New research is providing insights into obesity and health in the elderly at a time when three medical societies have released new recommendations to guide health professionals caring for overweight or obese individuals. The information has implications for medical, nursing, nutrition and activities personnel in long-term care environments.
In one study published online this week by JAMA Internal Medicine, Eileen Rillamas-Sun, PhD, of the Fred Hutchinson Cancer Research Center in Seattle and colleagues studied more than 36,000 women (average age at baseline: 72 years) from the Women’s Health Initiative. They found that those who were underweight or obese were more likely to die before the age of 85, whereas overweight and obese women had higher risks of incident disease and mobility disability. A waist circumference greater than about 35 inches also was associated with a higher risk of early death, incident disease and mobility disability.
“Successful strategies aimed at maintaining healthy body weight, minimizing abdominal fat accretion, and guiding safe, intentional weight loss for those who are already obese should be further investigated and disseminated,” the authors wrote.
In another study also published online this week by JAMA Internal Medicine, Borge G. Nordestgaard, MD, DMSc, and Mette Thomsen, MD, from Herlev Hospital, Copenhagen University Hospital, Denmark, examined data from more than 71,000 participants in a general population study. They found that being overweight or obese are risk factors for heart attack and ischemic heart disease regardless of whether individuals also have the cluster of cardiovascular risk factors (hypertension, high cholesterol and high blood glucose) known as metabolic syndrome.
Metabolic syndrome, therefore, “is no more valuable than BMI (body mass index) in identifying individuals at risk,” they wrote.
In a related commentary, Chandra L. Jackson, PhD, MS, and Meir J. Stampfer, MD, DrPH, of the Harvard School of Public Health, Boston, wrote: “The findings of Thomsen and Nordestgaard add important new evidence to counter the common belief in the scientific and lay communities that the adverse health effects of overweight are generally inconsequential as long as the individual is metabolically healthy.” Because losing weight and keeping off pounds is difficult, they add, preventing weight gain in the first place is of utmost importance.
That last point is especially relevant given the findings of a third study, of 31 women, by Dartmouth researchers and published in Psychological Science. It suggests that self control is more difficult for chronic dieters, whose brains are affected by their eating behaviors. While the researchers investigate whether willpower can be strengthened over time, they suggest that chronic dieters avoid tempting situations.
Meanwhile, the journals of the American Heart Association, the American College of Cardiology and the Obesity Society simultaneously have released a new clinical practice guideline for the treatment of obese or overweight adults.
"Healthcare providers should do more than advise patients affected by obesity or overweight to lose weight,” says Donna Ryan, MD, co-chair of the writing committee and professor emeritus at Louisiana State University's Pennington Biomedical Research Center in Baton Rouge. “They should be actively involved and help their patients reach a health body weight."
The treatment recommendations, based on the latest scientific evidence from 133 research studies, address the risks of obesity, the benefits of weight loss, diets for weight loss, the efficacy and effectiveness of comprehensive lifestyle interventions on weight loss, and weight loss maintenance and the benefits and risks of bariatric surgery.
The report recommends: