Chapman Ian M
Division of Medicine, University of Adelaide, Adelaide, Australia.
Interdiscip Top Gerontol. 2010;37:20-36. doi: 10.1159/000319992. Epub 2010 Aug 10.
Although obesity in young people is a risk factor for morbidity and mortality, the effect of obesity in the elderly is much more complex. For example, the body weight associated with maximal survival increases with increasing age. Even more striking is the 'obesity paradox' in the elderly, in which overweight is associated with increased risk for cardiovascular disease but decreased mortality from these diseases. Thus, although intentional weight loss by obese older people is probably safe, and likely to be beneficial if they have obesity-related morbidities, caution should be exercised in recommending weight loss to overweight older people on the basis of body weight alone. Methods of achieving weight loss in older adults are the same as in younger adults. Weight loss diets should be combined with an exercise program, if possible, to preserve muscle mass, as dieting results in loss of muscle as well as fat, and older people have reduced skeletal muscle mass compared to younger adults. Weight-loss drugs have not been extensively studied in older people and there is the potential for drug side effects and interactions. Weight loss surgery appears to be safe and effective, although it probably produces less weight loss than in younger adults. Little is yet known about the outcomes of such surgery in people over 65 years.
尽管年轻人肥胖是发病和死亡的危险因素,但肥胖对老年人的影响要复杂得多。例如,与最大生存相关的体重随年龄增长而增加。更引人注目的是老年人中的“肥胖悖论”,即超重与心血管疾病风险增加相关,但这些疾病导致的死亡率却降低。因此,虽然肥胖老年人有意减肥可能是安全的,而且如果他们有与肥胖相关的疾病,减肥可能有益,但仅根据体重就建议超重老年人减肥时应谨慎。老年人实现减肥的方法与年轻人相同。如果可能的话,减肥饮食应与运动计划相结合,以保持肌肉量,因为节食会导致肌肉和脂肪流失,而且与年轻人相比,老年人的骨骼肌量减少。减肥药在老年人中尚未得到广泛研究,存在药物副作用和相互作用的可能性。减肥手术似乎是安全有效的,尽管它可能比年轻人产生的体重减轻更少。对于65岁以上人群进行这种手术的结果知之甚少。