Obesity and weight management in the elderly: A focus on men

T. S. Han, F. C W Wu, M. E J Lean

Research output: Contribution to journalArticlepeer-review

Abstract

The rising rate of overweight/obesity among the ever-growing ageing population is imposing massive and rapidly changing burdens of ill health. The observation that the BMI value associated with the lowest relative mortality is slightly higher in older than in younger adults, mainly through its reduced impact on coronary heart disease, has often been misinterpreted that obesity is not as harmful in the elderly, who suffer a large range of disabling consequences of obesity. All medical consequences of obesity are multi-factorial and most alleviated by modest, achievable weight loss (5-10 kg) with an evidence-based maintenance strategy. But severe obesity, e.g. BMI >40 may demand greater weight loss e.g. >15 kg to reverse type 2 diabetes. Since relatively reduced physical activity and reduced muscle mass (sarcopenic obesity) are common in the elderly, combining exercise and modest calorie restriction optimally reduces fat mass and preserves muscle mass - age presents no obstacle and reducing polypharmacy is a valuable outcome. The currently licensed drug orlistat has no age-related hazards and is effective in a low fat diet, but the risks from bariatric surgery begin to outweigh benefits above age 60. For the growing numbers of obese elderly with diabetes, the glucagon-like peptide-1 (GLP-1) receptor analogue liraglutide appears a safe way to promote and maintain substantial weight loss. Obesity and sarcopenia should be prevented from younger age and during life-transitions including retiral to improve future health outcomes and quality of life, with a focus on those in "obese families".

Original languageEnglish
Pages (from-to)509-525
Number of pages17
JournalBest Practice and Research: Clinical Endocrinology and Metabolism
Volume27
Issue number4
Early online date23 May 2013
DOIs
Publication statusPublished - Aug 2013

Keywords

  • ageing
  • bariatric surgery
  • cancer
  • early life origins of obesity
  • endocrine disruptors
  • GLP-1 receptor analogue
  • health policy and planning
  • heart failure
  • sarcopenic obesity

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