Many people make it through adolescence without developing obesity. In fact, in our society, a great deal of weight gain typically occurs between ages 20 and 50 years. This gain is the result of several factors: decreasing physical activity, ''stress'' eating at both home and work, and for women, weight gain with pregnancy (1315). The increase of body weight during young adulthood lays the foundation for the medical consequences of obesity.
Prevention of adult-onset obesity again must focus on social factors. Here, public education and enhanced awareness of the dangers of weight gain are needed. "g Many young adults are not yet tuned into the health drawbacks of obesity, and they fail to take precautions to avoid it at this stage. Consequently, a more intensive educational effort for this age range is required. Adults must restructure their lives to allow more time for exercise, to minimize use of''labor-saving devices,'' and to | limit portion sizes of their food choices. Whether large- 5 scale social changes beyond education can be brought into play to prevent obesity in adults is uncertain.
After age 50, many people do not gain further weight. Although weight gain can occur, overweight and obe m sity assume a new dimension in the later stages of life. Even when absolute weight does not increase, changes in body composition begin to accelerate. Foremost is a decline in muscle mass (16,17). As a result, the ratio of adipose tissue to muscle mass usually is higher in older people than in middle age. This change shifts the metabolic balance in ways that favor the development of insulin resistance and the metabolic syndrome . Loss of muscle mass is brought about in part by an increasingly sedentary lifestyle. In addition, metabolic changes accompanying aging, which are not well understood, probably play a role. In any case, loss of muscle mass makes older people more susceptible to health consequences of obesity.
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