Obesity is growing among older persons and is associated with a tremendous burden of chronic disease and disability. Ill health, dependence, and poor quality-of-life often result. The obesity failure-to-thrive syndrome has been previously described by this author as functional compromise and decline in the setting of weight excess . The cost is staggering with a Medicare participant who has obesity costing $1,486 more in health care expenditures per year than a patient of healthy weight . Data from the Health and Retirement Study suggest that if obesity trends continue, disability will continue to grow in the 50- to 69-year age group . Strong associations exist with reported functional limitation, especially for reporting ADL in women; the probability doubles with moderate obesity and quadruples with severe obesity. Persons who are severely obese are more likely to be in fair or poor health and have more chronic health conditions. Men who are severely obese have 68% more and women 60% more health care costs compared with those of desirable weight. The impending public health crisis dictates priority for strategies for prevention and treatment. An understanding of how obesity impacts function is prerequisite to development and testing of potential interventions. On the basis of this review the following observations can be suggested: • Obesity generally precedes functional decline. • Obesity is associated with increased risk for destructive joint disease, particularly of the knees, which adversely impacts mobility functions. • Obesity is associated with a host of chronic diseases, such as diabetes mellitus, hypertension, metabolic syndrome, and heart disease, all of which may contribute to poor functioning. • Obesity is a proxy measure for a sedentary lifestyle and reduced mobility, which may in turn promote functional decline. • Increased fat mass and a relative decrement in muscle mass (sarcopenic obesity) may contribute to functional impairment. • The pro-inflammatory state associated with adiposity and related comorbidities may also contribute to erosion of muscle mass and functional decline. Because nonvolitional weight loss often portends adverse outcomes for older persons and is associated with underlying disease or inflammatory condition, recommendations for volitional weight reduction interventions for obese older persons have been subject to considerable controversy. As per the National Institutes of Health guidelines, weight-loss management in older people should be guided by an evaluation of potential risks and benefits for each individual patient . Limited investigation has been done of weight-reduction intervention among obese older persons with functional outcome measures. Studies suggest that benefits in function may be achieved for selected candidates with a combination of prudent diet, behavior modification, and increased levels of physical activity or exercise. For obese older persons with severe frailty, the emphasis may be better placed not on weight reduction, but on preservation of strength and flexibility. Obesity should, however, be considered in screening of older populations and in the planning, implementation, and evaluation of services for homebound older persons.
All Science Journal Classification (ASJC) codes
- Geriatrics and Gerontology