L’obésité du sujet âgé

Abstract

Our population is ageing, and obesity is increasing in the elderly. BMI value associated with the lowest relative mortality is slightly higher in older than in younger (between 25 and 32kg/m2). Nevertheless, the combined effect of aging and obesity increases the risk of comorbidities, including type 2 diabetes mellitus, cardiovascular risk, respiratory insufficiency, obstructive sleep apneas, cancer, urinary incontinence and dementia. The medical consequences of obesity are alleviated by modest, achievable weight loss (5–10kg) with an evidence-based maintenance strategy. A combination of exercise and modest calorie restriction appears to be the optimal method of reducing fat mass and preserving muscle mass. The clinical outcomes have been evaluated in diabetes mellitus and in cardiovascular diseases, showing favorable effects on the morbidity and probably on the mortality. Very-low-energy diets have to be avoided for elderly patients. The risk of muscle loss increases with the level of diet restriction. In older people, the risks of laparoscopic bariatric surgery are not higher than in younger but the benefits have not been evaluated. The sarcopenic obesity (excess in body fat and loss of muscle mass and function) burdens the functional consequences of obesity in older people. Since sarcopenia is frequent in the elderly, a screening should be done in obese patients for whom a restrictive diet is not recommended. In renal or cardiac insufficiency, only physical activity can be recommended. In elderly people, weight management interventions using moderate calorie restriction and physical activity exercise are recommended. Daily protein intake must be maintained. Health benefits and risks from long-term weight management in obese elderly have to be studied in randomized controlled studies.