Obesity in the Elderly
•
5 likes•2,059 views
Presentation at the Southern Philippines Medical Center Postgraduate Course, 1 Sept 2017, Davao City.
Report
Share
Related slideshows
More Related Content
What's hot
What's hot (20)
Similar to Obesity in the Elderly
Similar to Obesity in the Elderly (20)
More from Iris Thiele Isip-Tan
More from Iris Thiele Isip-Tan (20)
Recently uploaded
Recently uploaded (20)
Obesity in the Elderly
- 1. OBESITY IN THE ELDERLY IRIS THIELE ISIP TAN MD, MSC Professor, UP College of Medicine Chief, UP Medical Informatics Unit Director, UP Manila Interactive Learning Center
- 3. SARCOPENIC OBESITY age-related progressive loss of skeletal muscle & quality (or strength) with gain in adipose tissue
- 4. Kyung Mook Choi. Korean J Intern Med 2016;31:1054-1060.
- 5. Overweight & obesity and a static BMI commonly conceal sarcopenia in the elderly.
- 6. Loss of fat-free mass (muscle) with increase in intra- abdominal fat Height is reduced by spinal shortening (degenerative bone disease or kyphoscoliosis) Difficulty in getting height and weight because of frailty USE OF BMI IN ELDERLY Han et al British Medical Bulletin 2011;97:169-196
- 10. Obesity is a consequence of mismatched energy intake & expenditure Basal metabolic rate is reduced in elderly: loss of lean tissue & aging per se T.S. Han et al. Best Practice & Research Clinical Endocrinology & Metabolism 27 (2013) 509–525
- 12. Type 2 Diabetes in European Male Ageing Study Han et al British Medical Bulletin 2011;97:169-196
- 13. Han et al British Medical Bulletin 2011;97:169-196 Prevalence of Type 2 Diabetes in Obese Men
- 14. RESPIRATORY DYSFUNCTION Dyspnea: increased metabolic rate & elevated metabolic demand from minimal exertion Obesity hypoventilation syndrome and obstructive sleep apnea: excessive deposition of adipose tissue on neck, thorax & abdomen T.S. Han et al. Best Practice & Research Clinical Endocrinology & Metabolism 27 (2013) 509–525
- 15. ARTHRITIS Excessive weight —> osteoarthritis of weight- bearing joints Severe arthritis limits ability to perform exercise —> risk of weight gain from reduced energy expenditure T.S. Han et al. Best Practice & Research Clinical Endocrinology & Metabolism 27 (2013) 509–525
- 16. CANCERS Obese elderly men at increased risk: colon, gallbladder, pancreas, kidney & bladder Elevated insulin & IGF-1 in obese may promote tumor growth Increased leptin (promote cell proliferation) & reduced adiponectin (diminish anti-proliferative effects) T.S. Han et al. Best Practice & Research Clinical Endocrinology & Metabolism 27 (2013) 509–525
- 17. OBESITY PARADOX Obese elderly have lower mortality vs lean BUT based on BMI Excess mortality in lean individuals only in those who had lost weight; not observed among those who have always been lean Han et al British Medical Bulletin 2011;97:169-196
- 19. Mathus-Vliegen EMH. J Clin Gastroenterol 2012; 46(7):533-544.
- 20. Reduce intra-abdominal fat with modest, conventional diet restriction AND preservation of muscle mass and strength through physical activity Han et al British Medical Bulletin 2011;97:169-196
- 21. LIFESTYLE INTERVENTION Just as effective in older individuals Weight loss to improve physical function & quality of life Han et al British Medical Bulletin 2011;97:169-196
- 22. Low-fat nutrient-rich diet Regular physical activity STILL for weight management T.S. Han et al. Best Practice & Research Clinical Endocrinology & Metabolism 27 (2013) 509–525
- 23. Very low energy diets (VLED) conventionally avoided in elderly: 400-800 kcal/day Medical consultation needed if >70 y.o. T.S. Han et al. Best Practice & Research Clinical Endocrinology & Metabolism 27 (2013) 509–525
- 24. Protein intake of 0.6-0.8 g/kg/day does NOT protect elderly from muscle loss leading to sarcopenia Li z & Heber D. Nutrition Review 2011;70(1):57-64 Protein is most satiating nutrient and promotes retention of lean body mass
- 25. Consider meal- replacement shakes: supplement adequate amounts of essential amino acids to preserve lean body mass Li z & Heber D. Nutrition Review 2011;70(1):57-64
- 26. https://www.yogajournal.com/lifestyle/worlds-oldest-yoga-teacher-shares-secrets-long-active-life Tao Porchon-Lynch Resistance training has been shown to be the most effective intervention for reversing sarcopenia in the elderly. Li z & Heber D. Nutrition Review 2011;70(1):57-64
- 27. N = 160, ave age 70 y and above per group Weight management program + one of 3 exercise programs (aerobic, resistance training or both) Villareal D et al N Engl J Med 2017;376:1943-55.
- 28. Villareal D et al N Engl J Med 2017;376:1943-55. AEROBIC: 60 min/per session (10 min flexibility exercises + 40 min of aerobic exercises + 10 min of balance exercises). Treadmill walking, stationary cycling, stair climbing RESISTANCE: (40 min of nine upper-body and lower-body exercise using weight lifting machines) COMBINATION: 75 to 90 min long (30 to 40 min of aerobic + 30 to 40 min of resistance) t = 26 weeks
- 29. AEROBIC, RESISTANCE EXERCISE OR BOTH IN DIETING OBESE OLDER ADULTS Control: group sessions on healthy diet monthly Supplements to ensure intake of 1500 mg Ca/ day & 1000 IU vit D/day Body weight decreased by 9% in all exercise groups (no change in control group) Villareal D et al N Engl J Med 2017;376:1943-55.
- 30. Villareal D et al N Engl J Med 2017;376:1943-55. 500-750 kcal deficit diet (1 g high quality protein/kg/day) + 3 times weekly exercise
- 31. Monitor drugs whose action or half-life may be altered by weight loss Diuretics, antihypertensive & hypoglycemic drugs, warfarin, digoxin etc. H2-blockers, analgesics & antidepressants may no longer be needed Han et al British Medical Bulletin 2011;97:169-196
- 32. ORLISTAT Similar safety and benefit in elderly Steatorrhea may be troublesome for elderly: fecal incontinence & difficulty adhering to diet Han et al British Medical Bulletin 2011;97:169-196
- 33. Han et al British Medical Bulletin 2011;97:169-196 Bariatric surgery in older groups: greater perioperative complications & lower success (pre-existing heart disease)
- 35. IRIS THIELE ISIP TAN MD, MSC @endocrine_witch www.slideshare.net/isiptan