aging and obesity claire zizza tenth annual diabetes and obesity conference april 19, 2011
TRANSCRIPT
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Aging and Obesity
Claire ZizzaTenth Annual Diabetes and
Obesity ConferenceApril 19, 2011
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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
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Comments today are from
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How many older adults?
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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
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How many older adults are obese?
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What happens to our bodies as we age?
Increase in total fat mass (percent body fat)
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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
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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
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What happens to our bodies as we age?
Sarcopenia and obesity may act synergistically
Decreased strength
Decreased fitness
Loss of functional capacity
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What happens to our bodies as we age?
Fat mass redistributed in the abdominal area
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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
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What happens to our bodies as we age?
Limitations of BMI in older adults Age related changes in body
composition Losses in height
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What are the consequences of these
changes? Chronic health condition
Arthritis, hypertension, heart disease and stroke, cancer, and diabetes
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What are the consequences of these
changes? Physical and cognitive disability Nursing home admissions and
homebound status
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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
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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
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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”
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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.
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What should we do about these changes?
Lifestyle intervention
Low-energy diet
Physical activity
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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
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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
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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
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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
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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
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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
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What should we do about these changes?
Diet recommendations for weight
loss
Fad diets
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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
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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
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