Review

International Journal of Obesity (2005) 29, 1011–1029. doi:10.1038/sj.ijo.0803005; published online 31 May 2005

Health consequences of obesity in the elderly: a review of four unresolved questions

M Zamboni1, G Mazzali1, E Zoico1, T B Harris2, J B Meigs3, V Di Francesco1, F Fantin1, L Bissoli1 and O Bosello1

  1. 1Division of Geriatric Medicine, University of Verona, Verona, Italy
  2. 2Office of Geriatric Epidemiology, Epidemiology, Demography and Biometry Program, National Institute of Health, National Institute of Aging, Bethesda, MD, USA
  3. 3General Medicine Division, Department of Medicine, Massachusetts General, Hospital and Harvard Medical School, Boston, MA, USA

Correspondence: M Zamboni, Cattedra di Geriatria, University of Verona, Ospedale Maggiore- Piazzale Stefani 1, 37126 VERONA (Italy). E-mail: mauro.zamboni@univr.it

Received 6 June 2004; Revised 12 April 2005; Accepted 18 April 2005; Published online 31 May 2005.

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Abstract

Obesity prevalence is growing progressively even among older age groups. Controversy exists about the potential harms of obesity in the elderly. Debate persists about the relation between obesity in old age and total or disease-specific mortality, the definition of obesity in the elderly, its clinical relevance, and about the need for its treatment. Knowledge of age-related body composition and fat distribution changes will help us to better understand the relationships between obesity, morbidity and mortality in the elderly. Review of the literature supports that central fat and relative loss of fat-free mass may become relatively more important than BMI in determining the health risk associated with obesity in older ages. Weight gain or fat redistribution in older age may still confer adverse health risks (for earlier mortality, comorbidities conferring independent adverse health risks, or for functional decline). Evaluation of comorbidity and weight history should be performed in the elderly in order to generate a comprehensive assessment of the potential adverse health effects of overweight or obesity. The risks of obesity in the elderly have been underestimated by a number of confounders such as survival effect, competing mortalities, relatively shortened life expectancy in older persons, smoking, weight change and unintentional weight loss. Identification of elderly subjects with sarcopenic obesity is probably clinically relevant, but the definition of sarcopenic obesity, the benefits of its clinical identification, as well as its relation to clinical consequences require further study. Studies on the effect of voluntary weight loss in the elderly are scarce, but they suggest that even small amounts of weight loss (between 5–10% of initial body weight) may be beneficial. In older as well as in younger adults, voluntary weight loss may help to prevent the adverse health consequences of obesity.

Keywords:

aging, BMI, fat distribution, disability, sarcopenic obesity

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