Aging and Obesity

Claire ZizzaTenth Annual Diabetes and

Obesity ConferenceApril 19, 2011

Agenda

How many people? Older adults Obese older adults

What happens to our bodies as we age? What are the consequences of these

changes? What should we do about these

changes? Dietary recommendations

Comments today are from

How many older adults?

How many obese older adults?

Body Mass Index (BMI)

An excess of total body fat

Current clinical guidelines Overweight: 25 – 29.9 kg/m2

Obesity: ≥ 30 kg/m2

How many older adults are obese?

What happens to our bodies as we age?

Increase in total fat mass (percent body fat)

What happens to our bodies as we age?

Sarcopenia

Loss of skeletal muscle mass with aging

Increases with age Community dwelling adults: New Mexico

Elder Health Survey and the New Mexico Aging Process Study

15% in adults < 70 y 40% in adults > 80 y

What happens to our bodies as we age?

Sarcopenia Obesity Combination of excess body fat and a

decrease in skeletal muscle mass

Increases with age Community-dwelling older adults

2% for adults < 70 y 10% in adults > 80 y

What happens to our bodies as we age?

Sarcopenia and obesity may act synergistically

Decreased strength

Decreased fitness

Loss of functional capacity

What happens to our bodies as we age?

Fat mass redistributed in the abdominal area

What happens to our bodies as we age?

Abdominal Obesity A waist circumference of 102 cm or

higher in men and 88 cm or higher in women

Particularly for adults with a BMI between 25 and 34.9

What happens to our bodies as we age?

Limitations of BMI in older adults Age related changes in body

composition Losses in height

What are the consequences of these

changes? Chronic health condition

Arthritis, hypertension, heart disease and stroke, cancer, and diabetes

What are the consequences of these

changes? Physical and cognitive disability Nursing home admissions and

homebound status

What should we do about these changes?

Intentional weight loss has not been widely advocated for this age group by health care providers due to the uncertainty of whether the benefits outweigh the risks

What should we do about these changes?

Documented adverse effects of weight loss on muscle and bone

Lack of evidence for documented benefits of intentional weight loss

What should we do about these changes?

National Heart, Lung and Blood

Institute

“Age alone should not preclude

treatment for obesity in adult

men and women”

What should we do about these changes?

American Society for Nutrition and the Obesity Society Weight loss in older adults with obesity

should be considered on an individual basis Evaluate the benefits from alleviating and

managing co-morbid conditions and functional impairments

Consider the adverse effects on muscle mass, bone density, or other aspects of nutritional status.

What should we do about these changes?

Lifestyle intervention

Low-energy diet

Physical activity

What should we do about these changes?

Diet recommendations for weight

loss

Energy intake resulting in 1 to

1.5 lb/week of weight loss in

older adults

What should we do about these changes?

Diet recommendations for weight loss

Percent of energy from Protein-- 15% to 30% Carbohydrates-- 40% to 60% Fat --25% to 30%

Protein May need more: 1.0 to 1.2 g/kg of body

weight per day

What should we do about these changes?

Diet recommendations for weight

loss

Vitamin D Institute of Medicine

15 μg/day for 51-70 years 20 μg/day for >71 years

What should we do about these changes?

Diet recommendations for weight

loss

Vitamin B-12 Institute of Medicine

2.4 μg/day in the crystalline form

What should we do about these changes?

Diet recommendations for weight

loss

Fiber Institute of Medicine

Women—21 g per day Men—30 g per day

Prevent constipation

What should we do about these changes?

Diet recommendations for weight loss

Fluid intake 30 ml/kg of body weight per day

Prevent constipation Thirst recognition decreases with

age Avoid fluids in the evenings

What should we do about these changes?

Diet recommendations for weight

loss

Fad diets

Summary

Many body composition changes as we age

Weight loss for older adults Examine the pros and the cons on an

individual basis Medical exam Medications Readiness to lose weight

Conclusion

The increase in overweight and obesity among older adults is a complex nutritional concern

If not addressed current declines in mortality as well as disability among future generations of older adults may be reserved