Specifcs Contributors of Obesity in the Elderly
Decreased physical activity and decreased energy expenditure with ageing set the stage for increased fat accumulation and fat redistribution. As mentioned in What is Obesity? section of this website, body tissue that has a metabolic function (such as muscle) utilizes caloric energy, while fat does not. Reduction in muscle mass is an important determinant of physical function and metabolic rate. Sarcopenic obesity is a term used to describe a condition where lean mass decreases in relation to an increase in fat.

Weight gain in older age is as serious as it is in younger people, even if weight remains stable during the first half of life. The unhealthiest pattern is continuously gaining weight throughout life, which results in a risk for type 2 diabetes. In general, the percentage of body fat peaks in the sixth decade of life. Studies with whole-body Magnetic Resonance Imaging (MRI) show that overall adiposity (percentage of body fat) increases with age and shifts within body spaces. While subcutaneous adipose (fat distributed just below the skin) decreases over the years, visceral and intramuscular adipose increases.

Unique Effects of Obesity for the Elderly
Because the Elderly are inherently at risk for a host of age-related diseases, it was once thought that a small to moderate amount of excess weight in the elderly produced a protective effect, allowing for nutrient and caloric storage that could be utilized during times of increased illness. But recent findings indicate that this is not true. In people over 70, both thinness and overweight were associated with a higher rate of mortality.

There are a few benefits to overweight among the elderly. By stressing the skeleton, excess weight reduces the loss of bone mass, and overweight elderly people are less likely to suffer hip fractures, a major cause of morbidity and mortality. However, experts agree that the health risks of overweight and obesity are greater than any advantages.

Obese elderly people are more likely to become disabled and to be admitted to a nursing home. Obesity is a major predictor for loss of independence and exacerbates age-related decline in physical functioning.

Unique Weight Reduction Goals
The goal of treating obesity in the elderly is to reduce weight without losing lean mass or contributing to frailty. The primary purpose of treatment is different than that for younger patients; to increase physical functioning and quality of life, not necessarily to prevent weight-related disease.

In the past, bariatric surgery was generally not recommended for people 65 years of age and older, although it was deemed appropriate in some more severe cases. Recent studies; however, suggest that bariatric surgery, in obese patients above age 60 can be safely performed even in patients above age 70 and with the same benefits as for younger subjects.

Typically, elderly patients will to lose less weight than younger patients, and they are prone to increased complications. Most malabsorptive types of weight loss surgery, such as Roux-en Y, are not recommended for the elderly because the decrease in nutrient transfer and absorption associated with this type of surgery can contribute to osteoporosis and many other ailments associated with malnutrition. When considering bariatric surgery in obese elderly patients, the risks and benefits must be weighed carefully and with heightened case individuality.

Options to Surgery
Research suggests weight gain in older age is not caused by eating more or consuming energy-dense foods, but usually by a decline in physical activity. Prescribing a regimen of exercise may tip the balance of energy back toward normal.
Several studies show benefits from progressive resistance training, which helps conserve lean body mass, strengthen bone, and increase energy expenditure. Progressive resistance training, rather than endurance exercise is typically viewed to be more effective in most cases.

Chronic inflammation and endocrine changes contribute to the changes in metabolism and body composition that accompany ageing, and are potential therapeutic targets. Body weight and body mass index are imperfect indicators of risk from obesity for the elderly, simply because BMI measurements rely on a standard fat distribution throughout the body. For the elderly, the focus of treatment should be on reduction of intra-abdominal fat and preservation of muscle mass and strength. Reduced function and decreased quality of life accompany development of the complications of obesity such as diabetes and vascular disorders. There is considerable scope to impede the development of these complications in the elderly with lifestyle interventions.

The relative controversy over the appropriateness of bariatric surgery as a method of weight control for the elderly would suggest that an individual would be best served by addressing his or her obesity issues before reaching their senior years. As is common with all surgical cases, and with weight loss surgery in particular, the needs of the individual must be carefully considered. Even if you have been dismissed by other medical professionals, Dr. Nowzaradan welcomes your inquiries.