Abstract:
Obesity is a major health problem worldwide. Over 1 billion adults around the globe have obesity. The global epidemic of obesity mainly results from a combination of genetic susceptibility, increased availability of high-energy foods, increased exposure to environmental obesogens, and decreased requirement for physical activity in a modern society. Obesity causes morbidities, mortality, and high cost for the society. All age groups (e.g., children, adolescents, young adults, and elderly people) have been affected by the obesity pandemic. There has been a dramatic expansion of the worldwide elderly population over the last decades. The worldwide population of people older than 64 years is around 10%. It is estimated that by the year 2030, at least 20% of the population of the USA will be aged 65 years or older. Geriatric obesity is becoming a growing global health concern and represents a medical challenge for healthcare professionals. The worldwide prevalence of geriatric obesity is around 20%. In the USA, the prevalence of geriatric obesity using body mass index (BMI) criteria parallels the prevalence of non-geriatric obesity, currently around 42%. Interestingly, the centenarians (people living at least 100 years) have a lower prevalence of obesity (below 10%). In general, body weight increases through later middle age, then declines in older age. Fat mass (mainly visceral fat) increases with aging, peaking around 65-70 years, but decreases in very old age, while non-fat mass including muscle mass (especially in men) and bone mass (especially in women) decreases. There is also a decrease in height (especially in women), mainly due to the compression of spinal discs, impacting the BMI calculation. Elderly people tend to have low food intake and limited physical activity. The decreased muscle mass (sarcopenia) is a significant factor causing functional limitations. Due to the high prevalence of sarcopenia and the height decrease in the elderly population, BMI is not a reliable marker for the diagnosis and follow-up of geriatric obesity as it may not accurately reflect the fat mass. The most common complications of geriatric obesity include hypertension, ischemic heart disease, atrial fibrillation, stroke, type 2 diabetes, osteoarthritis, obstructive sleep apnea, metabolic dysfunction-associated steatotic liver disease, cancer, impaired physical function, depression, and decreased quality of life. Geriatric obesity can lead to institutionalization and ultimately to death. Obesity in adults is managed through multidisciplinary approaches including lifestyle (e.g., diet, exercise, and behavioral change), food supplements, drugs, medical devices, gut microbiome modulation, body contouring, and bariatric surgery. In the absence of contraindication, the elderly population with obesity can benefit from these treatments. However, the management of geriatric obesity is a medical challenge and weight loss intervention is a controversial topic. Although weight loss has several health benefits (attenuation or reversal of comorbidities), because of its potential detrimental impact on muscle mass and bone mineral density (osteopenia, osteoporosis), in selected cases, treatment should focus on improvement of dietary habits (including sufficient protein intake) and physical fitness/function (aerobic exercise and resistance training), and maintenance of body weight rather than weight loss.
