Obesity in Older Adults: A Disease, Not a Choice

Overweight. Obesity. Severe obesity. What do these terms mean, and how are people diagnosed with these conditions? What causes weight gain, and why it the situation worsening so quickly?

People’s body sizes have increased greatly over the past four decades. In 2017 and 2018, among Americans aged 60 years or older, 42.2 percent of men and 43.3 percent of women had obesity. A new publication from The Gerontological Society of America, “Obesity in Older Adults: Succeeding in a Complex Clinical Situation,” reviews the evaluation, consequences, and clinical management of obesity and overweight in older adults.

“Emerging concepts especially pertinent to older adults include new findings on hormonal influences of weight homeostasis, the effects of age at onset of obesity, nutrition and sarcopenia, and the impact of exercise, comorbid conditions, and functional status,” the report states.

Views on the nature of obesity have been evolving for a half century, and this progress culminated in recognition of obesity as a complex chronic disease with a pathophysiologic basis by the American Medical Association in 2013. This increasing recognition of obesity as a chronic disease that should be diagnosed and treated helps to avoid the stigma and confusion associated with this condition.

During the coronavirus pandemic, the detrimental effects of excess fat mass at older ages were clear, as these were the leading risk factors associated with virus-related hospitalization, intensive-care-unit admission, intubation or mechanical ventilation, and death. Yet the realities of life for older adults — other chronic diseases, mobility deficits, deficits in activities of daily living, conditions such as osteoarthritis that limit exercise options — make obesity and overweight more than just a stigmatized challenge in work and social settings.

The report states, “For many people with overweight and obesity, a three-pronged lifestyle therapy approach can be successful through use of dietary modification, physical activity, and behavioral modifications. When these do not achieve the necessary reductions in fat mass, medications can be added judiciously with careful attention to comorbid conditions. They produce larger decreases in body weight than are achieved with lifestyle changes alone, and their continued use helps keep weight off. Metabolic and bariatric surgery is the treatment that can produce the most weight loss, but also carries greater risk than either lifestyle treatments or medications. It is viewed as a viable option given the long lifespans people currently enjoy.

“As many conditions presenting when people reach older adulthood, decisions should be tempered by consideration of which interventions are most likely to be successful given the presence of other conditions.” The report indicates this is true for the therapeutic management of obesity, too.

Support for this publication was provided by Novo Nordisk.

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The Gerontological Society of America (GSA) is the nation's oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging. The principal mission of the Society — and its 5,500+ members — is to advance the study of aging and disseminate information among scientists, decision makers, and the general public. GSA’s structure also includes a policy institute, the National Academy on an Aging Society.