New research, guidelines affect care of overweight and obese seniors

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:

  • That healthcare providers calculate BMI annually—or more frequently—and use it to identify adults who may be at a higher risk of heart disease and stroke because of their weight.
  • That healthcare providers develop individualized weight loss plans that include a moderately reduced calorie diet, a program of increased physical activity and the use of behavioral strategies to help patients achieve and maintain a healthy body weight.
  • That weight loss counseling focus on people who need to lose weight because of obesity or overweight with conditions (diabetes, hypertension, high blood cholesterol, a waist circumference of more than 35 inches for women and more than 40 inches for men) that put them at higher risk for cardiovascular diseases
  • Tailoring dietary patterns to a person's food preferences and health risks. For example, a person with high blood cholesterol would benefit most from a low-calorie, lower-saturated fat diet including foods that he or she finds appealing.
  • Focusing on achieving sustained weight loss of 5 percent to 10 percent within the first six months. Such a loss can reduce hypertension, improve cholesterol and lessen the need for medications to control blood pressure and diabetes. Even as little as 3 percent sustained weight loss can reduce the risk for the development of type 2 diabetes as well as result in clinically meaningful reductions in triglycerides, blood glucose and other risk factors for cardiovascular disease.
  • Advising adults with a BMI of 40 or higher and those with a BMI of 35 or higher who have two other cardiovascular risk factors, such as diabetes or hypertension, that bariatric surgery may provide significant health benefits. The guideline does not recommend weight loss surgery for people with a BMI under 35 and does not recommend one surgical procedure over another.

The authors note that Medicare began covering behavioral counseling for patients affected by obesity in 2012, based on available evidence at that time. Under the Affordable Care Act, they add, most private insurance companies are expected to cover behavioral counseling and other treatments for obesity by 2014.

The National Heart, Lung, and Blood Institute of the National Institutes of Health convened the panel that wrote the report.

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