1. Aging and Obesity Claire Zizza Tenth Annual Diabetes and Obesity Conference April 19, 2011

2. Agenda How many people? How many people? Older adults Older adults Obese older adults Obese older adults What happens to our bodies as we age? What happens to our bodies as we age? What are the consequences of these changes? What are the consequences of these changes? What should we do about these changes? What should we do about these changes? Dietary recommendations Dietary recommendations

3. Comments today are from

4. How many older adults?

5. How many obese older adults? Body Mass Index (BMI) Body Mass Index (BMI) An excess of total body fat An excess of total body fat Current clinical guidelines Current clinical guidelines Overweight: 25 – 29.9 kg/m 2 Overweight: 25 – 29.9 kg/m 2 Obesity: ≥ 30 kg/m 2 Obesity: ≥ 30 kg/m 2

6. How many older adults are obese?

7. What happens to our bodies as we age? Increase in total fat mass (percent body fat) Increase in total fat mass (percent body fat)

8. What happens to our bodies as we age? Sarcopenia Sarcopenia Loss of skeletal muscle mass with aging Loss of skeletal muscle mass with aging Increases with age Increases with age Community dwelling adults: New Mexico Elder Health Survey and the New Mexico Aging Process Study Community dwelling adults: New Mexico Elder Health Survey and the New Mexico Aging Process Study 15% in adults < 70 y 15% in adults < 70 y 40% in adults > 80 y 40% in adults > 80 y

9. What happens to our bodies as we age? Sarcopenia Obesity Sarcopenia Obesity Combination of excess body fat and a decrease in skeletal muscle mass Combination of excess body fat and a decrease in skeletal muscle mass Increases with age Increases with age Community-dwelling older adults Community-dwelling older adults 2% for adults < 70 y 2% for adults < 70 y 10% in adults > 80 y 10% in adults > 80 y

10. What happens to our bodies as we age? Sarcopenia and obesity may act synergistically Sarcopenia and obesity may act synergistically Decreased strength Decreased strength Decreased fitness Decreased fitness Loss of functional capacity Loss of functional capacity

11. What happens to our bodies as we age? Fat mass redistributed in the abdominal area Fat mass redistributed in the abdominal area

12. What happens to our bodies as we age? Abdominal Obesity Abdominal Obesity A waist circumference of 102 cm or higher in men and 88 cm or higher in women A waist circumference of 102 cm or higher in men and 88 cm or higher in women Particularly for adults with a BMI between 25 and 34.9 Particularly for adults with a BMI between 25 and 34.9

13. What happens to our bodies as we age? Limitations of BMI in older adults Limitations of BMI in older adults Age related changes in body composition Age related changes in body composition Losses in height Losses in height

14. What are the consequences of these changes? Chronic health condition Chronic health condition Arthritis, hypertension, heart disease and stroke, cancer, and diabetes Arthritis, hypertension, heart disease and stroke, cancer, and diabetes

15. What are the consequences of these changes? Physical and cognitive disability Physical and cognitive disability Nursing home admissions and homebound status Nursing home admissions and homebound status

16. What should we do about these changes? Intentional weight loss has not been widely advocated for this age group by health care providers due to the uncertainty of whether the benefits outweigh the risks Intentional weight loss has not been widely advocated for this age group by health care providers due to the uncertainty of whether the benefits outweigh the risks

17. What should we do about these changes? Documented adverse effects of weight loss on muscle and bone Documented adverse effects of weight loss on muscle and bone Lack of evidence for documented benefits of intentional weight loss Lack of evidence for documented benefits of intentional weight loss

18. What should we do about these changes? National Heart, Lung and Blood Institute National Heart, Lung and Blood Institute “Age alone should not preclude treatment for obesity in adult men and women” “Age alone should not preclude treatment for obesity in adult men and women”

19. What should we do about these changes? American Society for Nutrition and the Obesity Society American Society for Nutrition and the Obesity Society Weight loss in older adults with obesity should be considered on an individual basis Weight loss in older adults with obesity should be considered on an individual basis Evaluate the benefits from alleviating and managing co-morbid conditions and functional impairments Evaluate the benefits from alleviating and managing co-morbid conditions and functional impairments Consider the adverse effects on muscle mass, bone density, or other aspects of nutritional status. Consider the adverse effects on muscle mass, bone density, or other aspects of nutritional status.

20. What should we do about these changes? Lifestyle intervention Lifestyle intervention Low-energy diet Low-energy diet Physical activity Physical activity

21. What should we do about these changes? Diet recommendations for weight loss Diet recommendations for weight loss Energy intake resulting in 1 to 1.5 lb/week of weight loss in older adults Energy intake resulting in 1 to 1.5 lb/week of weight loss in older adults

22. What should we do about these changes? Diet recommendations for weight loss Diet recommendations for weight loss Percent of energy from Percent of energy from Protein-- 15% to 30% Protein-- 15% to 30% Carbohydrates-- 40% to 60% Carbohydrates-- 40% to 60% Fat --25% to 30% Fat --25% to 30% Protein Protein May need more: 1.0 to 1.2 g/kg of body weight per day May need more: 1.0 to 1.2 g/kg of body weight per day

23. What should we do about these changes? Diet recommendations for weight loss Diet recommendations for weight loss Vitamin D Vitamin D Institute of Medicine Institute of Medicine 15 μg/day for 51-70 years 15 μg/day for 51-70 years 20 μg/day for >71 years 20 μg/day for >71 years

24. What should we do about these changes? Diet recommendations for weight loss Diet recommendations for weight loss Vitamin B-12 Vitamin B-12 Institute of Medicine Institute of Medicine 2.4 μ g/day in the crystalline form 2.4 μ g/day in the crystalline form

25. What should we do about these changes? Diet recommendations for weight loss Diet recommendations for weight loss Fiber Fiber Institute of Medicine Institute of Medicine Women—21 g per day Women—21 g per day Men—30 g per day Men—30 g per day Prevent constipation Prevent constipation

26. What should we do about these changes? Diet recommendations for weight loss Diet recommendations for weight loss Fluid intake Fluid intake 30 ml/kg of body weight per day 30 ml/kg of body weight per day Prevent constipation Prevent constipation Thirst recognition decreases with age Thirst recognition decreases with age Avoid fluids in the evenings Avoid fluids in the evenings

27. What should we do about these changes? Diet recommendations for weight loss Diet recommendations for weight loss Fad diets Fad diets

28. Summary Many body composition changes as we age Many body composition changes as we age Weight loss for older adults Weight loss for older adults Examine the pros and the cons on an individual basis Examine the pros and the cons on an individual basis Medical exam Medical exam Medications Medications Readiness to lose weight Readiness to lose weight

29. Conclusion The increase in overweight and obesity among older adults is a complex nutritional concern The increase in overweight and obesity among older adults is a complex nutritional concern If not addressed current declines in mortality as well as disability among future generations of older adults may be reserved If not addressed current declines in mortality as well as disability among future generations of older adults may be reserved