Health Functional and Therapeutic Implications of Obesity in Aging

Body weight generally increases from puberty through middle life. Some of this is due to muscle gain in the early years, but mostly it is fat. When weight gain is excessive, there is increased morbidity and mortality from diabetes, vascular disease, other chronic diseases, and malignancy. Although the prevalence of obesity is increasing, prognosis from associated chronic diseases is also improving. The consequence is that increasing proportions of the population reach old age and are either overweight or obese, or they become so in later life. The relationship between obesity and risk of death in later years of life is less clearcut than in younger subjects. There are no evidence-based guidelines for desirable body weight or managing obesity in the elderly. We do not really know how to measure obesity meaningfully in this age group. In fact, low body weight or weight loss appears to be a much more significant determinant of health in older subjects. However, obesity is associated with changes in metabolism and hormone levels, and with a low-grade inflammatory state. These changes are intimately involved with functional decline and provide opportunities for new therapeutic targets. Medical and surgical treatments for obesity have become widely available. There is a lack of specific data on their benefits in the aged population, but the benefits of exercise have become clear. Overall, the general increase in body weight in aging subjects may be a sign of improved nutrition, social environment, and medical care, and we should not simply regard it as a sign of ill health.

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