Unit for Medical and Surgical Therapy of Obesity, Department of Medical and Surgical Sciences, University of Padova, Padova, Italy.
Eat Weight Disord. 2009 Jun-Sep;14(2-3):e56-65. doi: 10.1007/BF03327801.
Obesity is increasing in the elderly and it is associated with an increased risk of medical complications, decline in physical function and disability. Very few studies specifically evaluated the outcome of obesity treatment in the aging patients. Aim of this work is therefore the evaluation of the efficacy of medical therapy in a group of obese patients >or=65 years old.
The study has been performed on the clinical records of obese outpatients treated at the medical branch of the Unit for Medical and Surgical Therapy of Obesity at the University of Padova. Patients were recruited from January 1st, 2001 to June 30th, 2006 in order to have patients with at least one year of potential follow-up. In particular two groups were enrolled: 100 patients >or=65 years old and 200 patients <65 years old. The baseline characteristics, the prescriptions and the treatment outcome were compared.
Mean age of the elderly patients was 69.1+/-3.7 years (range 65-80 years). We did not find any significant difference between elderly and adult patients in the sex distribution (female patients 76% in the elderly group and 72% in the adult group; p=0.276) and in the severity of overweight (body mass index: 37.8+/-6.0 kg/m2 in the elderly; 37.2+/-6.3 kg/m2 in adults; p=0.425). The elderly group was characterized by a higher incidence of comorbidities and a lower incidence of eating behavior disorders at baseline. No significant differences in the dietary prescription were found, whereas physical activity was prescribed in 27/100 elderly patients (27%) and in 97/200 (48%) adults patients (p<0.000). Weight loss was evaluated by analyzing the percentage of patients reaching at least a 10% weight loss from baseline after 12 months of treatment. In elderly patients still in active treatment after 12 months, only 5/28 (18%) patients reached the specified goal, whereas in adult patients still in treatment, 18/47 (38%) patients reached the goal (p<0.05). Lower age at baseline, female sex, and lower body mass index were found to be the only significant predictors of 10% weight loss in logistic regression. In our experience, drop-out rate after 12 months was similar in adults (77%) and in older patients (72%). In a multivariate Cox regression model, the risk of drop-out was reduced by married or widowed status, the prescription of physical activity at baseline, and the presence of type 2 diabetes. The risk of drop-out was increased by the presence of osteoarthritis. Even after adjustments for these confounding variables, age did not play any significant role as drop-out predictor.
Advanced age seems to be a predictor of poor response to treatment in obese outpatients treated by conventional medical therapy. Drop-out rate was not significantly influenced by age.
老年人肥胖症的发病率不断增加，且与医疗并发症风险增加、身体功能下降和残疾有关。很少有研究专门评估老年患者肥胖症治疗的结果。因此，本研究旨在评估一组年龄在 65 岁及以上肥胖患者的医学治疗效果。
该研究基于帕多瓦大学医学和外科肥胖治疗科的门诊肥胖患者的临床记录。从 2001 年 1 月 1 日至 2006 年 6 月 30 日，招募了患者，以便患者具有至少一年的潜在随访。特别纳入了两组：100 名年龄在 65 岁及以上的患者和 200 名年龄在 65 岁以下的患者。比较了两组的基线特征、处方和治疗结果。
老年患者的平均年龄为 69.1+/-3.7 岁（65-80 岁）。我们没有发现老年患者和成年患者在性别分布（女性患者在老年组中占 76%，在成年组中占 72%；p=0.276）和超重严重程度（体重指数：老年组为 37.8+/-6.0kg/m2；成年组为 37.2+/-6.3kg/m2；p=0.425）方面存在显著差异。老年组的特点是合并症发生率较高，基线时饮食行为障碍发生率较低。饮食处方没有发现显著差异，而在 27/100 名老年患者（27%）和 97/200 名成年患者（48%）中开了运动处方（p<0.000）。通过分析治疗 12 个月后至少有 10%体重减轻的患者比例来评估体重减轻。在 12 个月后仍处于积极治疗中的老年患者中，只有 5/28（18%）患者达到了指定目标，而在仍处于治疗中的成年患者中，18/47（38%）患者达到了目标（p<0.05）。逻辑回归分析显示，基线时年龄较小、女性和较低的体重指数是体重减轻 10%的唯一显著预测因素。在我们的经验中，成年患者（77%）和老年患者（72%）在 12 个月后的脱落率相似。在多变量 Cox 回归模型中，已婚或丧偶状态、基线时运动处方和 2 型糖尿病的存在降低了脱落风险。骨关节炎的存在增加了脱落的风险。即使在调整了这些混杂变量后，年龄也没有作为脱落预测因素发挥任何显著作用。
年龄较大似乎是接受常规医学治疗的肥胖门诊患者治疗反应不佳的预测因素。脱落率未受年龄显著影响。
