Obesity in Older Adults: A Systematic Review of the Evidence for Diagnosis and Treatment

• Published in: Obesity (Silver Spring, Md.) Vol. 14; no. 9; pp. 1485 - 1497
• Main Authors: McTigue, Kathleen M., Hess, Rachel, Ziouras, Jennifer
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.09.2006
• Subjects: Adipose Tissue - metabolism; Age; Aged; Anthropometry; Body fat; Cardiovascular Diseases - epidemiology; Counseling; diagnosis; Diagnosis, Differential; Diagnostic tests; elderly; evidence‐based medicine; Exercise; Female; Geriatrics; Health risk assessment; Health risks; Humans; Hypertension; Internal validity; Life Style; Male; Medical diagnosis; Morbidity; Mortality; Obesity; Obesity - complications; Obesity - diagnosis; Obesity - mortality; Obesity - therapy; Observational studies; Older people; Physical fitness; Research methodology; Risk Factors; Systematic review; treatment; Treatment Outcome; Weight control; Weight Loss - physiology; United States > US; Pittsburgh Pennsylvania; Pennsylvania
• ISSN: 1930-7381; 1930-739X
• DOI: 10.1038/oby.2006.171

Objective: Although obesity is increasing in older U.S. adults, treatment is controversial in this age group. We sought to examine evidence concerning obesity's health‐related risks, diagnostic methods, and treatment outcomes in older individuals. Research Methods and Procedures: We searched MEDLINE and Cochrane Library databases, consulted with experts, and examined bibliographies for English language studies discussing obesity in older adults (mean age ≥ 60), published between January 1980 and November 2005. Inclusion criteria were met by 32 longitudinal analyses, seven diagnostic studies, and 17 randomized controlled trial articles. At least two authors independently reviewed and ed study design, population, results, and quality information. Results: Correlations between body fat and three anthropometric measures (BMI, waist circumference, waist‐to‐hip ratio) decrease with age but remain clinically significant. Obesity contributes to risk for several cardiovascular endpoints, some cancers, and impaired mobility but protects against hip fracture. The association between obesity and mortality declines as age increases. Intensive counseling strategies incorporating behavioral, dietary, and exercise components promote a weight loss of 3 to 4 kg over 1 to 3.3 years. The loss is linked with improved glucose tolerance, improved physical functioning, reduced incidence of diabetes and a combined hypertension and cardiovascular endpoint, and reduced bone density. Discussion: In older adults, obesity can be diagnosed with standard clinical measures. Intensive counseling can promote modest sustained weight loss, but data are insufficient to evaluate surgical or pharmacological options. Obesity treatment is most likely to benefit individuals with high cardiovascular risk. Limited data suggest possible functional improvement. Treatment should incorporate measures to avoid bone loss.