Presentation at the Southern Philippines Medical Center Postgraduate Course, 1 Sept 2017, Davao City.

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

2. (Sarcopenic)
obesity
Consequences
of obesity
Management
of obesity

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

7. http://122.53.86.125/NNS/8thNNS.pdf

8. http://122.53.86.125/NNS/8thNNS.pdf

9. http://122.53.86.125/NNS/8thNNS.pdf

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

11. (Sarcopenic)
obesity
Consequences
of obesity
Management
of obesity

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

18. (Sarcopenic)
obesity
Consequences
of obesity
Management
of obesity

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)

34. (Sarcopenic)
obesity
Consequences
of obesity
Management
of obesity

35. IRIS THIELE ISIP TAN MD, MSC
@endocrine_witch
www.slideshare.net/isiptan