Obesity Management in the Older Adult

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Introduction: background information on health issue: effects on population and relevant statics

Obesity is an expanding problem that threatens one’s health, mobility and independence. The rate of obesity has doubled around the globe since 1980. There are several genetic, hormonal, psychological, and environmental factors in which cause obesity to occur. In the United States, roughly 40% of people suffer from obesity and it is now considered a “pandemic”. There are also disparities among all racial and ethnic groups. In Korea and Japan, the extensiveness of obesity is about 10%, but over the last decade the rates of obesity have increased. Because of this, the amount of prostate cancer cases is also rising and in Japan it is now the highest (Vuittonet, C. L., Sbharwal, A., & Pitchumoni, C. S.,2020). By the year 2050, it is predicted that the number of older adults will rise by over double, increasing the utilization of health care and costs. Given the enormity of this issue, efforts are needed to expand the reach of weight management interventions. There also needs to be encouragement for healthy physical function among diverse older adults who are obese and have a wide range of comorbidities.

Signs & Symptoms as it relates to your health issue

The medical costs due to excess body fat are rising and have become an important issue globally. Obesity causes systemic inflammation and has been shown to worsen one’s quality of life and life expectancy. “Obesity has a negative impact on muscle strength and physical function directly through biomechanical pathways and indirectly through multiple chronic conditions of aging such as arthritis, hypertension, diabetes, metabolic syndrome, and lipid disorders,” (Villareal, Apovian, Kushner, & Klein, 2005). Specifically, obesity exacerbates an age-related loss in muscle mass and physical function known as sarcopenia. Healthcare professionals should perform regular screenings. For instance, a BMI of 30 or above is considered Obesity. Signs and symptoms will be different from person to person. Typically, professionals will see a pronounced abdomen, non- pitting edema, fatigue, joint pain, shortness of breath when lying or upon exertion, and sleep disturbances to name a few (Valk, et al., 2019).

Diagnosis of health problem

Obesity can be diagnosed based on one’s medical history, physical exams, and tests to rule out other medical conditions. They can examine one’s waist circumference, BMI, total cholesterol, triglycerides, hormones, and blood glucose. Also, an evaluation of lifestyle factors should be included. This involves a detailed medical history, medication use, and sociocultural environment data are useful as well. If suspicions of an underlying disease are noted, specific testing for these causes are recommended. Furthermore, modifiable factors should be treated before starting an intervention or bariatric surgery. In addition, knowing the etiology can help to reduce the stigma that many obese individuals face.

Types of interventions used to treat health problem

An effective strategy to treat obesity is imperative due to the public health implications. Primary treatment is centered around lifestyle changes including caloric restriction and an exercise regimen paired with resistance training. Caloric restriction in the absence of exercise training attenuate the loss of lean mass and bone mineral density, therefore this should be avoided. A calcium and vitamin D supplementation as well as a sufficient protein intake should be considered while restricting calories (DTJ, 2019).

In addition to diet and exercise changes, there are therapies available today, like testosterone therapy and bariatric surgery. Testosterone replacement may be therapeutic by reversing the negative trends in body composition in older adult men. Testosterone has shown to maintain lean body mass during weight loss in obese middle-aged men undergoing calorie restriction. Testosterone makes small improvements in walking distance, increasing bone density, and strength. Unfortunately, a 56-week trial found that over a year after stopping the use of testosterone the positive changes in body composition were no longer detectable. More research is needed in order to see the long-term benefits and side effects of this type of therapy.

Hundreds of thousands of bariatric surgery procedures were performed globally in 2014. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are effective in older adults at reducing weight and the comorbidities associated with obesity (DTJ, 2019). Gastric bypass surgery seems to be more effective, however, older individuals undergoing gastric bypass have an increased risk for complications. Additional concerns are centered around the loss of lean body mass and bone mineral density associated with the large amount of weight lost following the surgery, which would be detrimental in older adults.

Treatment Modality

A nonrandomized study estimated the sensibility and effectiveness of a 13-month weight management intervention among adults, aged 60–75 years. “The approach used in the MOVE UP study had three components: (a) recruit a broad spectrum of program delivery sites in and around Allegheny County to maximize generalizability; (b) recruit a like number of community health workers to help engage participants and to serve as site interventionists; and © recruit and enroll eligible participants within each community delivery site to the largest extent possible,” (E., J., J., N., & O., 2018). The participants were encouraged to reach a 7% weight reduction from their baseline and 175 min of physical activity every week. The study emphasized physical activities that correlated to 50–70% of the participants maximal heart rate. Participants were instructed to engage in moderate-intensity exercise 5 days per week, starting at 10 min per day and progressing to 35 min per day (E., J., J., N., & O., 2018). Resistance training began in the second phase. Phase 3 and 4 were focused on strategies for weight loss maintenance, healthy eating, and physical activities. Results were found in the short term, but it is unknown how the participants will fare down the road. There needs to be more longitudinal research to prove the effectiveness of this kind of study. By documenting the pertinent health and psychosocial outcomes, the MOVE UP approach will be able to demonstrate how it is beneficial in the long run.

In several randomized controlled trials (RCTs), a restriction in calories by 500–1000 per day, with or without an exercise regimen, has shown to be effective for weight loss. However, when body mass is assessed via a dual-energy x-ray absorptiometry (DXA), it has also consistently decreased lean body mass and bone mineral density. “Exercise incorporating aspects of both aerobic endurance training (AT) and progressive resistance training (RT) does not result in significant weight loss in the absence of CR, but it does exert positive effects on body composition, improve physical function, increase strength, and positively affect quality of life in aging adults with obesity,” (DT; J. 2019).

Potential Barriers and Suggested strategies. Refer to guidelines

Notable gaps remain in signifying the effectiveness of weight loss approaches for older adults within a diverse community setting. The weight loss and activity interventions being studied are not being replicated in most public health settings. Next, there are concerns that a caloric deficit approach may be harmful in the older adult population. This is due to it the potential loss of muscle and bone mass, which can further exacerbate sarcopenia and increase fracture risk (DT; J. 2019). “The overall safety of weight loss interventions for patients aged 65 and older remains controversial’ and ‘…there is a need for further research to understand the most appropriate strategies and prescriptions for weight loss for some key populations including older adults,” (DT; J. 2019).

Healthcare professionals can also judge one’s nutrition risk in the community setting which can be very compounded. First, there are many nutrition screenings tools that one can utilize. One reason for this is that selecting the most appropriate screening tool is not straightforward. They have different risk profiles for target populations and differing reliability. Next, it is difficult to find professionals who will administer a nutrition screening tool. Lastly, if the screening tool has identified problems that require an immediate intervention, it may be a challenge to access to resources in the community setting. Regardless, nutrition screenings are considered a simple, yet vital step in determining if there are risk factors which require a more in depth nutritional and physical examination.

Prevention Measures

To reverse widespread obesity, efforts should focus on healthy eating and an active lifestyle in a variety of settings. First, healthcare providers should recommend their patients who are at risk see a Registered Dietician. Thus, a plan can be made for one’s individual needs in a safe manner. Along with this, recommending resistance training alongside endurance training is necessary. Next, they should weigh themselves at most once a week at the same time to keep track of their progression. Lastly, recommending that one sees a therapist regularly would be a great intervention as well. Our mental health plays a huge role in being consistent, managing stress and sleep, and maintaining one’s progress.

Summary

In conclusion, weight loss for the obese older adult population has to be in balance. At this time, there is not enough research to state what will work the best in the long run. For now, calorie restriction with physical activity and supplementation is the best approach that researchers have found. By working with interdisciplinary teams, one can find a sustainable and safe method for body fat reduction that works for their individual needs. With more research, we can hopefully cure this “body-fat pandemic”.

Citations

DT; J. (2019, January 22). Therapeutic and lifestyle approaches to obesity in older persons. Retrieved September 13, 2020, from https://pubmed.ncbi.nlm.nih.gov/30346314/

E., J., J., N., & O. (2018, June 18). Mobility and Vitality Lifestyle Program (MOVE UP): A Community Health Worker Intervention for Older Adults With Obesity to Improve Weight, Health, and Physical Function. Retrieved September 12, 2020, from https://www.caph.pitt.edu/wp-content/uploads/2018/08/Venditti-EM-et-al.-MOVEUP-CHW-Interven-Obese-Older-Adults_Innov-in-Aging-2018.pdf

Van der Valk, E.S., van den Akker, E.L.T., Savas, M., Kleinendorst. L., (2019). A comprehensive diagnostic approach to detect underlying … (2019, January 4). Retrieved September 13, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850662/

Villareal DT, Apovian CM, Kushner RF, Klein S. Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, the Obesity Society. Obes Res. 2005. https://doi.org/ 10.1038/oby.2005.228.

Vuittonet, C. L., Sbharwal, A., & Pitchumoni, C. S. (2020). Obesity in Older Adults: Pathophysiology and Clinical Implications. Geriatric Gastroenterology, 1–19. doi:10.1007/978–3–319–90761–1_98–1