Weight Reduction After Age 65

What are the issues?

• Are the indications for treating obesity in older adults the same as those for younger adults?
• Does weight loss reduce risk factors in older adults?
• Does weight reduction prolong the lives of older adults?
• Are there risks associated with obesity treatment that are unique to older adults?

The higher prevalence of cardiovascular risk factors in overweight versus non-overweight persons is clearly observed at older ages (596, 597).  In addition, obesity is a major predictor of functional limitations and mobility impairments in older adults (596, 598-600).  Both observational data (596) and applicable randomized controlled trials cited in these guidelines suggest that weight loss reduces risk factors and improves functional status in older persons in the same manner as in younger adults.

The question of whether weight reduction leads to increased survival among older adults has been raised because of observations that weight reduction after age 60 or 65 years may be unable to reverse deleterious effects of longstanding obesity (288, 596, 601, 602).  Also, weight loss at older ages has been associated with increased mortality (318, 603-607).  Some of the association of weight loss with higher mortality may be due to the increased frequency at older ages of involuntary weight loss due to identified or occult illness.

In any case, the association of weight loss with higher mortality applies most clearly to individuals who enter old age with a BMI in the lower part of the range. It is not clear that it applies to overweight older persons with CVD risk factors. This issue has been difficult to clarify in observational data, but there are no randomized trials in which the effects of obesity treatment on mortality can be directly assessed, at any age.

The wisdom or importance of treating obesity at older ages has also been questioned because of epidemiological observations suggesting a decreased significance of obesity-related relative risks at older ages. However, these relative-risk data are not a useful reference point for considering whether obese older persons will benefit. Relative risks are influenced by the characteristics of the comparison group. In this case, the comparison group is lower-weight older persons who have also had high morbidity and mortality.

Concerns about potential adverse effects of obesity treatment in older adults have been raised with respect to bone health and to dietary adequacy. Weight reduction may accelerate aging-related bone loss and thereby increase the risk of osteoporotic fractures in high-risk groups such as older white women (608-610).  This concern is more relevant to weight loss in thin persons than in obese persons. Some evidence suggests that including resistance training and moderate weight-bearing exercise as a part of a weight reduction program may help maintain bone integrity (611, 612). 

The general nutritional safety of weight reduction at older ages is of interest because restrictions on overall food intake due to dieting could result in inadequate intakes of protein or essential vitamins and minerals. In addition, involuntary weight loss indicative of occult disease might be mistaken for success in voluntary weight reduction. These concerns can be alleviated by providing proper nutritional counseling and regular body weight monitoring for older persons for whom weight reduction is prescribed.

Rationale: There is little evidence at present that obesity treatment should be withheld from adult men and women on the basis of age alone up to 80 years of age.