How did the most educated and wealthiest generation of Americans to date allow its collective health to fall by the wayside? The American lifestyle has largely shifted from active to sedentary and from community-oriented to socially isolating. Adults experience more stress in their hectic daily lives, which breeds depression and health problems, such as hypertension and high blood pressure. The net result of those factors is poor health and chronic ailments.
Surgical procedures of the upper gastrointestinal tract are collectively called bariatric surgery. The initial surgeries performed were the jejunocolic bypass and the jejunoileal bypass (where the small bowel is diverted to the large bowel, bypassing a lot of the surface area where food would have been absorbed). These procedures were fraught with problems and are no longer performed. Currently, procedures used include making the stomach area smaller or bypassing the stomach completely.
A new appreciation for the impact of gut microbes on body weight has intensified concerns about the profligate use of antibiotics in children. Blaser has shown that when young mice are given low doses of antibiotics, similar to what farmers give livestock, they develop about 15 percent more body fat than mice that are not given such drugs. Antibiotics may annihilate some of the bacteria that help us maintain a healthy body weight. “Antibiotics are like a fire in the forest,” Dominguez-Bello says. “The baby is forming a forest. If you have a fire in a forest that is new, you get extinction.” When Laurie Cox, a graduate student in Blaser’s laboratory, combined a high-fat diet with the antibiotics, the mice became obese. “There’s a synergy,” Blaser explains. He notes that antibiotic use varies greatly from state to state in the U.S., as does the prevalence of obesity, and intriguingly, the two maps line up—with both rates highest in parts of the South.
Engaging in a variety of exercises, such as aerobic exercises, resistance training, and flexibility exercises is essential for healthy aging. Most older, obese adults are able to safely engage in regular physical activity; however, because fitness levels vary, a medical professional is important to determine which exercises are appropriate for an individual’s specific needs. Certain medical conditions, as well as medications, can also affect a person’s tolerance for exercise.
BMI is the tool most commonly used to estimate and screen for overweight and obesity in adults and children. BMI is defined as weight in kilograms divided by height in meters squared. For most people, BMI is related to the amount of fat in their bodies, which can raise the risk of many health problems. A health care professional can determine if a person’s health may be at risk because of his or her weight.
Weight loss that will get you close to the normal BMI range may greatly lower high blood pressure. Other helpful changes are to quit smoking, reduce salt, and get regular physical activity. However, if lifestyle changes aren’t enough, your doctor may prescribe drugs to lower your blood pressure.
A 2016 review supported excess food as the primary factor. Dietary energy supply per capita varies markedly between different regions and countries. It has also changed significantly over time. From the early 1970s to the late 1990s the average food energy available per person per day (the amount of food bought) increased in all parts of the world except Eastern Europe. The United States had the highest availability with 3,654 calories (15,290 kJ) per person in 1996. This increased further in 2003 to 3,754 calories (15,710 kJ). During the late 1990s Europeans had 3,394 calories (14,200 kJ) per person, in the developing areas of Asia there were 2,648 calories (11,080 kJ) per person, and in sub-Saharan Africa people had 2,176 calories (9,100 kJ) per person. Total food energy consumption has been found to be related to obesity.
Obesity is one of the leading preventable causes of death worldwide. A number of reviews have found that mortality risk is lowest at a BMI of 20–25 kg/m2 in non-smokers and at 24–27 kg/m2 in current smokers, with risk increasing along with changes in either direction. This appears to apply in at least four continents. In contrast, a 2013 review found that grade 1 obesity (BMI 30–35) was not associated with higher mortality than normal weight, and that overweight (BMI 25–30) was associated with “lower” mortality than was normal weight (BMI 18.5–25). Other evidence suggests that the association of BMI and waist circumference with mortality is U- or J-shaped, while the association between waist-to-hip ratio and waist-to-height ratio with mortality is more positive. In Asians the risk of negative health effects begins to increase between 22–25 kg/m2. A BMI above 32 kg/m2 has been associated with a doubled mortality rate among women over a 16-year period. In the United States, obesity is estimated to 111,909 to 365,000 deaths per year, while 1 million (7.7%) of deaths in Europe are attributed to excess weight. On average, obesity reduces life expectancy by six to seven years, a BMI of 30–35 kg/m2 reduces life expectancy by two to four years, while severe obesity (BMI > 40 kg/m2) reduces life expectancy by ten years.
Frimel et al. (2008) reported on a cohort of 30 community-living frail older adults. The participants were sedentary (≤ 2 exercise sessions per week); had stable medications and stable weight (± 2 kg over the past year); and met two out of three criteria for mild–moderate physical frailty. The intervention used was similar to the previously included Villareal studies (Villareal 2006a; Villareal 2006b; Villareal 2008) with a slightly higher daily energy deficit (750 kcal per day versus 500–700 kcal/day). The goal was 10% loss of body weight over six months. Combined aerobic and resistance exercise sessions were 90 minutes three times per week and resistance exercises focused on upper extremity (UE) and lower extremity (LE) muscle groups. The loss of lean body mass was completely prevented in the UE, but not LE. Despite LE lean body mass loss, strength improved. It was proposed that muscle quality improved due to a decrease in muscle fat infiltration and inflammation due to weight loss, as previously reported (Goodpaster 2001; Nicklas 2004). It was also suggested that retention of lean body mass in the UE but not the LE was attributed to UE muscle being more responsive to high-intensity training because these muscle groups are not used regularly for daily activities such as walking and climbing stairs.
Dietary modification is the cornerstone of treating cardiovascular disease in older adults who are obese. Grundy (2004) has described obesity as a major underlying factor contributing to atherosclerotic cardiovascular disease (ASCVD) and a factor associated with multiple other ASCVD risk factors, including elevated blood pressure, hypertriglyceridemia, low high-density lipoproteins, high cholesterol, and high fasting plasma glucose. It is also a risk factor for type 2 diabetes. Even though there is a strong association between obesity and ASCVD, the relationship underlying the mechanism is not well understood. The fact that obesity acts on so many metabolic pathways, producing so many potential risk factors, makes it challenging to delineate the specific mechanism by which obesity contributes to ASCVD. Gundy suggested that the fundamental question for controlling cardiovascular diseases related to obesity is: how can we intervene at the public health level to reduce the high prevalence of obesity in the general population. He added that indeed, “This approach offers the greatest possibility for reducing the cardiovascular risk that accompanies obesity” (p. 2600). The widely disseminated Healthy People 2010 (U.S. Department of Health and Human Services, n.d.) challenges individuals, communities, professionals, and indeed all of us, to take specific steps to reduce obesity to ensure that good health, as well as long life, are enjoyed by all. Dietary modification is the cornerstone of treating cardiovascular disease in older adults who are obese. Interventions to decrease obesity are presented in the next section titled, “Interventions to Address Obesity.”
An initial step in detecting liver damage is a simple blood test to determine the presence of certain liver enzymes in the blood. Under normal circumstances, these enzymes reside within the cells of the liver. But when the liver is injured, these enzymes are spilled into the blood stream, and can lead to diseases like fatty liver, type 2 diabetes, obesity, and hepatitis. Several medications also can increase liver enzyme test results.
The high rates of obesity and depression, and their individual links with cardiovascular disease, have prompted many investigators to explore the relationship between weight and mood. An analysis of 17 cross-sectional studies found that people who were obese were more likely to have depression than people with healthy weights. (17) Since the studies included in the analysis assessed weight and mood only at one point in time, the investigators could not say whether obesity increases the risk of depression or depression increases the risk of obesity. New evidence confirms that the relationship between obesity and depression may be a two-way street: A meta-analysis of 15 long-term studies that followed 58,000 participants for up to 28 years found that people who were obese at the start of the study had a 55 percent higher risk of developing depression by the end of the follow-up period, and people who had depression at the start of the study had a 58 percent higher risk of becoming obese. (18)
The physical examination can aid in evaluating concerns prompted by history findings. Body weight without shoes should be assessed on a clinic scale. Evaluation of the oral cavity and dentition may indicate difficulty with chewing or swallowing. Heart, lung, gastrointestinal, and neurologic examinations evaluate for illnesses contributing to or causing weight loss.
Adults: A healthy weight for adults is usually when your BMI is 18.5 to less than 25. To figure out your BMI, use the National Heart, Lung, and Blood Institute’s online BMI calculator and compare it with the table below. You can also download the BMI calculator app for iPhone and Android. Even if your BMI is in the healthy range, it is possible to be diagnosed as obese if you have a large waist circumference that suggests increased amounts of fat in your abdomen that can lead to complications.
The medication is approved for patients who are obese (BMI >30) or overweight (BMQ >27) with one weight-related health issue. The predominant side effects were headache and dizziness, as well as fatigue. In patients with diabetes, low blood sugar was also a concern when taking Belviq.
The interaction between diet and gut bacteria can predispose us to obesity from the day we are born, as can the mode by which we enter the world. Studies have shown that both formula-fed babies and infants delivered by cesarean section have a higher risk for obesity and diabetes than those who are breast-fed or delivered vaginally. Working together, Rob Knight of the University of Colorado Boulder and Maria Gloria Dominguez-Bello of N.Y.U. have found that as newborns traverse the birth canal, they swallow bacteria that will later help them digest milk. C-section babies skip this bacterial baptism. Babies raised on formula face a different disadvantage: they do not get substances in breast milk that nurture beneficial bacteria and limit colonization by harmful ones. According to a recent Canadian study, babies drinking formula have bacteria in their gut that are not seen in breast-fed babies until solid foods are introduced. Their presence before the gut and immune system are mature, says Dominguez-Bello, may be one reason these babies are more susceptible to allergies, asthma, eczema and celiac disease, as well as obesity.
It’s best to work muscles to the point of fatigue, without overstraining, while taking enough time between workouts to allow the muscles to rest and recover. (Some examples of strength training exercises can be seen in Kathy Coover’s at-home workout. See KC Workout.pdf.)
The association between obesity and cancer is not quite as clear as that for diabetes and cardiovascular disease. This is due in part to the fact that cancer is not a single disease but a collection of individual diseases.
An early hint that gut microbes might play a role in obesity came from studies comparing intestinal bacteria in obese and lean individuals. In studies of twins who were both lean or both obese, researchers found that the gut community in lean people was like a rain forest brimming with many species but that the community in obese people was less diverse—more like a nutrient-overloaded pond where relatively few species dominate. Lean individuals, for example, tended to have a wider variety of Bacteroidetes, a large tribe of microbes that specialize in breaking down bulky plant starches and fibers into shorter molecules that the body can use as a source of energy.
Mirtazapine (Remeron), a serotonin antagonist used to treat depression, has gained interest as a possible treatment for unintentional weight loss in older patients because 12% of patients who take this drug for depression report weight gain.36 Although no literature exists to support its use for unintentional weight loss, mirtazapine may be an option for older patients with depression who also have unintentional weight loss. Because dizziness and orthostatic hypotension are possible adverse effects of mirtazapine, caution is warranted in patients at risk of falls.36,37
A new survey revealed the number of overweight and obese baby boomers rose from 61% in 2003 to 72% in 2012, while younger adults ages 18 to 47 saw just a 2% increase in obesity rates during the same period, in the Sacramento, CA, area. Researchers also found one-fifth of obese baby boomers in the area had diabetes. Fifty-six percent had hypertension, compared with 23% of their normal-weight counterparts. UCLA Center for Health Policy Research
According to Fabius, sudden weight loss is a frequent health problem in elderly populations. Judging by his own practice, he estimates that as many as 15 percent of seniors have or will suffer from such a condition.
There is an “obesity paradox” raging in the medical community. You may be surprised to hear this hot debate revolves around an unlikely group: our elders. Childhood and young adulthood obesity seem to always be in the headlines. But what about people ages 65 and older? Thanks to some new research, the debate of obesity in older people has been thrust into the medical spotlight.
I’ve developed a menengioma and I’ve had a smalk stroke. Finally…I’m suffering severe chronic pain from severely arthritic (bone on bone) knees and acutely painful arthritis of the lumbar spine. Alk this, pkus severe Fibromyalgia. I’ve become more and more sedentary and withdrawn, due to the pain….and can hardly walk a block. I entered a pain management program a few years ago and am following a carefully monitored program of opoid meds….without which, I’d be unable to live independently, and I’d be in a wheelchair.
17. Zhang X, Shu XO, Gao YT, Yang G, Matthews CE, Li Q, Li H, Jin F, Zheng W: Anthropometric predictors of coronary heart disease in Chinese women. Int J Obes Relat Metab Disord 2004; 28: 734– 740 [PubMed]
Choose a report:2018 Health of Women and Children Report2017 Annual Report2017 Health of Women Who Have Served2017 Senior Report2016 Annual Report2016 Health of Those Who Have Served Report2016 Health of Women and Children Report2016 Senior Report2015 Annual Report
Your emotions, and how you handle them, also matter. Many people eat when they’re mad, sad, bored, or stressed. Weight problems can add to that. If you feel badly or are self-conscious about your body, that can hold you back from the full life that people of all sizes deserve. In turn, you eat more, seeking comfort.
Public perceptions in Western society regarding healthy body weight differ from those regarding the weight that is considered ideal – and both have changed since the beginning of the 20th century. The weight that is viewed as an ideal has become lower since the 1920s. This is illustrated by the fact that the average height of Miss America pageant winners increased by 2% from 1922 to 1999, while their average weight decreased by 12%. On the other hand, people’s views concerning healthy weight have changed in the opposite direction. In Britain, the weight at which people considered themselves to be overweight was significantly higher in 2007 than in 1999. These changes are believed to be due to increasing rates of adiposity leading to increased acceptance of extra body fat as being normal.
Health clubs and weight-loss centers often use the skin caliper or bioelectric impedance analysis method; however, these can yield inaccurate results if an inexperienced person performs them or they are used on someone with significant obesity.
Let’s assume for a moment that somehow America, food deserts and all, becomes absolutely lousy with highly affordable outlets for wholesome, locally sourced dishes that are high in vegetables, fruits, legumes, poultry, fish, and whole grains, and low in fat and problem carbs. What percentage of the junk-food-eating obese do we want to predict will be ready to drop their Big Macs, fries, and Cokes for grilled salmon on chard? We can all agree that many obese people find the former foods extremely enjoyable, and seem unable to control their consumption of them. Is greater availability of healthier food that pushes none of the same thrill buttons going to solve the problem?
Learning about your condition. Education about obesity can help you learn more about why you became obese and what you can do about it. You may feel more empowered to take control and stick to your treatment plan. Read reputable self-help books and consider talking about them with your doctor or therapist.
Obesity has been reported to be the single greatest cause of disability for seniors, and it’s expected to put a great strain on the U.S. healthcare system in the coming years. It can lead to heart disease, diabetes, cancer, and osteoarthritis, among other conditions and diseases. Experts consider obesity one of the greatest health challenges of the 21st century.