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Obesity and Older Men

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The food environment, a factor potentially influencing diet, has received considerable attention from the media and policymakers in recent years. In particular, it is taken for granted that the food environments of a particular neighborhood, such as “food deserts” (where healthy food options are difficult to access), determine obesity, and thus, the food environment needs to be regulated. However, this idea does not assess the role of distance between the food environment and work, school, and home.

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Data from large population studies show that mean body weight and BMI gradually increase during most of adult life and reach peak values at 50–59 y of age in both men and women. After the age of 60 y, mean body weight and BMI tend to decrease. However, these observations, which were obtained from cross-sectional studies, can be affected by survival bias, because obese persons have higher mortality rates at younger ages. Therefore, premature mortality of obese young and middle-aged adults would tend to decrease mean body weight and BMI in surviving older adults. In fact, data from longitudinal cohort studies suggest that body weight and BMI do not change, or decreases only slightly, in older adults (60–70 y old at study entry). Aging is associated with considerable changes in body composition. After 20–30 y of age, fat-free mass (FFM) progressively decreases, whereas fat mass increases. FFM (primarily skeletal muscle) decreases by up to 40% from 20 to 70 y of age. Maximal FFM is usually reached at ≈20 y of age, and maximal fat mass is usually reached at ≈60–70 y of age; both fat measures subsequently decline thereafter

Therefore, both FFM and fat mass decrease during old age (>70 y). Aging is also associated with a redistribution of both body fat and FFM. With aging there is a greater relative increase in intraabdominal fat than in subcutaneous or total body fat, and there is a greater relative decrease in peripheral than in central FFM because of the loss of skeletal muscle. In addition, increases in intramuscular and intrahepatic fat in older persons are associated with insulin resistance. Obesity is defined as an unhealthy excess of body fat, which increases the risk of medical illness and premature mortality. However, it is difficult to accurately measure body fat mass in most clinical settings, because this assessment requires the use of sophisticated technologies that are not readily available. Therefore, BMI, calculated as body weight (in kg) divided by the square of height (in m), has been widely used and accepted as a simple method to classify medical risk by weight status. In older adults, age-related changes in body composition (ie, decreases in FFM and increases in fat mass) and loss of height caused by compression of vertebral bodies and kyphosis (posterior convex angulation of the spine) alter the relation between BMI and percentage body fat. Therefore, at any given BMI value, changes in body composition would tend to underestimate fatness, whereas the loss of height would tend to overestimate fatness. Although it has been suggested that the use of alternative methods to estimate height, such as knee height or arm span, may provide more reliable estimates of BMI, these approaches have not been adequately validated. Another limitation of using BMI to estimate disease risk is the effect of aging on fat distribution. Visceral fat (omental and mesenteric adipose tissue), subcutaneous abdominal fat, intramuscular fat, and intrahepatic fat, which are risk factors for insulin resistance and metabolic diseases, increase with aging. Therefore, the size of these depots is likely greater in older than in young adults at any given BMI value.

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Although the prevalence of obesity in persons who are over 80 years of age is about one-half that of older adults between the ages of 50 and 59, the fact is that more than 15% of the older American population is obese (Villareal et al., 2005). Moreover, as the aging population increases in number, so too will the number of chronic illnesses, which often accompany aging, increase in our society. Chronic conditions, such as arthritis, diabetes, hypertension, and heart disease, are among some of the most common, debilitating, and costly chronic conditions in older adults. These conditions are frequently accentuated by obesity. An important determinant of body-fat mass is the relationship between energy intake and expenditure. Obesity occurs when a person consumes more calories than she/he burns. We need calories to sustain life and have the energy be active; yet to maintain a desirable weight, we need to balance the amount of energy we ingest in the form of food with the energy we expend. Weight gain occurs when the balance is tipped and we take in more calories than we burn. Most studies indicate that how much we eat does not decline with advancing age. Therefore it is likely that a decrease in energy expenditure, particularly in the 50- to 65-year-old age group, contributes to the increase in body fat as we age

In those 65 years of age and older, hormonal changes that occur during aging may cause the accumulation of fat. Aging is associated with a decrease in growth hormone secretions, reduced responsiveness to thyroid hormone, decline in serum testosterone, and resistance to leptin. Resistance to leptin could cause a decreased ability to regulate appetite downward (Villareal et al., 2005). Genetic, environmental and social, as well as several other factors can all contribute to obesity.

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All things considered, obesity among older adults has increased noticeably in the last two decades in all continents. However, large variations between countries, race/ethnic groups and genders are observed. Obesity is related to increased risk of disability among older adult populations regardless of the measures used. Obesity affects functional status and mobility. Inflammation caused by obesity is linked to the added burden of disease when obesity is present concomitantly with many chronic conditions in older adults

Additionally, it is a marker of poor outcomes for most interventions for chronic conditions and interferes with management of most chronic diseases in older adults.

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Vainio, H., & Bianchini, F (Eds.).(2002). IARC handbooks of cancer prevention Vol. 6: Weight control and physical activity. Lyon, France: IARC Press.

Villareal, D., Apovian, C., Kushner, R., & Klein, S. (2005). Obesity in older adults: technical Review and position statement of the American Society for Nutrition and NAASO, The Obesity Society. American Journal of Clinical Nutrition,82(5), 923-934. Retrieved October 19, 2008

Yan, L.L, Daviglus, M.L., Liu, K., Pirzada, A., Garside, D.B., Schiffer, L., et al. (2004). Body mass index and health-related quality of life in adults 65 years and older. Obesity Research, 12, 69-76.

Zerah, F., Harf, A., Perlemuter, L., Lorino, H., Lorino, A., & Atlan, G. (1993). Effects of obesity on respiratory resistance. Chest, 103, 1470-1476.

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