self-report (of functional benefits). The last column indicates whether the

Summary and Significance

In the coming decades, unprecedented numbers of baby boomers will become senior citizens, in what is now termed “the graying of America.” Health policy makers are already concerned about the burden this population shift will bring because of the high use of health care services by this age group. The detrimental effects of a growing prevalence of OB in late life could further exacerbate the seriousness of a number of these age-related health concerns, depending on the body weight gain patterns

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