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The obesity challenge

February 1, 2007
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In the elderly, weight gain isn't always a good thing

Our next great challenge may be one that we have not worried about in many years: weight gain and obesity. General population trends of aging, obesity, and its complications improve the likelihood that more obese residents will enter long-term care facilities for both short-term rehabilitation and long-term stays. Decreased activity levels, the abundance of great-tasting food choices, larger portion sizes, and increased consumption of calorie-dense foods all contribute to create the potential for weight gain. In the older adult population, chronic illness, psychosocial factors, and certain medications such as steroids and antidepressants may also contribute.

Obesity and Disease Risk in Older Adults

From 1991 to 2000, the obesity rates of older Americans rose dramatically. Approximately 14.7% of older adults aged 60–69 and 11.4% of those over 70 years of age were considered obese in 1991. Those rates increased to 22.9% and 15.5% in 2000, an increase of 56% and 36%, respectively (1).1

Table. Obesity Rates, 1991 and 2000


Percentage of obesity in 1991

Percentage of obesity in 2000

Rate of increase from 1991 to 2000









Along with higher rates of obesity, older Americans are experiencing higher rates of obesity-related diseases. Obesity is a risk factor for four of the ten leading causes of death in the United States: coronary heart disease, type 2 diabetes, stroke, and several types of cancer. In addition, obese older adults report more limits to activity levels and more feelings of sadness and hopelessness than their more normal weight counterparts.2

Adults who are overweight are at increased risk of developing debilitating diseases, and as obesity levels increase so does the incidence of disease. Risk increases even further when overweight and obesity are combined with a high waist circumference.3

Estimates indicate that 70% of diabetes risk in the United States can be attributed to excess weight. There is a 41.9% higher prevalence of hypertension in obese men and a 37.8% higher prevalence in obese women. High blood cholesterol levels are 22% more likely in obese men and 27% more likely in obese women than their normal weight counterparts.4

Because of the relationship between obesity and the development of diseases and complications, costs associated with obesity are on the rise. A recent study revealed that 70-year-old obese adults would live about the same length of time as their normal weight counterparts. However, the obese adults would enjoy fewer disability free years of life and have higher rates of high blood pressure, heart disease, and diabetes. They would also cost the Medicare system about 34% more than their healthier, normal weight counterparts.1

Preventing Weight Gain

Regulatory requirements for menu guidelines challenge facilities to provide nutritious, well-balanced meals that are not overabundant in calories. It takes skill to develop a menu that provides all the required food items; balances color, flavor, and texture; and still keeps calories in line.

Sedentary lifestyles result in the need for fewer calories and thus contribute to weight gain. In addition, when residents are first admitted to a facility, the temptation to overeat may be overwhelming. This is especially true if they have come from a setting where access to food was a problem and are now in a setting that offers high-quality food with a multitude of choices.

As many of us have experienced firsthand, it's easier to gain weight than to lose it. Careful nutrition screening and weight monitoring can alert facility staff and attending physicians to potential problems with weight gain. Early identification allows the opportunity to provide nutrition counseling, encourage increased activity, and/or offer a special diet for weight control.

Advantages of Weight Loss

For residents who are struggling with obesity, weight loss may help reduce the risk of chronic disease, and for those who already have the disease, weight loss may help to control those diseases that tend to be worsened by obesity.

The National Heart, Lung, and Blood Institute summarizes the advantages of weight loss well in its review of the evidence-based research and recommendations3:

  • Blood Pressure: “Weight loss is recommended to lower elevated blood pressure in overweight and obese persons with high blood pressure.”

  • Serum/Plasma Lipids: “Weight loss is recommended to lower elevated levels of total cholesterol, LDL-cholesterol, and triglycerides, and to raise low levels of HDL-cholesterol in overweight and obese persons with dyslipidemia.”

  • Blood Glucose: “Weight loss is recommended to lower elevated blood glucose levels in overweight and obese persons with type 2 diabetes.”

All of the above are evidence category A, meaning evidence is from randomized controlled trials “that provide a consistent pattern of findings in the population for which the recommendation is made.”3