Academic journal article Generations

Weight Issues in Later Years

Academic journal article Generations

Weight Issues in Later Years

Article excerpt

Both research and practice have shown that undernourished and underweight older people as well as those who are obese are at risk for adverse outcomes that include functional decline, increased healthcare utilization, and increased risk of disease, disability, and death. This article focuses on the causes, trends, and potential interventions related to underweight and overweight among older people.

CHARACTERIZING BODY MASS

Body mass index (BMI) has become widely used in clinical practice to define degrees of under- and overweight according to criteria established by the National Institutes of Health (Table 1). BMI, a generally reasonable proxy for fat mass, is calculated as body weight in kg/height in m^sup 2^. BMI classifications have been useful for healthcare providers in order to plan appropriate intervention for clients.

OVERWEIGHT

Obesity, or significant overweight (BMI > 30 kg/m^sup 2^), is growing in prevalence among older people (see Table 2). The National Health and Nutrition Examination Survey (NHANES) HI showed increases for both men and women in all age groups. In 1999- 2000 the prevalence of overweight (BMI > 25) for those older than 60 years of age was an astonishing 74 percent for males and 68 percent for females (Flegal et al., 2002). Excess weight and obesity are associated with serious diseases and conditions that afflict older people, including high blood pressure, diabetes mellitus, metabolic syndrome, osteoarthritis, dyslipidemia (characterized by high fatty acids and low HDL, or good, cholesterol), coronary artery disease, and respiratory disease. Among older people, high BMI is also associated with increased self-reported functional limitations, decreased measured physical performance, and elevated risk of subsequent functional decline (Apovian et al., 2002; Jensen and Friedmann, 2002). An obese Medicare participant costs $1,486 more in healthcare expenditures per year than does a participant of healthy weight (Finkelstein et al., 2003).

Causes of obesity. Studies indicate that genetic predisposition is an important risk factor for obesity. Individuals with obese parents are more likely to have difficulties with obesity themselves, probably as a result of a combination of genetic and environmental factors. Evidence from studies of twins suggests that biological relatives show similar body-weight-maintenance characteristics resulting from interaction of genetic makeup with environment (National Institutes of Health, 1998; Centers for Disease Control and Prevention, 2004). Bouchard (1990) and colleagues found that pairs of twins exposed to periods of positive and negative energy balance (that is, calories consumed versus calories expended) experienced greater similarities within pairs for rate of weight gain, proportion of weight gain, and the site of excessive fat.

Factors such as environment, lifestyle, and behavior also have key roles in the growing prevalence of obesity. Weight gain frequently occurs during middle age. This timing may in part be related to the sedentary lifestyle that is common in middle-aged and older people. Regrettably, many older adults associate weight gain and sedentary lifestyle with the aging process and make little effort toward prevention. Excessive energy intake from food in combination with reduced energy expenditure from decreased physical activity is associated with positive energy balance that results in weight gain. NHANES III (1988-1991) revealed that adults consumed 100-300 calories more per day than did their counterparts in NHANES II (1976-1980) (McDowell et al., 1994). Women frequently experience additional gain in body fat during the time around the onset of menopause. Body fat peaks later in women (as late as 50 to 60 years of age) as compared to men (Morley, 1997). Older women are more likely to live alone than are older men. Homebound status and living alone have been associated with higher BMI, inadequate intakes of desirable nutrients, and unhealthy dietary patterns (Ledikwe et al. …

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