Excerpt

Obesity, a disorder of body composition defined by a relative or absolute excess of body fat, is extremely common among older US adults. In 1999–2000, 33% men and 39% of women aged 65–74 were obese, as were 20% and 25%, respectively, above the age of 74. With steadily increasing prevalence in youth and younger adults, and links with adverse health outcomes, obesity has received increasing clinical and public health attention.

Diagnostic tests for obesity detect either generalized or central fat distribution. Body mass index (BMI = kg. of weight divided by the square of height in meters) is the standard clinical measure of generalized obesity. Skin fold thickness also correlates closely with overall body fat percentage. Waist circumference (WC) and waist-to-hip ratio (WHR) aim to detect central fat accumulation, as it carries increased cardiovascular risk. Accuracy and clinical relevance of these tools varies with gender and ethnicity, and possibly age.

In the general adult population, most treatment options (diet, exercise and behavioral, or pharmacologic) can lead to modest, sustainable improvements in weight, sufficient for improving intermediate health measures such as glycemic control, lipids, and blood pressure. Surgical intervention among the very obese can produce substantial weight loss and may markedly improve a number of health outcomes. However, high-quality surgical data are lacking, and while surgical adverse events are rare, they can be serious. As there are age-related differences in fat distribution, physiology, and underlying health status, the generalizability of these findings to older populations is unclear.

Contents

• Executive Summary
• I. Background
• II. Methods
• III. Results
  • III.A Are there limitations in diagnosing obesity in the elderly with BMI? Should another measurement be used with BMI or in place of BMI for diagnosing obesity in the elderly?
  • III.B Can weight loss be used as a surrogate for improved net health outcomes? If so, how much weight loss and over what time period of time?
  • III.C Which elderly patients with obesity would experience an improved health outcome with weight loss treatment?
  • III.D Are there dietary or behavioral therapies that improve net health outcomes in obese elderly?
  • III.E Are there surgical therapies that improve net health outcomes in obese elderly?
• IV. Discussion
  • IV.A General Conclusions
  • IV.B Future Research Topics
• References
• Appendix 1 Key Questions and Article Eligibility Criteria
• Appendix 2 Summary of Evidence Strength Criteria
• Appendix 3 Search Strategies