\

Weight loss, obesity and related disorders in the elderly

Older persons who consume a normal variety of foods are unlikely to have any dietary deficiency; however, not all older persons consume a ‘normal’ diet. Thus, weight loss occurring in an older person, whether they consume a “normal” diet or not, should be of concern says, by Dr V.S. Natarajan

Is weight loss common in the elderly?

As a rule of thumb, unintentional weight loss of more than 5lb (2.3 kg) /5% of body weight in a month or 10lb (4.5 kg) / 10% body weight in 6 months is worrying.

What are all the main causes of weight loss?

Several causes can contribute to weight loss including poor oral intake, alterations in metabolism, or increased loss of nutrients through the urine or bowel. Poor oral intake can be due to nausea, early satiety, depressed mood, and alterations in taste.

Causes of inadequate nutrient intake that can be frequently over-looked include poverty, bereavement, abuse and neglect. Other contributing causes include impaired vision or hearing, dental or chewing problems, upper extremity dysfunction, diminished sense of taste and smell, drug-drug and drug-food interactions and food preferences or fads. A number of medical conditions can present with a chief complaint of weight loss.

Also read: Mental health of the elderly

Factors responsible for weight loss:

  • Diabetes mellitus
  • Depression
  • Cancer
  • Hyperthyroidism
  • Hypothyroidism
  • Infection Tuberculosis
  • AIDS
  • Gastrointestinal disease
  • Malabsorption Hepatitis
  • Peptic Ulcer disease Chronic diseases
  • Heart failure
  • Chronic lung disease
  • Chronic renal failure

Mouth disorders

  • Poor dentition
  • Ill-fitting dentures

Neurologic conditions

  • Dementia
  • Stroke
  • Parkinson’s disease

Social factors

  • Poverty
  • Isolation

Other

  • Alcoholism

Invariably the cause is multifunctional, frequently the result of a combination of medication effects, social factors, psychiatric conditions and physical disorders resulting in disability. In about one-fourth of cases, no cause can be found. In these persons, it is postulated that weight loss occurs because of age-associated factors (reduced metabolic rate, reduced activity levels) together with higher than normal circulating levels of anorexogenic hormones that are associated with chronic conditions.

What is the syndrome of “failure to thrive”?

A syndrome of “failure to thrive” has been described in which withdrawal (physical, social and emotional) from society. Persons with this “syndrome” become depressed and apathetic and over time, slowly deteriorate and continue to lose weight.

Also read: Health tips for the elderly

What is the treatment for weight loss?

The treatment of weight loss should be directed as the underlying cause. Because the cause of weight loss is usually multifunctional, the treatment must be highly individualized and frequently involves addressing many issues simultaneously. Consultation with a dietician can be helpful. A dietician can advise patients how to increase their caloric intake.

What is the role of appetite stimulants?

In general, appetite stimulants are not effective in stimulating weight gain. The most commonly used agent is megestrol acetate, a progesterone preparation that has been used with variable success to stimulate appetite in patients with cancer. Other agents that have been tried in patients with anorexia associated with AIDS and cancer include anabolic steroids and psychostimulants.

Human growth hormone has been recently shown to be potentially helpful in treating under nutrition in older persons. Other drugs that can help stimulate appetite and cyproheptadine (serotonin inhibition) and chlorpromazine. There are no good studies of their effectiveness. Small amounts of alcohol are felt by some to stimulate the appetite.

Obesity

What is the difference between overweight and obesity?

The excessive amount of fat deposition in the body is varied from overweight and obesity. Using the data of desirable body weight for height one can assess their weight.

Body weight can be classified as follows:

Normal weight            : Within 10% of ideal weight

Under weight              : Less than 10% of ideal weight

Over weight                : Greater than 10-20% of ideal weight

Obese                          : Greater than 20% of ideal weight

Why do the elderly put on more weight?

Causes of obesity in elderly are yet to be pinpointed. But the following may be considered as factors leading to obesity:

Heredity

Hypothyroidism

Physical inactivity

Excessive intake of food

Drugs like steroids and insulin injections

What are all the health problems caused by overweight?

Complications of obesity in the elderly are many. It will lead to a lot of problems and also affect the quality of life due to restricted mobility, falls and depression.

Complications of obesity:

  • Reduce life expectancy by about 25% colon and prostate cancer in men. Uterine, breast, cervical and ovarian cancer in women.
  • Heart attack
  • Blood clot in the leg veins
  • Diabetes mellitus
  • Gall bladder stone
  • Hypertension
  • Arthritis
  • Impaired functional status
  • Fungal infection
  • Depression

A low waist-to-hip ratio protects against some of these complications. An increased waist-to-hip ratio suggests an increase in internal organ fat, which in turn is associated with increased risk of hypertension, diabetes, heart attack and premature death. Women should have lower waist-to-hip ration than men.

What are the benefits of weight reduction?

  • One can walk comfortably without any breathing problem.
  • One can walk easily without excess sweating.
  • Overall one will feel healthy and one can get more energy to play with their children and to take part in their social activities
  • Reduction of 5 to 10 % of your weight can definitely reduce high blood pressure, heart attack, diabetes

How to reduce overweight?

The vast majority of overweight elderly have put on weight because of unhealthy eating habits. The first step should be changing the food habit. The principal treatment in obesity is to reduce the calorie intake. The diet of elderly persons trying to lose weight should provide at least 800-1000 kcal per day with supplements of vitamins and minerals.

Lack of physical activity is a main cause of obesity in elderly. So start doing exercises. One can easily burn 100 cal by walking 2 kms per day. Exercise should be combined with proper diet.

No drugs are helpful in reducing the weight. These drugs give you the side effects only.

Also read: Elderly and hypertension

What are the foods to be avoided?

  • Roots and tubers e.g. Potato, tapioca, yam, sweet, potato, carrot and beetroot.
  • Nuts and oilseeds e.g. Coconut, groundnut, cashew nut, almond, badam and pistachio.
  • Oils e.g. butter, ghee, coconut oil, unrefined oil, dalda.
  • Fleshy foods e.g. Mutton crab, prawn, beef, egg-yolk, organ meats like liver, brain, etc
  • Fruits e.g. Preserved fruits, dates and figs, mango, sappota, custard apple, banana.
  • Milk products e.g. whole milk, cheese, butter, cream, curd, milk sweets, pudding, custard, ice creams, milk shakes and flavoured milk.
  • Miscellaneous e.g. Sweets, alcohol, cool drinks, fried foods, pickles and papads.

What are the foods to be included?

 The following items are recommended on a modest scale, but care should be taken to see that the daily consumption of calories does not exceed the prescribed amount.

  • Cereals: rice, wheat, semolina, ragi, oats, rice flakes, vermicelli
  • Pulses: all kinds of pulses e.g. Green gram, black gram, red gram, Bengal gram, broken Bengal gram,etc
  • Vegetables: snake-gourd, bitter gourd, ash gourd, white raddish, cabbage, cauliflower, ladies finger, drumstick, cucumber, brinjal, etc and all green leafy vegetables.
  • Spices: pepper, garlic, vinegar, mustard, coriander, etc
  • Fruits: all fruits except dry fruits, mango, sappota, custard apple, banana
  • Meat products: chicken, white of hen’s egg, fish (small varieties)
  • Oils: sesame oil (gingely) sunflower oil, soyabeans oil, refined oil.
  • Milk and products: skimmed milk, curd made from skimmed milk, butter milk, whole milk (fat removed).
  • Miscellaneous: thin soup, bread, pickles(without oil), soda, coffee or tea without milk.

Obesity is the most common disorder in the developing countries. Regardless of the age all are facing this problem. Overeating and lack of exercise are the main causes for this. Be aware of what you eat and enjoy exercises. Walking with friends is good for mind and body.

%d bloggers like this: