With obesity there is an increase in relative risk of type 2 diabetes, hypertension, and cardiovascular diseases. These can induce a vicious circle of a downward spiral of morbidity and mortality. Obesity is also associated with disability and health costs. In the US alone, it is $192.2 billion. This would be a formidable worldwide cost if interpolated globally. Obesity is also associated with sleep disturbance, respiratory difficulties, joint and mobility disorders, as well as social stigma. Treatments are varied and multifaceted and one shoe does not fit all. The different treatments are a low caloric diet (600 calories/day—this is quite debatable in the elderly); motivational and behavior approaches to sustain changes in eating and activity, these too need a lot of dedicated workforce; and drug treatment should be regarded as a therapeutic trial. Drugs should be stopped if there is no weight loss in two months' time. All drugs have side effects.
TopIntroduction
Obesity is a global health issue (Centers for Disease Control and Prevention, 2010) and one of the most neglected too. It is mostly dealt with adequately in children who may be suffering from various genetic obesity syndromes. In the rapidly modernized and mostly urbanized world with varying unhealthy eating habits, sedentary lifestyle and lack of exercise and motivation to keep oneself healthy, it has evolved as a major health hazard (Bray et al., 2017; World Obesity Federation, 2021). There is relatively less research on obesity in the elderly, but it is more complicated in the geriatric population due to the comorbid conditions they frequently present with.
Statistics related to obesity are alarming. Globally, 13% of adults aged 18 years and older were obese in 2016. Obesity represents approximately 20% of the US population and 22% worldwide. The World Health Organization (WHO) estimates that approximately 40% of adults are overweight (BMI 25–29.9) and 30% of adults are obese (BMI over 30) (WHO, 2000) (Centers for Disease Control and Prevention, 2010; Bray et al., 2017; World Obesity Federation, 2021; World Obesity Federation, n.d.; Rimm, 2014). According to CDC by 2035 over one third of those over the age of 60 will be considered obese.
Interestingly but truly, they blame it on longevity, indiscriminate use of refined foods related to obesity, urbanization, lack of rural structure and many other factors that have become almost synonymous with the future life trends mankind is pursuing. This is not only a problem of the effluent societies, but this is fast growing into other less developed societies and countries. We are at the crossroads of famine and plenty. Obesity is considered like a saving account and it stays there till one gets old. To get rid of it, one has to spend it. Merely decreasing the amount putting into a saving account would still keep the bank fat and it would not do the job.
According to WHO: Basal Metabolic Index or BMI with certain caveats is considered the benchmark for obesity. A BMI of >30 is a marker of obesity. This concept has been challenged as it does not consider the central obesity (also called visceral or abdominal obesity). Currently, 7% of the world’s population is over 65 years of age. This figure is projected to rise to 12% by 2030. Some 35% of world population is overweight or obese and so this is exponentially increasing with the baby boom. Simple statistics dictate that it is equally common across all age groups and elderly population is no exception.
Chronic conditions, such as arthritis, diabetes, hypertension, and heart disease, are among some of the most common, debilitating chronic conditions in older adults (Rubino et al., 2020; Brewis et al., 2018). These conditions are frequently accentuated by obesity and vice versa too (unfortunately).
Obesity is accumulation of excessive fat that presents an overall health risk (WHO). Fat accumulation however does not stay the only morbidity as it has close association with cardiovascular, metabolic, musculoskeletal, respiratory, and psychiatric conditions. Obesity begets obesity and once obese, always obese is a dreadful saying. Metabolic Obesity which leads to metabolic syndrome is characterized by abdominal or visceral obesity. This is measured by waist circumference. This is defined as a waist circumference of 40 inches in men and 35 inches in women. This measure has a strong association with metabolic syndrome and diabetes mellitus. It increases mortality and morbidity several folds.
An important determinant of body-fat mass is the relationship between energy intake and expenditure. Obesity occurs when a person consumes more calories than she/he burns. We need calories to sustain life and have the energy to be active and agile, yet to maintain a desirable weight. We need to balance the amount of energy we ingest in the form of food with the energy we use up during our activities of daily living and instrumental activities of daily living. The more sedentary and mechanized life would become, more would be its impact of the weight gain.